The decline in activities of daily living at discharge (DADLD) index : stratifying patients at lower and higher risk

Background: Decreased ability to perform Activities of Daily Living (ADLs) during hospitalisation has negative consequences for patients and health service delivery. Objective: To develop an Index to stratify patients at lower and higher risk of a significant decline in ability to perform ADLs at discharge. Design: Prospective two cohort study comprising a derivation (n=389; mean age 82.3 years; SD� 7.1) and a validation cohort (n=153; mean age 81.5 years; SD� 6.1). Patients and setting: General medical patients aged = 70 years admitted to three university-affiliated acute care hospitals in Brisbane, Australia. Measurement and main results: The short ADL Scale was used to identify a significant decline in ability to perform ADLs from premorbid to discharge. In the derivation cohort, 77 patients (19.8%) experienced a significant decline. Four significant factors were identified for patients independent at baseline: 'requiring moderate assistance to being totally dependent on others with bathing'; 'difficulty understanding others (frequently or all the time)'; 'requiring moderate assistance to being totally dependent on others with performing housework'; a 'history of experiencing at least one fall in the previous 90 days prior to hospital admission' in addition to 'independent at baseline', which was protective against decline at discharge. 'Difficulty understanding others (frequently or all the time)' and 'requiring moderate assistance to being totally dependent on others with performing housework' were also predictors for patients dependent in ADLs at baseline. Sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of the DADLD dichotomised risk scores were: 83.1% (95% CI 72.8; 90.7); 60.5% (95% CI 54.8; 65.9); 34.2% (95% CI 27.5; 41.5); 93.5% (95% CI 89.2; 96.5). In the validation cohort, 47 patients (30.7%) experienced a significant decline. Sensitivity, specificity, PPV and NPV of the DADLD were: 78.7% (95% CI 64.3; 89.3); 69.8% (95% CI 60.1, 78.3); 53.6% (95% CI 41.2; 65.7); 88.1% (95% CI 79.2; 94.1). Conclusions: The DADLD Index is a useful tool for identifying patients at higher risk of decline in ability to perform ADLs at discharge.

Littoral Marginalia

Poem

The Australian beachspace : flagging the spaces of Australian beach texts

The Australian beach is a significant component of the Australian culture and a way of life. The Australian Beachspace explores existing research about the Australian beach from a cultural and Australian studies perspective. Initially, the beach in Australian studies has been established within a binary opposition. Fiske, Hodge, and Turner (1987) pioneered the concept of the beach as a mythic space, simultaneously beautiful but abstract. In comparison, Meaghan Morris (1998) suggested that the beach was in fact an ordinary or everyday space. The research intervenes in previous discussions, suggesting that the Australian beach needs to be explored in spatial terms as well as cultural ones. The thesis suggests the beach is more than these previously established binaries and uses Soja's theory of Thirdspace (1996) to posit the term beachspace as a way of describing this complex site. The beachspace is a lived space that encompasses both the mythic and ordinary and more. A variety of texts have been explored in this work, both film and literature. The thesis examines textual representations of the Australian beach using Soja's Thirdspace as a frame to reveal the complexities of the Australian beach through five thematic chapters. Some of the texts discussed include works by Tim Winton's Breath (2008) and Land's Edge (1993), Robert Drewe's short story collections The Bodysurfers (1987) and The Rip (2008), and films such as Newcastle (dir. Dan Castle 2008) and Blackrock (dir. Steve Vidler 1997). Ultimately The Australian Beachspace illustrates that the multiple meanings of the beach's representations are complex and yet frequently fail to capture the layered reality of the Australian beach. The Australian beach is best described as a beachspace, a complex space that allows for the mythic and/or/both ordinary at once.

