Malnutrition coding shortfalls in Australian and New Zealand hospitals

Aim The International Classification of Diseases, version 10, Australian modification (ICD-10-AM) is used to classify diseases in hospital patients in Australia and New Zealand. ICD-10-AM defines malnutrition as ‘[body mass index] BMI <18.5 kg/m2 or unintentional weight loss of ≥5% with evidence of suboptimal intake resulting in subcutaneous fat loss and/or muscle wasting’. The Australasian Nutrition Care Day Survey (ANCDS) is the most comprehensive survey to evaluate malnutrition prevalence in acute care patients from Australian and New Zealand hospitals. This study determined if malnourished participants were assigned malnutrition-related codes according to ICD-10-AM. Methods The ANCDS recruited acute care patients from 56 hospitals. Hospital-based dietitians evaluated participants' nutritional status using BMI and Subjective Global Assessment (SGA). In keeping with the ICD-10-AM definition, malnutrition was defined as BMI <18.5 kg/m2, SGA-B (moderately malnourished) or SGA-C (severely malnourished). After 3 months, in this prospective cohort study, staff members from each hospital's health information/medical records department provided coding results for malnourished participants. Results Malnutrition was prevalent in 30% (n = 869) of the cohort (n = 2976) and a significantly small number of malnourished patients were coded for malnutrition (n = 162, 19%, P < 0.001). In 21 hospitals, none of the malnourished participants were coded. Conclusions This is the largest study to provide a snapshot of malnutrition coding in Australian and New Zealand hospitals. Findings highlight gaps in malnutrition documentation and/or subsequent coding, which could potentially result in significant loss of casemix-related revenue for hospitals. Dietitians must lead the way in developing structured processes for malnutrition identification, documentation and coding.

Reflections on tomorrow’s menu : evidence for inpatient meal preferences at a large tertiary public hospital

There are limited studies that describe patient meal preferences in hospital; however this data is critical to develop menus that address satisfaction and nutrition whilst balancing resources. This quality study aimed to determine preferences for meals and snacks to inform a comprehensive menu revision in a large (929 bed) tertiary public hospital. The method was based on Vivanti et al. (2008) with data collected by two final year dietetic students. The first survey comprised 72 questions, achieved a response rate of 68% (n = 192), with the second more focused at 47 questions achieving a higher response rate of 93% (n = 212). Findings showed over half the patients reporting poor or less than normal appetite, 20% describing taste issues, over a third with a LOS >7 days, a third with a MST _ 2 and less than half eating only from the general menu. Soup then toast was most frequently reported as eaten at home when unwell, and whilst most reported not missing any foods when in hospital (25%), steak was most commonly missed. Hot breakfasts were desired by the majority (63%), with over half preferring toast (even if cold). In relation to snacks, nearly half (48%) wanted something more substantial than tea/coffee/biscuits, with sandwiches (54%) and soup (33%) being suggested. Sandwiches at the evening meal were not popular (6%). Difficulties with using cutlery and meal size selection were identified as issues. Findings from this study had high utility and supported a collaborative and evidenced based approach to a successful major menu change for the hospital.

Let them eat steak : food preferences of patients in a tertiary public hospital

Information on foods patients like and dislike is the essential basis for planning menus which are acceptable to patients and promote adequate consumption. The aim of this study was to obtain quantitative data on the food preferences of inpatients at a large metropolitan public hospital for use in menu planning. Methodology was based on a study by Williams et al (1988), and included additional questions about appetite and taste changes. The survey used a 9 point hedonic scale to rate foods listed in random order and was modified to incorporate more contemporary foods than those used in the originalWilliams study. Surveys were conducted by final year University of Queensland dietetics students on Food Service Practicum at the Royal Brisbane and Women’s Hospital (929 beds) in 2012. The first survey (220 questions, n = 157) had a response rate of 61%. The second included more sandwich fillings and salads (231 questions, n = 219, response rate 67%). Total number surveyed was 376. Results showed the most preferred foods were roast potato, grilled steak, ice cream, fresh strawberries, roast lamb, roast beef, grapes and banana. The least preferred foods were grapefruit, soybeans, lentils, sardines, prune juice and grapefruit juice. Patients who reported taste changes (10%) had similar food preferences to those who didn’t report taste changes. Patients who reported poor/very poor appetite (10%) generally scored foods lower than those who reported OK (22%), good/very good appetite (65%). The results of this study informed planning for a new patient menu at the RBWH in December 2012.

Introduction to the first international workshop on process management for highly dynamic and pervasive scenarios(PM4HDPS 2008)

Nowadays, process management systems (PMSs) are widely used in many business scenarios, e.g. by government agencies, by insurance companies, and by banks. Despite this widespread usage, the typical application of such systems is predominantly in the context of static scenarios, instead of pervasive and highly dynamic scenarios. Nevertheless, pervasive and highly dynamic scenarios could also benefit from the use of PMSs.

