Dengue fever viral exposure rates among blood donors during outbreaks in North Queensland

Introduction: Dengue poses a problem for safe transfusion of blood components with confirmed reports of transfusion-transmission in Hong Kong and Singapore. The largest outbreak in 50 years occurred in North Queensland during 2008/2009 with more than 1,000 confirmed cases in Cairns and Townsville. During this outbreak, supplementary questioning for all donors was implemented, and fresh components were not manufactured from at risk donors. We aim to determine the seroprevalence of dengue exposure in this population during this epidemic. Methods: Samples were collected from blood donors during the 2008/2009 epidemic and 3 months after the last confirmed case. These samples were tested for anti-Dengue IgM, IgG and NS1 antigen with commercially available ELISA based assay kits from PanBio. Results: Initial analyses revealed 2.7% of samples from deferred donors were IgM repeat reactive. Of these, 16% were also positive for anti-dengue IgG, while none of these were positive for the NS1 viral antigen. However, two NS1 positives were found in samples collected from deferred donors. Conclusions: This initial analysis represents recent and cumulative past exposure in a presumed asymptomatic population, and will provide documentation of the rate of asymptomatic dengue infection during the epidemic. This data can also be used to assess the risk of dengue becoming endemic in North Queensland given that the mosquito vector is established in this region.

The role of nurse educators in student clinical education in Saudi Arabia

Introduction: Clinical education is considered a significant part of the learning process for nursing students. There is, however, no research that has explored this area of learning in Saudi Arabia. Theoretical Framework: Informed by a symbolic interactionist framework, this research explored the role of nurse educators in student clinical education in Saudi Arabia. Method: Using Glaserian grounded theory methods the data were derived from 14 face-to-face interviews with nurse educators from both hospital and faculty settings in King Abdu-Aziz University (KAU) and King Abdu-Aziz University Hospital (KAUH). Findings: The findings of the research are represented in the core category Redefining Identity Work and its two constituent categories Questioning the Situation and Creating Role Identity. The core and sub- categories were generated through a theoretical exploration of the identity work of nurse educators in Saudi Arabia. Conclusion: The social identity of the nurse educators was mediated culturally and socially within the hospital and university contexts and Saudi Arabian culture. In light of an increased understanding of the identity and role of nurse educators in clinical education in Saudi Arabia, the research presents implications and recommendations that may contribute to the development of nursing education as a coherent health care profession that is perceived as a desirable career option for Saudi women and men.

Environmental sustainability of urban road transport : an integrated analysis for life cycle emission impact

Despite of significant contributions of urban road transport to global economy and society, it is one of the largest sources of local and global emission impact. In order to address the environmental concerns of urban road transport it is imperative to achieve a holistic understanding of contributory factors causing emissions which requires a complete look onto its whole life cycle. Previous studies were mainly based on segmental views which mostly studied environmental impacts of individual transport modes and very few considered impacts other than operational phase. This study develops an integrated life cycle inventory model for urban road transport emissions from a holistic modal perspective. Singapore case was used to demonstrate the model. Results show that total life cycle greenhouse gas emission from Singapore’s road transport sector is 7.8 million tons per year. The total amount of criteria air pollutants are also estimated in this study.

A pre-post evaluation of an ambulatory nutrition support service for malnourished patients post hospital discharge: a pilot study

