The impact of malnutrition and decreased food intake on length of stay, readmission, and mortality in acute care patients

Rationale: The Australasian Nutrition Care Day Survey (ANCDS) evaluated if malnutrition and decreased food intake are independent risk factors for negative outcomes in hospitalised patients. Methods: A multicentre (56 hospitals) cross-sectional survey was conducted in two phases. Phase 1 evaluated nutritional status (defined by Subjective Global Assessment) and 24-hour food intake recorded as 0, 25, 50, 75, and 100% intake. Phase 2 data, which included length of stay (LOS), readmissions and mortality, were collected 90 days post-Phase 1. Logistic regression was used to control for confounders: age, gender, disease type and severity (using Patient Clinical Complexity Level scores). Results: Of 3122 participants (53% males, mean age: 65±18 years) 32% were malnourished and 23% consumed�25% of the offered food. Median LOS for malnourished (MN) patients was higher than well-nourished (WN) patients (15 vs. 10 days, p<0.0001). Median LOS for patients consuming �25% of the food was higher than those consuming �50% (13 vs. 11 days, p<0.0001). MN patients had higher readmission rates (36% vs. 30%, p = 0.001). The odds ratios of 90-day in-hospital mortality were 1.8 times greater for MN patients (CI: 1.03 3.22, p = 0.04) and 2.7 times greater for those consuming �25% of the offered food (CI: 1.54 4.68, p = 0.001). Conclusion: The ANCDS demonstrates that malnutrition and/or decreased food intake are associated with longer LOS and readmissions. The survey also establishes that malnutrition and decreased food intake are independent risk factors for in-hospital mortality in acute care patients; and highlights the need for appropriate nutritional screening and support during hospitalisation. Disclosure of Interest: None Declared.

Impact of a novel nurse-led prechemotherapy education intervention (ChemoEd) on patient distress, symptom burden, and treatment-related information and support needs : results from a randomised, controlled trial

Background: High levels of distress and need for self-care information by patients commencing chemotherapy suggest that current prechemotherapy education is suboptimal. We conducted a randomised, controlled trial of a prechemotherapy education intervention (ChemoEd) to assess impact on patient distress, treatment-related concerns, and the prevalence and severity of and bother caused by six chemotherapy side-effects. Patients and methods: One hundred and ninety-two breast, gastrointestinal, and haematologic cancer patients were recruited before the trial closing prematurely (original target 352). ChemoEd patients received a DVD, question-prompt list, self-care information, an education consultation ≥24 h before first treatment (intervention 1), telephone follow-up 48 h after first treatment (intervention 2), and a face-to-face review immediately before second treatment (intervention 3). Patient outcomes were measured at baseline (T1: pre-education) and immediately preceding treatment cycles 1 (T2) and 3 (T3). Results: ChemoEd did not significantly reduce patient distress. However, a significant decrease in sensory/psychological (P = 0.027) and procedural (P = 0.03) concerns, as well as prevalence and severity of and bother due to vomiting (all P = 0.001), were observed at T3. In addition, subgroup analysis of patients with elevated distress at T1 indicated a significant decrease (P = 0.035) at T2 but not at T3 (P = 0.055) in ChemoEd patients. Conclusions: ChemoEd holds promise to improve patient treatment-related concerns and some physical/psychological outcomes; however, further research is required on more diverse patient populations to ensure generalisability.

ICT driven pedagogies and its impact on learning outcomes in high school mathematics

ICT (Information and Communication Technology) creates numerous opportunities for teachers to re-think their pedagogies. In subjects like mathematics which draws upon abstract concepts, ICT creates such an opportunity. Instead of a mimetic pedagogical approach, suitably designed activities with ICT can enable learners to engage more proactively with their learning. In this quasi-experimental designed study, ICT was used in teaching mathematics to a group of first year high school students (N=25) in Australia. The control group was taught predominantly through traditional pedagogies (N=22). Most of the variables that had previously impacted on the design of such studies were suitably controlled in this yearlong investigation. Quantitative and qualitative results showed that students who were taught by ICT driven pedagogies benefitted from the experience. Pre and post-test means showed that there was a difference between the treatment and control groups. Of greater significance was that the students (in the treatment group) believed that the technology enabled them to engage more with their learning.