On the beach : exploring the complex egalitarianism of the Australian beach

Australia, internationally, is known as a beach loving country, particularly in popular culture. The beach did not figure significantly in academic discussion before the 1980s when Fiske, Hodge, and Turner (1987, 54) researched the beach as a space of myth, seeing it as an integral part of the modern Australian identity. One common myth in Australia is that the beach is an equaliser, a place of multiple ethnicities, shapes, sizes, and genders (Dutton, 1985). I agree that the beach remains a significant aspect of Australian identity; however, limiting its meaning to a mythic space contributing to a homogenous national identity is not adequate. This paper will explore how Australian texts comment on or challenge the myth of the beach as an egalitarian space. I argue that recent Australian texts show a more complex, layered representation of this concept; and that the beach also in this respect can no longer be understood as a myth transcending difference.

Inside the pleasure dome : cultural tourism on Australia’s Gold Coast

In 2018 the City of the Gold Coast in south-east Queensland, Australia, will host the next Commonwealth Games. The City is made up a 57 km stretch of coastline and hinterland divided by a major highway. The famous surfing beaches are framed by high-rise development while the hinterland is marketed as a green, unspoilt environment. The winning bid for the Games, and discussion about future infrastructure and marketing of the region’s attributes, has focussed attention on the way City residents and policy makers think about their region in broad terms. Whereas in the past tourism marketing has been directed towards the pleasures of sun and surf by day and bright lights by night, various regional tourist stakeholders are beginning to reorient their programs. This paper considers some of the competing aims of the various stakeholders in this region and the interaction of existing ‘cultures’ with new technology and the demands of permanent residents, using data from a case study of e-literary trails developed in Brisbane, the capital city of Queensland. The importance of tourist imaginaries as a basis for using rich accounts of the past for future planning is emphasized.

Handmade clay balls and recycled crush glass as alternative media in water filtration

For many years materials such as quarried sand, anthracite, and granular activated carbon have been the principal media-products traditionally used in water and wastewater filtration plants. Pebble Matrix Filtration (PMF) is a novel non-chemical, sustainable pre-treatment method of protecting Slow Sand Filters (SSF) from high turbidity during heavy monsoon periods. PMF uses sand and pebbles as the filter media and the sustainability of this new technology might depend on availability and supply of pebbles and sand, both finite resources. In many countries there are two principal methods of obtaining pebbles and sand, namely dredging from rivers and beaches, and due to the scarcity of these resources in some countries the cost of pebbles is often 4-5 times higher than that of sand. In search for an alternative medium to pebbles after some preliminary laboratory tests conducted in Colombo-Sri Lanka, Poznan-Poland and Cambridge-UK, a 100-year-old brick factory near Sudbury, Suffolk, has produced hand-made clay pebbles satisfying the PMF quality requirements. As an alternative to sand, crushed recycled glass from a UK supplier was used and the PMF system was operated together with hand-made clay balls in the laboratory for high turbidity removal effectively. The results of laboratory experiments with alternative media are presented in this paper. There are potential opportunities for recycled crushed glass and clay ball manufacturing processes in some countries where they can be used as filter media.

All the Flavours of Asia

A travel article about food and landscape in Thailand. Thick forest islands the first limestone karst that we see. In the cracks and ledges of these cliff faces, low trees make a steady ascent. From the road, it looks an impossible climb, but the forest has managed to find a line to the top and to form a platform of dense canopy. We’re coming into Krabi, an area of southern Thailand famous for these formations. Soon, the forest base will be replaced by ocean. Grottos, undercuts, and yellow beaches will add a skirt of luxury to the drama to the cliffs...

Visit Perth, Fremantle and Rottnest Island in Western Australia

A travel article about Perth, Freemantle, and Rottnest Island. In all probability, the water at Cottesloe Beach is no bluer than at all the other beaches of Australia. But early afternoon on the day I arrive, that blue seems total, or perhaps even on the edge of some other colour spectrum still being invented. The blue of the west...

Sun, sun and more sun — how to register as a pharmacist in Australia

To me, Australia has always seemed like an alluring destination, with its beautiful beaches, amazing wildlife and beautiful coastal cities. For some years, there have been many pharmacists who have enjoyed working and travelling around this country. Recently, though, there have been a number of changes made to the registration process, which has made this aspiration more difficult...