Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality

Background & aims The confounding effect of disease on the outcomes of malnutrition using diagnosis-related groups (DRG) has never been studied in a multidisciplinary setting. This study aims to determine the impact of malnutrition on hospitalisation outcomes, controlling for DRG. Methods Subjective Global Assessment was used to assess the nutritional status of 818 patients within 48 hours of admission. Prospective data were collected on cost of hospitalisation, length of stay (LOS), readmission and mortality up to 3 years post-discharged using National Death Register data. Mixed model analysis and conditional logistic regression matching by DRG were carried out to evaluate the association between nutritional status and outcomes, with the results adjusted for gender, age and race. Results Malnourished patients (29%) had longer hospital stays (6.9±7.3 days vs. 4.6±5.6 days, p<0.001) and were more likely to be readmitted within 15 days (adjusted relative risk = 1.9, 95%CI 1.1–3.2, p=0.025). Within a DRG, the mean difference between actual cost of hospitalisation and the average cost for malnourished patients was greater than well-nourished patients (p=0.014). Mortality was higher in malnourished patients at 1 year (34% vs. 4.1 %), 2 years (42.6% vs. 6.7%) and 3 years (48.5% vs. 9.9%); p<0.001 for all. Overall, malnutrition was a significant predictor of mortality (adjusted hazard ratio = 4.4, 95%CI 3.3-6.0, p<0.001). Conclusions Malnutrition was evident in up to one third of inpatients and led to poor hospitalisation outcomes, even after matching for DRG. Strategies to prevent and treat malnutrition in the hospital and post-discharge are needed.

Bottle-feeding and the risk of pyloric stenosis

OBJECTIVES: Bottle-feeding has been suggested to increase the risk of pyloric stenosis (PS). However, large population-based studies are needed. We examined the effect of bottle-feeding during the first 4 months after birth, by using detailed data about the timing of first exposure to bottle-feeding and extensive confounder information. METHODS: We performed a large population-based cohort study based on the Danish National Birth Cohort, which provided information on infants and feeding practice. Information about surgery for PS was obtained from the Danish National Patient Register. The association between bottle-feeding and the risk of PS was evaluated by hazard ratios (HRs) estimated in a Cox regression model, adjusting for possible confounders. RESULTS: Among 70 148 singleton infants, 65 infants had surgery for PS, of which 29 were bottle-fed before PS diagnosis. The overall HR of PS for bottle-fed infants compared with not bottle-fed infants was 4.62 (95% confidence interval [CI]: 2.78–7.65). Among bottle-fed infants, risk increases were similar for infants both breast and bottle-fed (HR: 3.36 [95% CI: 1.60–7.03]), formerly breastfed (HR: 5.38 [95% CI: 2.88–10.06]), and never breastfed (HR: 6.32 [95% CI: 2.45–16.26]) (P = .76). The increased risk of PS among bottle-fed infants was observed even after 30 days since first exposure to bottle-feeding and did not vary with age at first exposure to bottle-feeding. CONCLUSIONS: Bottle-fed infants experienced a 4.6-fold higher risk of PS compared with infants who were not bottle-fed. The result adds to the evidence supporting the advantage of exclusive breastfeeding in the first months after birth.

Driver behaviour and decision making at railway level crossings : An exploratory on-road case study

Crashes at rail level crossings represent a significant problem, both in Australia and worldwide. Advances in driving assessment methods, such as the provision of on-road instrumented test vehicles, now provide researchers with the opportunity to further understand driver behaviour at rail level crossings in ways not previously possible. This paper gives an overview of a recent on-road pilot study of driver behaviour at rail level crossings in which 25 participants drove a pre-determined route, incorporating 4 rail level crossings, using MUARC's instrumented On-Road Test Vehicle (ORTeV). Drivers provided verbal commentary whilst driving the route, and a range of other data were collected, including eye fixations, forward, cockpit and driver video, and vehicle data (speed, braking, steering wheel angle, lane tracking etc). Participants also completed a post trial cognitive task analysis interview. Extracts from the wider analyses are used to examine in depth driver behaviour at one of the rail level crossings encountered during the study. The analysis presented, along with the overall analysis undertaken, gives insight into the driver and wider systems factors that shape behaviour at rail level crossings, and highlights the utility of using a multi-method, instrumented vehicle approach for gathering data regarding driver behaviour in different contexts.