Children, young people and their social and spatial citizenship rights

The use of public space by children and young people is a contentious issue in a number of developed and developing countries and a range of measures are frequently deployed to control the public space which usually deny the rights of children and young people to claim the space for their use. Child and youth curfews, oppressive camera surveillance and the unwarranted attentions of police and private security personnel as control measures in public space undermine attempts to secure greater participation by children and young people in constructing positive strategies to address concerns that impact on them and others in a local area. Evidence from research in Scotland undertaken by Article 12 (2000) suggests that young people felt strongly that they did not count in local community matters and decision making and the imposition on them of a curfew by the adult world of the local area created resentment both at the harshness of the measure and disappointment at an opportunity lost to be consulted and involved in dealing with perceived problems of the locality. This is an important cluster of linked issues as Brown (1998:116) argues that young people are ‘selectively constructed as “problem” and “other” with their concerns marginalised, their lifestyles problematised and their voices subdued’, and this flows into their use of public space as their claims to its use as an aspect of social citizenship are usually cast as inferior or rejected as they ‘stand outside the formal polity’ as ‘non persons’. This has major implications for the ways in which young people view their position in a community as many report a feeling of not being wanted, valued or tolerated. The ‘youth question’ according to Davis (1990) acts as a form of ‘screen’ on which observers and analysts project hopes and fears about the state of society, while in the view of Loader (1996:89) the ‘question of young people’ sits within a discourse comprising two elements, the one being youth, particularly young males, as the ‘harbinger of often unwelcome social change and threat’ and the other element ‘constructs young people as vulnerable’. This discourse of threat is further exemplified in the separation of children from teenagers as Valentine (1996) suggests, the treatment of younger children using public space is often dramatically different to that of older children and the most feared stage of all, 'youth'

Speaker linking using complete-linkage clustering

Speaker diarization determines instances of the same speaker within a recording. Extending this task to a collection of recordings for linking together segments spoken by a unique speaker requires speaker linking. In this paper we propose a speaker linking system using linkage clustering and state-of-the-art speaker recognition techniques. We evaluate our approach against two baseline linking systems using agglomerative cluster merging (AC) and agglomerative clustering with model retraining (ACR). We demonstrate that our linking method, using complete-linkage clustering, provides a relative improvement of 20% and 29% in attribution error rate (AER), over the AC and ACR systems, respectively.

Abundance of Natural Riparian Forests and Tree Plantations in the Amudarya Delta of Uzbekistan and their impact on emissions of soil-borne greenhouse gases

Through a forest inventory in parts of the Amudarya river delta, Central Asia, we assessed the impact of ongoing forest degradation on the emissions of greenhouse gases (GHG) from soils. Interpretation of aerial photographs from 2001, combined with data on forest inventory in 1990 and field survey in 2003 provided comprehensive information about the extent and changes of the natural tugai riparian forests and tree plantations in the delta. The findings show an average annual deforestation rate of almost 1.3% and an even higher rate of land use change from tugai forests to land with only sparse tree cover. These annual rates of deforestation and forest degradation are higher than the global annual forest loss. By 2003, the tugai forest area had drastically decreased to about 60% compared to an inventory in 1990. Significant differences in soil GHG emissions between forest and agricultural land use underscore the impact of the ongoing land use change on the emission of soil-borne GHGs. The conversion of tugai forests into irrigated croplands will release 2.5 t CO2 equivalents per hectare per year due to elevated emissions of N2O and CH4. This demonstrates that the ongoing transformation of tugai forests into agricultural land-use systems did not only lead to a loss of biodiversity and of a unique ecosystem, but substantially impacts the biosphere-atmosphere exchange of GHG and soil C and N turnover processes.

Nitrous oxide emissions from irrigated wheat in Australia : impact of irrigation management

Background and Aims: Irrigation management affects soil water dynamics as well as the soil microbial carbon and nitrogen turnover and potentially the biosphere-atmosphere exchange of greenhouse gasses (GHG). We present a study on the effect of three irrigation treatments on the emissions of nitrous oxide (N2O) from irrigated wheat on black vertisols in South-Eastern Queensland, Australia. Methods: Soil N2O fluxes from wheat were monitored over one season with a fully automated system that measured emissions on a sub-daily basis. Measurements were taken from 3 subplots for each treatment within a randomized split-plot design. Results: Highest N2O emissions occurred after rainfall or irrigation and the amount of irrigation water applied was found to influence the magnitude of these “emission pulses”. Daily N2O emissions varied from -0.74 to 20.46 g N2O-N ha-1 day-1 resulting in seasonal losses ranging from 0.43 to 0.75 kg N2O N ha-1 season -1 for the different irrigation treatments. Emission factors (EF = proportion of N fertilizer emitted as N2O) over the wheat cropping season, uncorrected for background emissions, ranged from 0.2 to 0.4% of total N applied for the different treatments. Highest seasonal N2O emissions were observed in the treatment with the highest irrigation intensity; however, the N2O intensity (N2O emission per crop yield) was highest in the treatment with the lowest irrigation intensity. Conclusions: Our data suggest that timing and amount of irrigation can effectively be used to reduce N2O losses from irrigated agricultural systems; however, in order to develop sustainable mitigation strategies the N2O intensity of a cropping system is an important concept that needs to be taken into account.