Introduction Malnutrition is common among hospitalised patients, with poor follow-up of nutrition support post-discharge. Published studies on the efficacy of ambulatory nutrition support (ANS) for malnourished patients post-discharge are scarce. The aims of this study were to evaluate the rate of dietetics follow-up of malnourished patients post-discharge, before (2008) and after (2010) implementation of a new ANS service, and to evaluate nutritional outcomes post-implementation. Materials and Methods Consecutive samples of 261 (2008) and 163 (2010) adult inpatients referred to dietetics and assessed as malnourished using Subjective Global Assessment (SGA) were enrolled. All subjects received inpatient nutrition intervention and dietetic outpatient clinic follow-up appointments. For the 2010 cohort, ANS was initiated to provide telephone follow-up and home visits for patients who failed to attend the outpatient clinic. Subjective Global Assessment, body weight, quality of life (EQ-5D VAS) and handgrip strength were measured at baseline and five months post-discharge. Paired t-test was used to compare pre- and post-intervention results. Results In 2008, only 15% of patients returned for follow-up with a dietitian within four months post-discharge. After implementation of ANS in 2010, the follow-up rate was 100%. Mean weight improved from 44.0 ± 8.5kg to 46.3 ± 9.6kg, EQ-5D VAS from 61.2 ± 19.8 to 71.6 ± 17.4 and handgrip strength from 15.1 ± 7.1 kg force to 17.5 ± 8.5 kg force; p<0.001 for all. Seventy-four percent of patients improved in SGA score. Conclusion Ambulatory nutrition support resulted in significant improvements in follow-up rate, nutritional status and quality of life of malnourished patients post-discharge.

The need for legislative reform of the privity doctrine in commercial contracts in Malaysia : a comparative analysis

This thesis commences with the proposition that the first limb of the doctrine of privity causes injustice to third party beneficiaries in Malaysia, particularly in commercial contracts. The doctrine of privity has been the subject of criticism by the judiciary and academic commentators in common law jurisdictions, mainly directed at the first limb of the doctrine, whereby only parties to a contract can sue and be sued. The first limb prevents a third party from enforcing benefits conferred on them by those contracts thereby resulting in third parties suffering loss and injustice to those parties. In several common law countries, such as England, Australia, New Zealand and Singapore, legislative reform of the doctrine has occurred. The legislative reform has abrogated to a significant extent the doctrine of privity in commercial contracts. Malaysia is a common law country, where the doctrine of privity is still applied to contracts. An analysis of Malaysian case law demonstrates that the most affected third party beneficiaries are those seeking to enforce insurance and construction contracts. While a small number of other third parties to commercial contracts, such as agreements to pay for work done, sale and purchase agreements and tenancy agreements are also affected, the detriment is not as significant. As a consequence, this thesis focuses primarily on the impact of the doctrine of privity on commercial contracts in the areas of insurance and construction in Malaysia The thesis aims to recommend appropriate reforms to address the injustices arising from the privity doctrine for third parties seeking to obtain the benefit of insurance and construction contracts, which may also benefit third parties to other types of commercial contracts. While the Malaysian insurance, consumer protection, negotiable instruments and agency laws allow third party beneficiaries to enforce benefits in contracts, the rights are found to be inadequate. As not all third parties seeking to enforce an insurance or construction contract can rely upon the legislation, the injustice arising from the doctrine of privity remains and needs to be addressed. To achieve this aim, a comparative analysis of the rights of third party beneficiaries under insurance and construction contracts in Malaysia, Australia and England is undertaken. The results of the analysis are used to identify appropriate elements for a legislative framework guided by the three essential criteria for effective law reform developed in the thesis. The three criteria are certainty, public interest and justice. The thesis recommends first the enactment of general legislation applicable to all commercial contracts including insurance contracts. Secondly, the thesis recommends specific targeted legislation to address the injustice faced by third party beneficiaries in construction contracts.

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.

Evaluation of an ambulatory nutrition support service for malnourished patients post hospital discharge