To err (on the road) is human? An on-road study of driver errors

Human error, its causes and consequences, and the ways in which it can be prevented, remain of great interest to road safety practitioners. This paper presents the findings derived from an on-road study of driver errors in which 25 participants drove a pre-determined route using MUARC's On-Road Test Vehicle (ORTeV). In-vehicle observers recorded the different errors made, and a range of other data was collected, including driver verbal protocols, forward, cockpit and driver video, and vehicle data (speed, braking, steering wheel angle, lane tracking etc). Participants also completed a post trial cognitive task analysis interview. The drivers tested made a range of different errors, with speeding violations, both intentional and unintentional, being the most common. Further more detailed analysis of a sub-set of specific error types indicates that driver errors have various causes, including failures in the wider road 'system' such as poor roadway design, infrastructure failures and unclear road rules. In closing, a range of potential error prevention strategies, including intelligent speed adaptation and road infrastructure design, are discussed.

Driver knowledge about road fatalities in Australia

The term “road toll” quantifies road deaths and attracts media attention, particularly during Easter/Christmas holiday periods. Since the media focuses considerable attention on this issue, we might expect that this would translate into awareness among drivers the number of people killed, which in turn, would hopefully encourage safer driving. Road safety professionals are cognisant of road toll trends but there is little information available to indicate awareness of road fatalities among the general population. This research investigated awareness of fatalities on Queensland and Australian roads among Queensland drivers.

Are you a mindful driver? A review of the potential explanatory value of mindfulness in predicting speeding behaviour

Mindfulness is a concept which has been widely used in studies on consciousness, but has recently been applied to the understanding of behaviours in other areas, including clinical psychology, meditation, physical activity, education and business. It has been suggested that mindfulness can also be applied to road safety, though this has not yet been researched. A standard definition of mindfulness is “paying attention in a particular way, on purpose in the present moment and non-judgemental to the unfolding of experience moment by moment” [1]. Scales have been developed to measure mindfulness; however, there are different views in the literature on the nature of the mindfulness construct. This paper reviews the issues raised in the literature and arrives at an operational definition of mindfulness considered relevant to road safety. It is further proposed that mindfulness is best construed as operating together with other psychosocial factors to influence road safety behaviours. The specific case of speeding behaviour is outlined, where the psychosocial variables in the Theory of Planned Behaviour (TPB) have been demonstrated to predict both intention to speed and actual speeding behaviour. A role is proposed for mindfulness in enhancing the explanatory and predictive powers of the TPB concerning speeding. The implications of mindfulness for speeding countermeasures are discussed and a program of future research is outlined.

Private supervisors of learner drivers and Queensland's graduated driver licensing system : how important are they?

Background: A key element of graduated driver licensing systems is the level of support provided by parents. In mid-2007 changes were made to Queensland’s graduated driver licensing system, including amendments to the learner licence with one of the more significant changes requiring learners to record 100 hours of supervised driving practice in a logbook. Prior to mid-2007, there was no minimum supervision requirement. Aims: The aim of this study was to document the experiences of the supervisors of Queensland learner drivers after the changes made to the graduated driver licensing system in mid-2007. Methods: The sample of 552 supervisors of learner drivers was recruited using a combination of convenience and snowball sampling techniques. The internet survey was open for completion between July 2009 and May 2010 and took approximately 15 to 20 minutes for participants to complete. Results: For 59.7 per cent of the participants, this was the first time that they had supervised a learner driver. For 63.2 per cent, they classified themselves as the main supervisor for the learner driver. Participants provided an average of 79.62 hours of supervision (sd = 92.38), while other private supervisors provided 34.89 hours of supervision (sd = 41.74) to the same learner and professional driving instructors 18.55 hours of supervision (sd = 27.54). The vast majority of supervisors recorded all or most of the practice that they provided their learner driver in their log book with most supervisors indicating that they believed that the hours recorded in the learner’s logbook were either accurate or very accurate. While many supervisors stated that they did not receive any advice regarding the supervision of learner drivers, some had received advice from others such as friends or through discussions with a professional driving instructor. Discussion and conclusions: While graduated driver licensing systems implicitly encourage the involvement of parents and other private supervisors, these people tend not to be systematically involved. As demonstrated in this study, private supervisors provide a significant amount of supervised practice and seek to record this practice accurately and honestly in the learner’s logbook. However, even though a significant number of participants reported that this was the first time that they had supervised a learner driver, they accessed little support or guidance for their role. This suggests a need to more overtly encourage and support the role of private supervisors for learner drivers.

