Audit of the Care of the Dying in a Network of Hospitals and Institutions in Queensland

Background: Most Australians die in institutions and there is evidence to suggest that the care of these patients is not always optimal. Care pathways for the dying have been designed to transfer benchmarked hospice care to other settings (e.g. acute hospitals and residential age-care facilities) by defining goals of best care, providing guidelines to provide that care and documenting outcome. Method: A retrospective audit was undertaken across a network of health-care institutions in Queensland. The 18 goals considered essential for the care of the dying within the Liverpool Care Pathway were taken as a benchmark. Documentation of achievement of each of these goals was sought. Results: The notes of 160 patients who had died in eight institutions (four hospitals, three hospices, one nursing home) were reviewed. Several areas for improvement were identified, particularly in those goals relating to communication, resuscitation orders and care after death. Few units documented the provision of written information to families. Most patients were prescribed medications in anticipation of pain and agitation but less were prescribed drugs for other common symptoms in the dying. Most of the goals were achieved in a higher percentage of cases in hospice units. Marked differences in practice were noted between different institutions. Conclusion: The audit identified several aspects in the care of the terminally ill that could be improved. End-stage pathways may provide a model for improving the care of patients dying in hospitals and institutions in Australia.

Appetite sensations and satiety quotient : predictors of energy intake and weight loss

PURPOSE: The aim of this study was to further evaluate the validity and clinical meaningfulness of appetite sensations to predict overall energy intake as well as body weight loss. METHODS: Men (n=176) and women (n=139) involved in six weight loss studies were selected to participate in this study. Visual analogue scales were used to measure appetite sensations before and after a fixed test meal. Fasting appetite sensations, 1 h post-prandial area under the curve (AUC) and the satiety quotient (SQ) were used as predictors of energy intake and body weight loss. Two separate measures of energy intake were used: a buffet style ad libitum test lunch and a three-day self-report dietary record. RESULTS: One-hour post-prandial AUC for all appetite sensations represented the strongest predictors of ad libitum test lunch energy intake (p0.001). These associations were more consistent and pronounced for women than men. Only SQ for fullness was associated with ad libitum test lunch energy intake in women. Similar but weaker relationships were found between appetite sensations and the 3-day self-reported energy intake. Weight loss was associated with changes in appetite sensations (p0.01) and the best predictors of body weight loss were fasting desire to eat; hunger; and PFC (p0.01). CONCLUSIONS: These results demonstrate that appetite sensations are relatively useful predictors of spontaneous energy intake, free-living total energy intake and body weight loss. They also confirm that SQ for fullness predicts energy intake, at least in women.

Springbrook : Challenges in developing a long-term, rainforest wireless sensor network

We describe the design, development and learnings from the first phase of a rainforest ecological sensor network at Springbrook - part of a World Heritage precinct in South East Queensland. This first phase is part of a major initiative to develop the capability to provide reliable, long-term monitoring of rainforest ecosystems. We focus in particular on our analysis around energy and communication challenges which need to be solved to allow for reliable, long-term deployments in these types of environments.

Poster Abstract : A sensor network for compression and streaming of GPS trajectory data

We present the design and deployment results for PosNet - a large-scale, long-duration sensor network that gathers summary position and status information from mobile nodes. The mobile nodes have a fixed-sized memory buffer to which position data is added at a constant rate, and from which data is downloaded at a non-constant rate. We have developed a novel algorithm that performs online summarization of position data within the buffer, where the algorithm naturally accommodates data input and output rate mismatch, and also provides a delay-tolerant approach to data transport. The algorithm has been extensively tested in a large-scale long-duration cattle monitoring and control application.

