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.

Assessing performance and capability in the work place : focusing on essential skills and knowledge in student work placements

The determination of performance standards and assessment practices in regard to student work placements is an essential and important task. Inappropriate, inadequate, or excessively complex assessment tasks can influence levels of student engagement and the quality of learning outcomes. Critical to determining appropriate standards and assessment tasks is an understanding and knowledge of key elements of the learning environment and the extent to which opportunities are provided for students to engage in critical reflection and judgement of their own performance in the contexts of the work environment. This paper focuses on the development of essential skills and knowledge (capabilities) that provide evidence of learning in work placements by describing an approach taken in the science and technology disciplines. Assessment matrices are presented to illustrate a method of assessment for use within the context of the learning environment centred on work placements in science and technology. This study contributes to the debate on the meaning of professional capability, performance standards and assessment practices in work placement programs by providing evidence of an approach that can be adapted by other programs to achieve similar benefits. The approach may also be valuable to other learning contexts where capability and performance are being judged in situations that are outside a controlled teaching and learning environment i.e. in other life-wide learning contexts.

The inclusion lottery : who's in and who's out? Tracking inclusion and exclusion in New South Wales government schools

The last few decades have witnessed a broad international movement towards the development of inclusive schools through targeted special education funding and resourcing policies. Student placement statistics are often used as a barometer of policy success but they may also be an indication of system change. In this paper, trends in student enrolments from the Australian state of New South Wales are considered in an effort to understand what effect inclusive education has had in this particular region of the world.

In defence of Victoria's Children's Court : its value and role in the child protection system

Australian child protection systems have been subject to sustained and significant criticism for many decades. As a central part of that system Children’s Courts have been implicated: three recent inquiries into the child protection system in Victoria all criticised the Family Division of the Children’s Court.1 In the resulting debate two diametrically opposed points of view surfaced about the Children’s Court and the role that legal procedures and professionals should play in child protection matters. On one side bodies like the Children’s Court of Victoria, Victoria Legal Aid (‘VLA’), the Law Institute of Victoria (‘LIV’), and the Federation of Community Legal Centres (‘FCLC’) argued that the Children’s Court plays a vital role in child protection and should continue to play that role.2 On the other side a coalition of human service and child protection agencies called for major change including the removal of the Children’s Court from the child protection system. Victoria’s Department of Human Services (‘DHS’) has been critical of the Court3 as have community sector organisations like Anglicare, Berry Street, MacKillop Family Services and the Salvation Army — all agencies the DHS funds to deliver child protection services.4 Victoria’s Child Safety Commissioner has also called for major reform, publicly labelling the Court a ‘lawyers’ playground’ and recommending abolishing the Court’s involvement in child protection completely.

Shut up and write! Some surprising uses of cafes and crowds in doctoral writing

This chapter discusses a ‘writing movement’, which is currently occurring in various parts of Australia through the support of social media. A concept emerging from the café scene in San Francisco, ‘Shut Up and Write!’ is a meetup group that brings writers together at a specific time and place to write side by side, thus making writing practice, social. This concept has been applied to the academic environment and our case-study explores the positive outcomes in two locations: RMIT University and Queensland University of Technology. This informal learning practice can be implemented to assist research students in developing academic skills.

A boy and his toys : technology and gadgetry in the James Bond films

This chapter provides an indepth examination of the history of product placement in the James Bond film series, specifically focusing on the emergence of technology and gadgetry in the series and the impact this had on the number and types of products that were placed in the films.

A comparison of perceived crash risk among cyclists and drivers in Brisbane

The Queensland Government has implemented strategies promoting a shift from individual car use to active transport, a transition which requires drivers to adapt to sharing the road with increased numbers of people cycling through transport network. For this to occur safely, changes in both road infrastructure and road user expectations and behaviors will be needed. Creating separate cycle infrastructure does not remove the need for cyclists to commence, cross or finish travel on shared roads. Currently intersections are one of the predominant shared road spaces where crashes result in cyclists being injured or killed. This research investigates how Brisbane cyclists and drivers perceive risk when interacting with other road users at intersections. The current study replicates a French study conducted by co-authors Chaurand and Delhomme in 2011 and extends it to assess gender effects which have been reported in other Australian cycling research. An online survey was administered to experienced cyclists and drivers. Participants rated the level of risk they felt when imagining a number of different road situations. Based on the earlier French study it is expected that perceived crash risk will be influenced both by the participant’s mode of travel and the type of interacting vehicle and perceived risk will be greater when the interaction is with a car than a bicycle. It is predicted that risk perception will decrease as the level of experience increases and that male participants will have a higher perception of skill and lower perception of risk than females. The findings of this Queensland study will provide a valuable insight into perceived risk and the traffic behaviours of drivers and cyclists when interacting with other road users and results will be available for presentation at the Congress.