Print media portrayals of giving : exploring national ‘cultures of philanthropy’

In their 2010 study drawing on 500 empirical philanthropy studies, Bekkers and Wiepking identified eight consistently significant giving mechanisms. The pilot study reported here extends what is known about one mechanism, values, as a giving driver, in particular considering how national cultural values apply to giving. Personal values are not formed in a vacuum. They are influenced by the wider culture and society: thus values have a socio-cultural dimension. Accordingly, this pilot research draws on media theory and cultural studies work on national ethos to explore how these national cultural values interact with giving. A directed qualitative content analysis has been undertaken to compare US and Australian print media coverage about philanthropy. The two nations share an Anglo–Saxon orientation but differ significantly in national character and philanthropic activity. This study posits that a nation's media coverage about giving will reflect its national cultural ethos. This coverage can also shape personal values, thus implications exist for theory about the antecedents of personal giving values. Wider national values may drive or stifle giving, so this wider view of values as a driver has implications also for philanthropy promotion and fundraising.

ACE research briefing paper 005: Global Entrepreneurship Monitor (GEM) - Australia 2011 National Report

This report maps the current state of entrepreneurship in Australia using data from the Global Entrepreneurship Monitor (GEM) for the year 2011. Entrepreneurship is regarded as a crucial driver for economic well-being. Entrepreneurial activity in new and established firms drives innovation and creates jobs. Entrepreneurs also fuel competition thereby contributing indirectly to market and productivity growth along with improving competitiveness of the national economy. Given the economic landscape that exists as a result of the global financial crisis (GFC), it is probably more important than ever for us to understand the effects and drivers of entrepreneurial activity and attitudes in Australia. The central finding of this report is that entrepreneurship is certainly alive and well in Australia. With 10.5 per cent of the adult population involved in setting up a new business or owning a newly founded business as measured by the total entrepreneurial activity rate (TEA) in 2011, Australia ranks second only to the United States among the innovation-driven (developed) economies. Compared with 2010 the TEA rate has increased by 2.7 percentage points. Furthermore, in regard to employee entrepreneurial activity (EEA) rate in established firms, Australia ranks above average. According to GEM data, 5 per cent of the adult population is engaged in developing or launching new products, a new business unit or subsidiary for their employer. Further analysis of the GEM data also clearly shows that Australia compares well with other major economies in terms of the ‘quality’ of entrepreneurial activities being pursued. Indeed, it is not only the quantity of entrepreneurs but also the level of their aspirations and business goals that are important drivers for economic growth. On average, for each business started in Australia driven by the lack of alternatives for the founder to generate income from any other source, there are five other businesses started where the founders specifically want to take advantage of a business opportunity that they believe will increase their personal income or independence. With respect to innovativeness, 31 per cent of Australian new businesses offer products or services which they consider to be new to customers or where very few, or in some cases no, other businesses offer the same product or service. Both these indicators are higher than the average for innovation-driven economies. Somewhat below average is the international orientation of Australian entrepreneurs whereby only 12 per cent aim at having a substantial share of customers from international markets. So what drives this high quantity and quality of entrepreneurship in Australia? The analysis of the data suggests it is a combination of both business opportunities and entrepreneurial skills. It seems that around 50 per cent of the Australian population identify opportunities for a start-up venture and believe that they have the necessary skills to start a business. Furthermore, a large majority of the Australian population report that high media attention for entrepreneurship provides successful role models for prospective entrepreneurs. As a result, 12 per cent of our respondents have expressed the intention to start a business within the next three years. These numbers are all well above average when compared to the other major economies. With regard to gender, the GEM survey shows a high proportion of female entrepreneurs. Approximately 8.4 per cent of adult females are actually involved in setting up a business or have recently done so. Although this female TEA rate is slightly down from 2010, Australia ranks second among the innovation-driven economies. This paints a healthy picture of access to entrepreneurial opportunities for Australian women.