Design and deployment of a remote robust sensor network : experiences from an outdoor water quality monitoring network

This paper investigates a wireless sensor network deployment - monitoring water quality, e.g. salinity and the level of the underground water table - in a remote tropical area of northern Australia. Our goal is to collect real time water quality measurements together with the amount of water being pumped out in the area, and investigate the impacts of current irrigation practice on the environments, in particular underground water salination. This is a challenging task featuring wide geographic area coverage (mean transmission range between nodes is more than 800 meters), highly variable radio propagations, high end-to-end packet delivery rate requirements, and hostile deployment environments. We have designed, implemented and deployed a sensor network system, which has been collecting water quality and flow measurements, e.g., water flow rate and water flow ticks for over one month. The preliminary results show that sensor networks are a promising solution to deploying a sustainable irrigation system, e.g., maximizing the amount of water pumped out from an area with minimum impact on water quality.

An empirical study of data collection protocols for wireless sensor networks

In the past few years, numerous data collection protocols have been developed for wireless sensor networks (WSNs). However, there has been no comparison of their relative performance in realistic environments. Here we report the results of an empirical study using a Fleck3 sensor network testbed for four different data collection protocols: One phase pull Directed Diffusion (DD), Expected Number of Transmissions (ETX), ETX with explicit acknowledgment (ETX-eAck), and ETX with implicit acknowledgment (ETX-iAck). Our empirical study provides useful insights for future sensor network deployments. When the required application end-to-end reliability is not strict (e.g., 70%) and link quality is good, DD and ETX are the best options because of their simplicity and low routing overhead. Both ETX-eAck and ETX-iAck achieve more than 90% end-to-end reliability when the link quality is reasonable (less than 25% packet loss). When the link quality is good, ETX-iAck introduces significantly less routing overhead (up to 50%) than ETX-eAck. However, if the radio transceiver supports variable packet length, ETX-eAck can outperform ETX-iAck when the link quality is poor. The important message from this paper is that choice of data collection protocol should come after the operating environment is understood. This understanding must include the characteristics of the radio transceiver, and link loss statistics from a long-term (across seasons and weather variation) radio survey of the site.

Data collection, storage and retrieval with an underwater sensor network

In this paper we present a novel platform for underwater sensor networks to be used for long-term monitoring of coral reefs and �sheries. The sensor network consists of static and mobile underwater sensor nodes. The nodes communicate point-to-point using a novel high-speed optical communication system integrated into the TinyOS stack, and they broadcast using an acoustic protocol integrated in the TinyOS stack. The nodes have a variety of sensing capabilities, including cameras, water temperature, and pressure. The mobile nodes can locate and hover above the static nodes for data muling, and they can perform network maintenance functions such as deployment, relocation, and recovery. In this paper we describe the hardware and software architecture of this underwater sensor network. We then describe the optical and acoustic networking protocols and present experimental networking and data collected in a pool, in rivers, and in the ocean. Finally, we describe our experiments with mobility for data muling in this network.

The effects of exercise-induced weight loss on appetite-related peptides and motivation to eat

Context: The magnitude of exercise-induced weight loss depends on the extent of compensatory responses. An increase in energy intake is likely to result from changes in the appetite control system toward an orexigenic environment; however, few studies have measured how exercise impacts on both orexigenic and anorexigenic peptides. ---------- Objective: The aim of the study was to investigate the effects of medium-term exercise on fasting/postprandial levels of appetite-related hormones and subjective appetite sensations in overweight/obese individuals. ---------- Design and Setting: We conducted a longitudinal study in a university research center. ---------- Participants and Intervention: Twenty-two sedentary overweight/obese individuals (age, 36.9 ± 8.3 yr; body mass index, 31.3 ± 3.3 kg/m2) took part in a 12-wk supervised exercise programme (five times per week, 75% maximal heart rate) and were requested not to change their food intake during the study. ---------- Main Outcome Measures: We measured changes in body weight and fasting/postprandial plasma levels of glucose, insulin, total ghrelin, acylated ghrelin (AG), peptide YY, and glucagon-like peptide-1 and feelings of appetite. ---------- Results: Exercise resulted in a significant reduction in body weight and fasting insulin and an increase in AG plasma levels and fasting hunger sensations. A significant reduction in postprandial insulin plasma levels and a tendency toward an increase in the delayed release of glucagon-like peptide-1 (90–180 min) were also observed after exercise, as well as a significant increase (127%) in the suppression of AG postprandially. ---------- Conclusions: Exercise-induced weight loss is associated with physiological and biopsychological changes toward an increased drive to eat in the fasting state. However, this seems to be balanced by an improved satiety response to a meal and improved sensitivity of the appetite control system.