Implementing the Clean Development Mechanism in Fiji : opportunities and barriers in the energy sector

The Clean Development Mechanism (CDM) has been praised for its ingenuity in mobilising finance to implement sustainable development practices in non-industrialised countries (known as Non-Annex 1 parties under the Kyoto Protocol). During the first commitment period of the Kyoto Protocol (2008-2012), a large number of clean development mechanism projects have been registered with the CDM board. In addition to the large number of registered CDM projects, there are significant numbers of proposed projects stalled in implementation due to the cumbersome and lengthy CDM approval process. Despite this regulatory criticism it is recognised that the role performed by the CDM is essential for achieving a significant reduction in global green house gas emissions. This is because the CDM funds sustainable development in countries that lack capacity to do so on their own. It is anticipated that some form of CDM instrument will continue post the 2012 timeframe and that reform of the mechanism will be focused around making the mechanism’s approval and implementation processes faster and more efficient.

Characterization of in vitro Chlamydia muridarum persistence and utilization in an in vivo mouse model of Chlamydia vaccine

Problem: Chlamydia trachomatis genital tract infections are easily treated with antibiotics, however the majority of infections are asymptomatic and therefore untreated, highlighting the need for a vaccine. Because most infections are asymptomatic, vaccination could potentially be administered to individuals who may have an acute infection at that time. In such individuals the effect of vaccination on the existing infection is unknown; however one potential outcome could be the development of a persistent infection. In vitro chlamydial persistence has been well characterized in various strains, however there have been no reported studies in C. muridarum. Method of Study: We performed ultrastructural characterization, and transcriptome analysis of selected genes. We then used the transcriptional profiles of the selected genes to examine whether intranasal immunization of mice during an active genital infection would induce persistence in the upper reproductive tract of female mice. Results and Conclusions: We found that persistence developed in the oviducts of mice as a result of immunization. This is a significant finding, not only because it is the first time that C. muridarum persistence has been characterized in vitro, but also due to the fact that there is minimal characterization of in vivo persistence of any chlamydial species. This highlights the importance of the timing of vaccination in individuals.

Spaces for Solidarity and Individualism in Educational Contexts

Foreword For children and youth, as citizens in a society, being a part of educational systems means being involved in a community. Through participation in educational systems, there is important learning about the self and others, both for individual development and social solidarity. Individual development and social solidarity are interrelated. These are important values in education at all levels. Individuals are social beings and are necessarily interdependent on others. Nevertheless, individualism and social solidarity are values that sometimes can diverge and come into conflict. These values can be defined and interpreted in various ways. In a time of neo-liberalism, for example, where individual choices and rights are put at the forefront of the societal and educational discourses in many countries it is relevant to raise questions on how issues of solidarity and individualism are interpreted and negotiated in education. What kind of shape and definitions do these concepts take when schools and preschools live under the intense pressures for the accountability of educational outcomes(Biesta, 2009)? Under what conditions can values, such as solidarity and individualism, co-exist and develop in multicultural and globalized societies, without one dominating the other...

Nurse staffing levels and the incidence of mortality and morbidity in the adult intensive care unit : a literature review

BACKGROUND: Studies have shown that nurse staffing levels, among many other factors in the hospital setting, contribute to adverse patient outcomes. Concerns about patient safety and quality of care have resulted in numerous studies being conducted to examine the relationship between nurse staffing levels and the incidence of adverse patient events in both general wards and intensive care units. AIM: The aim of this paper is to review literature published in the previous 10 years which examines the relationship between nurse staffing levels and the incidence of mortality and morbidity in adult intensive care unit patients. METHODS: A literature search from 2002 to 2011 using the MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Australian digital thesis databases was undertaken. The keywords used were: intensive care; critical care; staffing; nurse staffing; understaffing; nurse-patient ratios; adverse outcomes; mortality; ventilator-associated pneumonia; ventilator-acquired pneumonia; infection; length of stay; pressure ulcer/injury; unplanned extubation; medication error; readmission; myocardial infarction; and renal failure. A total of 19 articles were included in the review. Outcomes of interest are patient mortality and morbidity, particularly infection and pressure ulcers. RESULTS: Most of the studies were observational in nature with variables obtained retrospectively from large hospital databases. Nurse staffing measures and patient outcomes varied widely across the studies. While an overall statistical association between increased nurse staffing levels and decreased adverse patient outcomes was not found in this review, most studies concluded that a trend exists between increased nurse staffing levels and decreased adverse events. CONCLUSION: While an overall statistical association between increased nurse staffing levels and decreased adverse patient outcomes was not found in this review, most studies demonstrated a trend between increased nurse staffing levels and decreased adverse patient outcomes in the intensive care unit which is consistent with previous literature. While further more robust research methodologies need to be tested in order to more confidently demonstrate this association and decrease the influence of the many other confounders to patient outcomes; this would be difficult to achieve in this field of research.