The impact of an enhanced graduated driver licensing program in Queensland

The Queensland graduated driver licensing (GDL) context (post-July 2007) - The experiences of young Learner drivers - Comparison of pre- (‘Original-GDL’) and post-July 2007 (‘Enhanced-GDL’) experiences - Post-July 2007 experiences - GDL-related issues - Other factors in young novice driver safety - Person-related factors - Social factors

Culture as a driver of entrepreneurship : contrasting independent entrepreneurship versus employee entrepreneurship

Principal Topic Counties in Northern Europe, such as Sweden, Finland and Denmark, have comparatively low per capita rates of entrepreneurship as measured by independent new venture start-up rates – as for example measured by the Global Entrepreneurship Monitor (GEM) Total entrepreneurial activity (TEA) rate. However, the latest 2011 GEM data reveals that these same countries have comparatively very high Employee Entrepreneurship Activity (EEA) rates – that is a high rate per capita of employees involved in new product development or new enterprise activities. This observation has prompted us to investigate the role of national culture in driving independent versus employee entrepreneurial activities. Prior research has established that national (and regional) culture plays an important role in forming an “entrepreneurial culture” that encourages (or discourages) independent business start-ups and TEA (e.g. Davidsson, 1995; Beugelsdijk, 2007). However, the relationship of culture and EEA has not received research attention. Moreover, empirical relationships between elements of national culture and independent entrepreneurship have revealed some surprising results. For example, Wildeman et al. (1999) report an unexpected higher share of individual business ownership in countries that have higher uncertainty avoidance, higher power distance and lower individualism according to Hofstede’s dimensions of culture. They speculate that dissatisfaction can be a source of entrepreneurship: in countries with a high power distance, a high uncertainty avoidance and low individualism, there may be relatively more business owners since enterprising individuals cannot satisfy their needs within existing organizations. Yet it remains a rather open question whether entrepreneurial behaviour in existing organisations provides a satisfactory explanation for these empirical findings. Methods We will conduct a cross sectional study of the influence of national culture according to the five / six dimensions of Hofstede (1980; 2001) on both TEA and EEA for the 54 countries that participated in GEM 2011. Since it is well established that the opportunities for entrepreneurship vary substantially with a country’s level of economic development, we intend to conduct separate analyses for the three categories of development – innovation driven economies, efficient driven economies and factor driven economies. We also intend to restrict our assessment of TEA to opportunity driven entrepreneurship, as necessity driven entrepreneurship has a different relationship to the “entrepreneurial culture” that is the focus of our study. We will control for a range of factors such as GDP growth, ease of doing business index and unemployment. Results and Implications Descriptive analyses of the GEM TEA and EEA data reveal clusters of countries that appear to be have similar national culture. We are yet to conduct regression analyses.

Localising national identity : Albany's Anzacs

Local representations of the significance of Albany, Western Australia, in the first world war and of the city's part in the birth of Anzac register substantial points of departure from national histories. While both the Anzac mythos and official renderings of Australia's wars are vigorously contested, Albany's reformulation offers a clear example of the ways in which communities actively inflect national narratives to create expressions of differentiated local identity. This article explores the relationship between the national and the local by focusing on the local narrative of the massing and departure of'The Great Anzac Convoy' in King George Sound in 1914. Particular attention is given to the way Albany has been able to appropriate and localise this event and the origins of Anzac, consequently promoting itself as an important element of the national identity, from which it nevertheless remains distinct. This localisation of an important element of national identity confers cultural standing and a potentially empowered position in relation to this national identity.

The arts and Australia's national innovation system 1994 - 2008 arguments, recommendations, challenges

Based on 15 years of arts and innovation literature, this paper explores the central proposition that the arts sector - particularly the performing arts, visual arts and crafts, new media arts and creative writing - should be included in Australian Government innovation policy development and play a significant role in national innovation. After a brief overview of innovation policy and the national innovation systems approach in Australia, we examine the marginal place of the arts in Australia's innovation agenda and various attempts to include them. We identify the principal voices that have argued for arts and innovation development: the humanities, arts and social sciences (HASS) sector, digital content industries, arts education and university research, and new media arts. After three main periods of arts and innovation policy activity from the mid.1990s (when the importance of innovation as a key driver of Australia's prosperity was recognised) to early 2008, a fourth period has opened up as part of the Australian Government's Review of the National Innovation System in 2008.