Using a smartphone application for customer-centric banking

The banking industry is under pressure. In order to compete, banks should adapt to concentrating on the specific customer needs, following an outside-in perspective. This paper presents the design of a business model for banks that considers this development by providing flexible and comprehensive support for retail banking clients. It is demonstrated that the identification of customer processes and the consequent alignment of banking services to those processes implies great potential to increase customer retention in banking. It will be shown that information technology – especially smartphones – can serve as an interface between customer and suppliers to enable an alignment of offerings to customer processes. This approach enables the integration of banks into their customers’ lifestyle, creating emotional value added, improving the personal relationship and the customers’ affiliation with the bank. The paper presents the design of such a customer-process-centric smartphone application and derives success factors for implementation.

A dual inverter-based supercapacitor direct integration scheme for wind energy conversion systems

Interfacing converters used in connecting energy storage systems like supercapacitors and battery banks to wind power systems introduce additional cost and power losses. This paper therefore presents a direct integration scheme for supercapacitors used in mitigating short-term power fluctuations in wind power systems. This scheme uses a dual inverter topology for both grid connection and interfacing a supercapacitor bank. The main inverter of the dual inverter system is powered by the rectified output of a wind turbine-coupled permanent-magnet synchronous generator. The auxiliary inverter is directly connected to the supercapacitor bank. With this approach, an interfacing converter is not required, and there are no associated costs and power losses incurred. The operation of the proposed system is discussed in detail. Simulation and experimental results are presented to verify the efficacy of the proposed system in suppressing short-term wind power fluctuations.

Diode-clamped three-level inverter-based battery/supercapacitor direct integration scheme for renewable energy systems

This paper describes a diode-clamped three-level inverter-based battery/supercapacitor direct integration scheme for renewable energy systems. The study is carried out for three different cases. In the first case, one of the two dc-link capacitors of the inverter is replaced by a battery bank and the other by a supercapacitor bank. In the second case, dc-link capacitors are replaced by two battery banks. In the third case, ordinary dc-link capacitors are replaced by two supercapacitor banks. The first system is supposed to mitigate both long-term and short-term power fluctuations while the last two systems are intended for smoothening long-term and short-term power fluctuations, respectively. These topologies eliminate the need for interfacing dc-dc converters and thus considerably improve the overall system efficiency. The major issue in aforementioned systems is the unavoidable imbalance in dc-link voltages. An analysis on the effects of unbalance and a space vector modulation method, which can produce undistorted current even in the presence of such unbalances, are presented in this paper. Furthermore, small vector selection-based power sharing and state of charge balancing techniques are proposed. Experimental results, obtained from a laboratory prototype, are presented to verify the efficacy of the proposed modulation and control techniques.

Computation of ECG signal features using MCMC modelling in software and FPGA reconfigurable hardware

Computational optimisation of clinically important electrocardiogram signal features, within a single heart beat, using a Markov-chain Monte Carlo (MCMC) method is undertaken. A detailed, efficient data-driven software implementation of an MCMC algorithm has been shown. Initially software parallelisation is explored and has been shown that despite the large amount of model parameter inter-dependency that parallelisation is possible. Also, an initial reconfigurable hardware approach is explored for future applicability to real-time computation on a portable ECG device, under continuous extended use.

Cybercrime attribution : an Eastern European case study

Phishing and related cybercrime is responsible for billions of dollars in losses annually. Gartner reported more than 5 million U.S. consumers lost money to phishing attacks in the 12 months ending in September 2008 (Gartner 2009). This paper asks whether the majority of organised phishing and related cybercrime originates in Eastern Europe rather than elsewhere such as China or the USA. The Russian “Mafiya” in particular has been popularised by the media and entertainment industries to the point where it can be hard to separate fact from fiction but we have endeavoured to look critically at the information available on this area to produce a survey. We take a particular focus on cybercrime from an Australian perspective, as Australia was one of the first places where Phishing attacks against Internet banks were seen. It is suspected these attacks came from Ukrainian spammers. The survey is built from case studies both where individuals from Eastern Europe have been charged with related crimes or unsolved cases where there is some nexus to Eastern Europe. It also uses some earlier work done looking at those early Phishing attacks, archival analysis of Phishing attacks in July 2006 and new work looking at correlation between the Corruption Perception Index, Internet penetration and tertiary education in Russia and the Ukraine. The value of this work is to inform and educate those charged with responding to cybercrime where a large part of the problem originates and try to understand why.

Privacy enhanced electronic cheque system

With the introduction of Check 21 law and the development of FSTC's echeck system, there has been an increasing usage of e-cheque conversions and acceptance among retailers, banks, and consumers. However, the current e-cheque system does not address issues concerning privacy, confidentiality, and traceability. We highlight the issues concerning the current electronic cheque system and provide a solution to overcome those drawbacks.