Evaluation of Attacks and Countermeasures in Large Scale Networks

Computer worms represent a serious threat for modern communication infrastructures. These epidemics can cause great damage such as financial losses or interruption of critical services which support lives of citizens. These worms can spread with a speed which prevents instant human intervention. Therefore automatic detection and mitigation techniques need to be developed. However, if these techniques are not designed and intensively tested in realistic environments, they may cause even more harm as they heavily interfere with high volume communication flows. We present a simulation model which allows studies of worm spread and counter measures in large scale multi-AS topologies with millions of IP addresses.

In the Wake of Cyclone Yasi : Facilitation and Evaluation in Community Narrative-Driven Projects

On 3 February 2011, Cyclone Yasi struck the coast of North Queensland, causing widespread damage. The cyclone destroyed the small coastal town of Cardwell, about 165 kilometres north of Townsville, Queensland. This chapter serves as a case study of a collaborative outreach project mobilised in response to this disaster in North Queensland. A public history research team, consisting of practitioners from the Queensland University of Technology’s Creative Industries Faculty, with the support of the Oral History Association of Australia, Queensland branch, partnered with the Cardwell and District Historical Society to support the society to collect community narratives in the wake of Cyclone Yasi.

Framing local stories for community consumption facilitation and evaluation in narrative driven arts-based projects

Cyclone Yasi struck the Cassowary Coast of Queensland in the early hours of Feb 3, 2011, destroying many homes sand property, including the destruction of the Cardwell and district historical society’s premises. With their own homes flattened, many were forced to live in mobile accommodation, with extended family, or leave altogether. The historical society members however were more devastated by their flattened foreshore museum and loss of their collection material. A call for assistance was made through the OHAA Qld branch, who along with QUT sponsored a trip to somehow plan how they could start to pick up the pieces to start again. This presentation highlights the need for communities to gather, preserve and present their own stories, in a way that is sustainable and meaningful to them, but that good advice and support along the way is important. Two 2 day workshops were held in March and then September, augmented by plenty of email correspondence and phone calls in between. Participants learnt that if they could conduct quality oral history interviews, they could later use these in many exhibitable ways including: documentary pieces; digital stories; photographic collections; creative short stories; audio segments –while also drawing closely together a suffering community. This story is not only about the people who were interviewed about the night Yasi struck, but the amazing women (all over 50) of the historical society who were willing to try and leap the digital divide that faces older Australians, especially those in rural Australia, so that their older local stories would not be lost and so that new stories could also be remembered.

Conflict and seduction in the public sphere

In a critical but sympathetic reading of Habermas’s work (1984, 1987a, 1987b, 2003), Luke Goode (2005) recently sought to rework his theory of deliberative democracy in an age of mediated and increasingly digital public spheres. Taking a different approach, Alan McKee (2005) challenged the culture- and class-bound strictures of Habermasian rationalism, instead pursuing a more radically pluralist account of postmodern public spheres. The editors of this special section of Media, Culture & Society invited us to discuss our differing approaches to the public sphere. Goode holds that the institutional bases of contemporary public spheres (political parties, educational institutions or public media) remain of critical importance, albeit in the context of a kaleidoscopic array of unofficial and informal micro-publics, both localized and de-territorialized. In contrast, McKee sustains a ‘hermeneutics of suspicion’ toward the official, hegemonic institutions of the public sphere since they tend to exclude and delegitimize discourses and practices that challenge their polite middle-class norms. McKee’s recent research has focused on sexual cultures, particularly among youth (McKee, 2011). Goode’s recent work has examined new social media spaces, particularly in relation to news and public debate (e.g. Goode, 2009; Goode et al., 2011). Consequently, our discussion turned to a domain which links our interests: after Goode discussed some of his recent research on (in)civility on YouTube as a new media public sphere, McKee challenged him to consider the case of pornographic websites modelled on social media sites.1 He identifies a greater degree of ‘civility’ in these pornographic sibling sites than on YouTube, requiring careful consideration of what constitutes a ‘public sphere’ in contemporary digital culture. Such sites represent an environment that shatters the opposition of public and private interest, affording public engagement on matters of the body, of intimacy, of gender politics, of pleasure and desire – said by many critics to be ruled out of court in Habermasian theory. Such environments also trouble traditional binaries between the cognitive and the affective, and between the performative and the deliberative. In what follows we explore the differences between our approaches in the form of a dialogue. As is often the case, our approaches seemed less at odds after engaging in conversation than may have initially appeared. But important differences of emphasis remain.