Introduction Malnutrition is common among hospitalised patients, with poor follow-up of nutrition support post-discharge. Published studies on the efficacy of ambulatory nutrition support (ANS) for malnourished patients post-discharge are scarce. The aims of this study were to evaluate the rate of dietetics follow-up of malnourished patients post-discharge, before (2008) and after (2010) implementation of a new ANS service, and to evaluate nutritional outcomes post-implementation. Materials and Methods Consecutive samples of 261 (2008) and 163 (2010) adult inpatients referred to dietetics and assessed as malnourished using Subjective Global Assessment (SGA) were enrolled. All subjects received inpatient nutrition intervention and dietetic outpatient clinic follow-up appointments. For the 2010 cohort, ANS was initiated to provide telephone follow-up and home visits for patients who failed to attend the outpatient clinic. Subjective Global Assessment, body weight, quality of life (EQ-5D VAS) and handgrip strength were measured at baseline and five months post-discharge. Paired t-test was used to compare pre- and post-intervention results. Results In 2008, only 15% of patients returned for follow-up with a dietitian within four months post-discharge. After implementation of ANS in 2010, the follow-up rate was 100%. Mean weight improved from 44.0 ± 8.5kg to 46.3 ± 9.6kg, EQ-5D VAS from 61.2 ± 19.8 to 71.6 ± 17.4 and handgrip strength from 15.1 ± 7.1 kg force to 17.5 ± 8.5 kg force; p<0.001 for all. Seventy-four percent of patients improved in SGA score. Conclusion Ambulatory nutrition support resulted in significant improvements in follow-up rate, nutritional status and quality of life of malnourished patients post-discharge.

Parametric modelling for the efficient design of daylight strategies with complex geometries

Daylight devices are important components of any climate responsive façade system. But, the evolution of parametric CAD systems and digital fabrication has had an impact on architectural form so that regular forms are shifting to complex geometries. Architectural and engineering integration of daylight devices in envelopes with complex geometries is a challenge in terms of design and performance evaluation. The purpose of this paper is to assess daylight performance of a building with a climatic responsive envelope with complex geometry that integrates shading devices in the façade. The case study is based on the Esplanade buildings in Singapore. Climate-based day-light metrics such as Daylight Availability and Useful Daylight Illuminance are used. DIVA (daylight simulation), and Grasshopper (parametric analysis) plug-ins for Rhinoceros have been employed to examine the range of performance possibilities. Parameters such as dimension, inclination of the device, projected shadows and shape have been changed in order to maximize daylight availability and Useful Daylight Illuminance while minimizing glare probability. While orientation did not have a great impact on the results, aperture of the shading devices did, showing that shading devices with a projection of 1.75 m to 2.00 m performed best, achieving target lighting levels without issues of glare.

Children’s accommodation during reading of Chinese and English texts

Purpose: Inaccurate accommodation during nearwork and subsequent accommodative hysteresis may influence myopia development. Myopia is highly prevalent in Singapore; an untested theory is that Chinese children are prone to these accommodation characteristics. We measured the accuracy of accommodation responses during and nearwork-induced transient myopia (NITM) after periods spent reading Chinese and English texts. Methods: Refractions of 40 emmetropic and 43 myopic children were measured with a free-space autorefractor for four reading tasks of 10-minute durations: Chinese (SimSun, 10.5 points) and English (Times New Roman, 12 points) texts at 25 cm and 33 cm. Accuracy was obtained by subtracting accommodation response from accommodation demand. Nearwork-induced transient myopia was obtained by subtracting pretask distance refraction from posttask refraction, and regression was determined as the time for the posttask refraction to return to pretask levels. Results: There were significant, but small, effects of text type (Chinese, 0.97 ± 0.32 diopters [D] vs. English, 1.00 ± 0.37 D; F1,1230 = 7.24, p = 0.007) and reading distance (33 cm, 1.01 ± 0.30 D vs. 25 cm, 0.97 ± 0.39 D; F1,1230 = 7.74, p = 0.005) on accommodation accuracy across all participants. Accuracy was similar for emmetropic and myopic children across all reading tasks. Neither text type nor reading distance had significant effects on NITM or its regression. Myopes had greater NITM (by 0.07 D) (F1,81 = 5.05, p = 0.03) that took longer (by 50s) (F1,81 = 31.08, p < 0.01) to dissipate. Conclusions: Reading Chinese text caused smaller accommodative lags than reading English text, but the small differences were not clinically significant. Myopic children had significantly greater NITM and longer regression than emmetropic children for both texts. Whether differences in NITM are a cause or consequence of myopia cannot be answered from this study.