Prandial subcutaneous injections of glucagon-like peptide-1 cause weight loss in obese human subjects

Recombinant glucagon-like peptide-1 (7–36)amide (rGLP-1) was recently shown to cause significant weight loss in type 2 diabetics when administered for 6 weeks as a continuous subcutaneous infusion. The mechanisms responsible for the weight loss are not clarified. In the present study, rGLP-1 was given for 5d by prandial subcutaneous injections (PSI) (76nmol 30min before meals, four times daily; a total of 302·4nmol/24h) or by continuous subcutaneous infusion (CSI) (12·7nmol/h; a total of 304·8nmol/24h). This was performed in nineteen healthy obese subjects (mean age 44·2 (sem 2·5) years; BMI 39·0 (sem 1·2)kg/m2) in a prospective randomised, double-blind, placebo-controlled, cross-over study. Compared with the placebo, rGLP-1 administered as PSI and by CSI generated a 15% reduction in mean food intake per meal (P=0·02) after 5d treatment. A weight loss of 0·55 (sem 0·2) kg (P<0·05) was registered after 5d with PSI of rGLP-1. Gastric emptying rate was reduced during both PSI (P<0·001) and CSI (P<0·05) treatment, but more rapidly and to a greater extent with PSI of rGLP-1. To conclude, a 5d treatment of rGLP-1 at high doses by PSI, but not CSI, promptly slowed gastric emptying as a probable mechanism of action of increased satiety, decreased hunger and, hence, reduced food intake with an ensuing weight loss.

Fold back current control and admittance protection scheme for a distribution network containing distributed generators

Islanded operation, protection, reclosing and arc extinguishing are some of the challenging issues related to the connection of converter interfaced distributed generators (DGs) into a distribution network. The isolation of upstream faults in grid connected mode and fault detection in islanded mode using overcurrent devices are difficult. In the event of an arc fault, all DGs must be disconnected in order to extinguish the arc. Otherwise, they will continue to feed the fault, thus sustaining the arc. However, the system reliability can be increased by maximising the DG connectivity to the system: therefore, the system protection scheme must ensure that only the faulted segment is removed from the feeder. This is true even in the case of a radial feeder as the DG can be connected at various points along the feeder. In this paper, a new relay scheme is proposed which, along with a novel current control strategy for converter interfaced DGs, can isolate permanent and temporary arc faults. The proposed protection and control scheme can even coordinate with reclosers. The results are validated through PSCAD/EMTDC simulation and MATLAB calculations.

Low fat loss response after medium-term supervised exercise in obese is associated with exercise-induced increase in food reward

Objective: To examine exercise-induced changes in the reward value of food during medium-term supervised exercise in obese individuals. ---------- Subjects/Methods: The study was a 12-week supervised exercise intervention prescribed to expend 500 kcal/day, 5 d/week. 34 sedentary obese males and females were identified as responders (R) or non-responders (NR) to the intervention according to changes in body composition relative to measured energy expended during exercise. Food reward (ratings of liking and wanting, and relative preference by forced choice pairs) for an array of food images was assessed before and after an acute exercise bout. ---------- Results. 20 responders and 14 non-responders were identified. R lost 5.2 kg±2.4 of total fat mass and NR lost 1.7 kg±1.4. After acute exercise, liking for all foods increased in NR compared to no change in R. Furthermore, NR showed an increase in wanting and relative preference for high-fat sweet foods. These differences were independent of 12-weeks regular exercise and weight loss. ---------- Conclusion. Individuals who showed an immediate post-exercise increase in liking and increased wanting and preference for high-fat sweet foods displayed a smaller reduction in fat mass with exercise. For some individuals, exercise increases the reward value of food and diminishes the impact of exercise on fat loss.