Australia and its impact fees

Australia is a country, which has much of its legislative roots in its Commonwealth heritage. However due to its size and nature, its planning and development processes are more aligned to countries such as the United States. This paper will present an overview of the Australian urban land market, its infrastructure funding mechanisms (property taxes) and current provisions in each of Australia’s seven States and Territories that provide for developer contributions for local infrastructure (impact fees).

Airborne collision scenario flight tests : impact of angle measurement errors on reactive vision-based avoidance control

The future emergence of many types of airborne vehicles and unpiloted aircraft in the national airspace means collision avoidance is of primary concern in an uncooperative airspace environment. The ability to replicate a pilot’s see and avoid capability using cameras coupled with vision based avoidance control is an important part of an overall collision avoidance strategy. But unfortunately without range collision avoidance has no direct way to guarantee a level of safety. Collision scenario flight tests with two aircraft and a monocular camera threat detection and tracking system were used to study the accuracy of image-derived angle measurements. The effect of image-derived angle errors on reactive vision-based avoidance performance was then studied by simulation. The results show that whilst large angle measurement errors can significantly affect minimum ranging characteristics across a variety of initial conditions and closing speeds, the minimum range is always bounded and a collision never occurs.

Extending and validating the is-impact model in Saudi Arabia : accounting for computer network quality

Organizations from every industry sector seek to enhance their business performance and competitiveness through the deployment of contemporary information systems (IS), such as Enterprise Systems (ERP). Investments in ERP are complex and costly, attracting scrutiny and pressure to justify their cost. Thus, IS researchers highlight the need for systematic evaluation of information system success, or impact, which has resulted in the introduction of varied models for evaluating information systems. One of these systematic measurement approaches is the IS-Impact Model introduced by a team of researchers at Queensland University of technology (QUT) (Gable, Sedera, & Chan, 2008). The IS-Impact Model is conceptualized as a formative, multidimensional index that consists of four dimensions. Gable et al. (2008) define IS-Impact as "a measure at a point in time, of the stream of net benefits from the IS, to date and anticipated, as perceived by all key-user-groups" (p.381). The IT Evaluation Research Program (ITE-Program) at QUT has grown the IS-Impact Research Track with the central goal of conducting further studies to enhance and extend the IS-Impact Model. The overall goal of the IS-Impact research track at QUT is "to develop the most widely employed model for benchmarking information systems in organizations for the joint benefit of both research and practice" (Gable, 2009). In order to achieve that, the IS-Impact research track advocates programmatic research having the principles of tenacity, holism, and generalizability through extension research strategies. This study was conducted within the IS-Impact Research Track, to further generalize the IS-Impact Model by extending it to the Saudi Arabian context. According to Hofsted (2012), the national culture of Saudi Arabia is significantly different from the Australian national culture making the Saudi Arabian culture an interesting context for testing the external validity of the IS-Impact Model. The study re-visits the IS-Impact Model from the ground up. Rather than assume the existing instrument is valid in the new context, or simply assess its validity through quantitative data collection, the study takes a qualitative, inductive approach to re-assessing the necessity and completeness of existing dimensions and measures. This is done in two phases: Exploratory Phase and Confirmatory Phase. The exploratory phase addresses the first research question of the study "Is the IS-Impact Model complete and able to capture the impact of information systems in Saudi Arabian Organization?". The content analysis, used to analyze the Identification Survey data, indicated that 2 of the 37 measures of the IS-Impact Model are not applicable for the Saudi Arabian Context. Moreover, no new measures or dimensions were identified, evidencing the completeness and content validity of the IS-Impact Model. In addition, the Identification Survey data suggested several concepts related to IS-Impact, the most prominent of which was "Computer Network Quality" (CNQ). The literature supported the existence of a theoretical link between IS-Impact and CNQ (CNQ is viewed as an antecedent of IS-Impact). With the primary goal of validating the IS-Impact model within its extended nomological network, CNQ was introduced to the research model. The Confirmatory Phase addresses the second research question of the study "Is the Extended IS-Impact Model Valid as a Hierarchical Multidimensional Formative Measurement Model?". The objective of the Confirmatory Phase was to test the validity of IS-Impact Model and CNQ Model. To achieve that, IS-Impact, CNQ, and IS-Satisfaction were operationalized in a survey instrument, and then the research model was assessed by employing the Partial Least Squares (PLS) approach. The CNQ model was validated as a formative model. Similarly, the IS-Impact Model was validated as a hierarchical multidimensional formative construct. However, the analysis indicated that one of the IS-Impact Model indicators was insignificant and can be removed from the model. Thus, the resulting Extended IS-Impact Model consists of 4 dimensions and 34 measures. Finally, the structural model was also assessed against two aspects: explanatory and predictive power. The analysis revealed that the path coefficient between CNQ and IS-Impact is significant with t-value= (4.826) and relatively strong with â = (0.426) with CNQ explaining 18% of the variance in IS-Impact. These results supported the hypothesis that CNQ is antecedent of IS-Impact. The study demonstrates that the quality of Computer Network affects the quality of the Enterprise System (ERP) and consequently the impacts of the system. Therefore, practitioners should pay attention to the Computer Network quality. Similarly, the path coefficient between IS-Impact and IS-Satisfaction was significant t-value = (17.79) and strong â = (0.744), with IS-Impact alone explaining 55% of the variance in Satisfaction, consistent with results of the original IS-Impact study (Gable et al., 2008). The research contributions include: (a) supporting the completeness and validity of IS-Impact Model as a Hierarchical Multi-dimensional Formative Measurement Model in the Saudi Arabian context, (b) operationalizing Computer Network Quality as conceptualized in the ITU-T Recommendation E.800 (ITU-T, 1993), (c) validating CNQ as a formative measurement model and as an antecedent of IS Impact, and (d) conceptualizing and validating IS-Satisfaction as a reflective measurement model and as an immediate consequence of IS Impact. The CNQ model provides a framework to perceptually measure Computer Network Quality from multiple perspectives. The CNQ model features an easy-to-understand, easy-to-use, and economical survey instrument.