Heritage & habitus : designing to support situated, living knowledge

We refer to an ongoing endeavour aimed to assist Indigenouscommunities in Australian in persisting their personal and cultural memories linked to temporally dynamic interactions in situ. The design enables Indigenous users to upload items they collect themselves (e.g. photographs, audio, video) using mobile phones,in their traditional lands into a topographical simulation; and, thento associate these items with their own hand-drawn markings inthe simulation. The design responds to the rich interconnectedness between Indigenous culture and the land and the need to converge spatial information technologies with practices that are not, inherently, conditioned by the geometries of the West. We propose that the design approach contributes to thinking about ways that mobile guides can respond to multiple realities and corporeal and affective phenomena.

Segmental torso masses and joint torques produced by gravity in the adolescent scoliotic spine

Introduction Calculating segmental torso masses in Adolescent Idiopathic Scoliosis (AIS) patients allows the gravitational loading on the scoliotic spine during relaxed standing to be estimated. Methods Low dose CT data was used to calculate vertebral level-by-level torso masses and spinal joint torques for 20 female AIS patients (mean age 15.0 ± 2.7 years, mean Cobb angle 53 ± 7.1°). ImageJ software (v1.45 NIH USA) was used to threshold the T1 to L5 CT images and calculate the segmental torso volume and mass for each vertebral level. Masses for the head, neck and arms were taken from published data.1 Intervertebral joint torques in the coronal and sagittal planes at each vertebral level were found from the position of the centroid of the segment masses relative to the joint centres (assumed to be at the centre of the intervertebral disc). The joint torque at each level was found by summing torque contributions for all segments above that joint. Results Segmental torso mass increased from 0.6kg at T1 to 1.5kg at L5. The coronal plane joint torques due to gravity were 5-7Nm at the apex of the curve; sagittal torques were 3-5.4Nm. Conclusion CT scans were in the supine position and curve magnitudes are known to be smaller than those in standing.2 Hence, this study has shown that gravity produces joint torques potentially of higher than 7Nm in the coronal plane and 5Nm in the sagittal plane during relaxed standing in scoliosis patients. The magnitude of these torques may help to explain the mechanics of AIS progression and the mechanics of bracing. This new data on torso segmental mass in AIS patients will assist biomechanical models of scoliosis.

A methodological framework for benchmarking smart transport cities

Besides responding to challenges of rapid urbanization and growing traffic congestion, the development of smart transport systems has attracted much attention in recent times. Many promising initiatives have emerged over the years. Despite these initiatives, there is still a lack of understanding about an appropriate definition of smart transport system. As such, it is challenging to identify the appropriate indicators of ‘smartness’. This paper proposes a comprehensive and practical framework to benchmark cities according to the smartness in their transportation systems. The proposed methodology was illustrated using a set of data collected from 26 cities across the world through web search and contacting relevant transport authorities and agencies. Results showed that London, Seattle and Sydney were among the world’s top smart transport cities. In particular, Seattle and Paris ranked high in smart private transport services while London and Singapore scored high on public transport services. London also appeared to be the smartest in terms of emergency transport services. The key value of the proposed innovative framework lies in a comparative analysis among cities, facilitating city-to-city learning.

Redistribution and technology adoption under uncertainty : a political economy perspective

We examine the role of politico-economic influences on macroeconomic performance within the framework of an endogenous growth model with costly technology adoption and uncertainty. The model is aimed at understanding the diversity in growth and inequality experiences across countries. Agents adopt either of two risky technologies, one of which is only available through financial intermediaries, who are able to alleviate some of this risk. The entry cost of financial intermediation depends on the proportion of government revenue that is allocated towards cost-reducing financial development expenditure, and agents vote on this proportion. The results show that agents at the top and bottom ends of the distribution prefer alternative means of re-distribution, thereby effectively blocking the allocation of resources towards cost-reducing financial development expenditure. Thus political factors have a role in delaying financial and capital deepening and economic development. Furthermore, the model provides a political-economy perspective on the Kuznets curve; uncertainty interacts with the political economy mechanism to produce transitional inequality patterns that, depending on initial conditions, can unearth the Kuznets-curve experience. Finally, the political outcomes are inefficient relative to policies aimed at maximizing the collective welfare of agents in the economy.