Audit fees and asset securitization risks

The thesis investigates “where were the auditors in asset securitizations”, a criticism of the audit profession before and after the onset of the global financial crisis (GFC). Asset securitizations increase audit complexity and audit risks, which are expected to increase audit fees. Using US bank holding company data from 2003 to 2009, this study examines the association between asset securitization risks and audit fees, and its changes during the global financial crisis. The main test is based on an ordinary least squares (OLS) model, which is adapted from the Fields et al. (2004) bank audit fee model. I employ a principal components analysis to address high correlations among asset securitization risks. Individual securitization risks are also separately tested. A suite of sensitivity tests indicate the results are robust. These include model alterations, sample variations, further controls in the tests, and correcting for the securitizer self-selection problem. A partial least squares (PLS) path modelling methodology is introduced as a separate test, which allows for high intercorrelations, self-selection correction, and sequential order hypotheses in one simultaneous model. The PLS results are consistent with the main results. The study finds significant and positive associations between securitization risks and audit fees. After the commencement of the global financial crisis in 2007, there was an increased focus on the role of audits on asset securitization risks resulting from bank failures; therefore I expect that auditors would become more sensitive to bank asset securitization risks after the commencement of the crisis. I find that auditors appear to focus on different aspects of asset securitization risks during the crisis and that auditors appear to charge a GFC premium for banks. Overall, the results support the view that auditors consider asset securitization risks and market changes, and adjust their audit effort and risk considerations accordingly.

Effect of plasma environment on synthesis of vertically aligned carbon nanofibers in plasma-enhanced chemical vapor deposition

We present a theoretical model describing a plasma-assisted growth of carbon nanofibers (CNFs), which involves two competing channels of carbon incorporation into stacked graphene sheets: via surface diffusion and through the bulk of the catalyst particle (on the top of the nanofiber), accounting for a range of ion- and radical-assisted processes on the catalyst surface. Using this model, it is found that at low surface temperatures, Ts, the CNF growth is indeed controlled by surface diffusion, thus quantifying the semiempirical conclusions of earlier experiments. On the other hand, both the surface and bulk diffusion channels provide a comparable supply of carbon atoms to the stacked graphene sheets at elevated synthesis temperatures. It is also shown that at low Ts, insufficient for effective catalytic precursor decomposition, the plasma ions play a key role in the production of carbon atoms on the catalyst surface. The model is used to compute the growth rates for the two extreme cases of thermal and plasma-enhanced chemical vapor deposition of CNFs. More importantly, these results quantify and explain a number of observations and semiempirical conclusions of earlier experiments.

Beyond the barriers : road construction safety issues from the office and the roadside

Conceptually, the management of safety at roadworks can be seen in a three level framework. At the regulatory level, roadworks operate at the interface between the work environment, governed by workplace health and safety regulations, and the road environment, which is subject to road traffic regulations and practices. At the organizational level, national, state and local governments plan and purchase road construction and maintenance which are then delivered in-house or tendered out to large construction companies who often subcontract multiple smaller companies to supply services and labor. At the operational level, roadworks are difficult to isolate from the general public, hindering effective occupational health and safety controls. This study, from the State of Queensland, Australia, examines how well this tripartite framework functions. It includes reviews of organizational policy and procedures documents; interviews with 24 subject matter experts from various road construction and maintenance organizations, and on-site interviews with 66 road construction personnel. The study identified several factors influencing the translation of safety policies into practice including the cost of safety measures in the context of competitive tendering, lack of firm evidence of the effectiveness of safety measures, and pressures to minimize disruption to the travelling public.

Training needs research applied to the development of a standardised incident investigator training framework

In response to the rail industry lacking a consistently accepted standard of minimal training to perform incident investigations, the Australasian rail industry requested the development of a unified approach to investigator training. This paper details how the findings from a training needs analysis were applied to inform the development of a standardised training package for rail incident investigators. Data from job descriptions, training documents and subject matter experts sourced from 17 Australasian organisations were analysed and refined to yield a draft set of 10 critical competencies. Finally the draft of critical competencies was reviewed by industry experts to verify the accuracy and completeness of the competency list and to consider the most appropriate level of qualification for training development. The competencies identified and the processes described to translate research into an applied training framework in this paper, can be generalised to assist practitioners and researchers in developing industry approved standardised training packages.

Battery clamped three-level inverter for renewable energy systems

This paper presents a novel battery direct integration scheme for renewable energy systems. The idea is to replace ordinary capacitors of a three-level flying-capacitor inverter by three battery banks to alleviate power fluctuations in renewable generation. This approach eliminates the need for interfacing dc-dc converters and thus considerably improves the overall efficiency. However, the major problem with this approach is the uneven distribution of space vectors which is due to unavoidable unbalance in clamping voltages. A detailed analysis on the effects of this issue and a novel carrier based pulse width modulation method, which can generate undistorted currents even in the presence of unevenly distributed space vectors, are presented in this paper. A charge/discharge controller is also proposed for power sharing and state of charge balancing of battery banks. Simulation results are presented to verify the efficacy of the proposed system, modulation method and power sharing controller.