Neighbourhood disadvantage, individual-level socioeconomic position, and self-reported chronic arthritis : a cross-sectional multilevel study

Objective: To examine the association between individual- and neighborhood-level disadvantage and self-reported arthritis. Methods: We used data from a population-based cross-sectional study conducted in 2007 among 10,757 men and women ages 40–65 years, selected from 200 neighborhoods in Brisbane, Queensland, Australia using a stratified 2-stage cluster design. Data were collected using a mail survey (68.5% response). Neighborhood disadvantage was measured using a census-based composite index, and individual disadvantage was measured using self-reported education, household income, and occupation. Arthritis was indicated by self-report. Data were analyzed using multilevel modeling. Results: The overall rate of self-reported arthritis was 23% (95% confidence interval [95% CI] 22–24). After adjustment for sociodemographic factors, arthritis prevalence was greatest for women (odds ratio [OR] 1.5, 95% CI 1.4–1.7) and in those ages 60–65 years (OR 4.4, 95% CI 3.7–5.2), those with a diploma/associate diploma (OR 1.3, 95% CI 1.1–1.6), those who were permanently unable to work (OR 4.0, 95% CI 3.1–5.3), and those with a household income <$25,999 (OR 2.1, 95% CI 1.7–2.6). Independent of individual-level factors, residents of the most disadvantaged neighborhoods were 42% (OR 1.4, 95% CI 1.2–1.7) more likely than those in the least disadvantaged neighborhoods to self-report arthritis. Cross-level interactions between neighborhood disadvantage and education, occupation, and household income were not significant. Conclusion: Arthritis prevalence is greater in more socially disadvantaged neighborhoods. These are the first multilevel data to examine the relationship between individual- and neighborhood-level disadvantage upon arthritis and have important implications for policy, health promotion, and other intervention strategies designed to reduce the rates of arthritis, indicating that intervention efforts may need to focus on both people and places.

Impact of the internal business environment on knowledge management within construction organisations

Purpose: Recent knowledge management (KM) literature suggests that KM activities are influenced by the elements of the internal business environment (BE) of organisations. This paper attempts to provide some unique insights into the contextual input of the KM process through empirically identifying the major factors (i.e. “forces”) within the internal BE of construction organisations operating in Hong Kong, and investigating their impact on the intensity of KM activities. Design/methodology/approach: A questionnaire survey was administered to a sample of construction contractors operating in Hong Kong to elicit opinions on the internal BE and intensity of KM activities as executed by targeted organisations. A total of 149 usable responses were received from 99 organisations representing about 38 percent of the research population. In parallel, to the survey, a total of 15 semi-structured interviews were undertaken to provide more insights into the phenomenon under investigation. Findings: Supported by the empirical and qualitative evidence, this study established that firstly, both organisational and technical environments have the capacity to either positively or negatively impact the intensity of KM activities, and both environments serve as stimuli in increasing each other's dynamism; secondly, certain types of KM activities are stronger “energy receivers” and easily to be “powered up” by manipulating factors representing these two environments. Then, through interactions between KM activities, the intensity of the whole strategic KM cycle will be increased thus helping to strengthen organisational competitive advantage.