Probiotics and diarrhoea management in enterally tube fed critically ill patients : what is the evidence?

Objective: The aim of this literature review is to identify the role of probiotics in the management of enteral tube feeding (ETF) diarrhoea in critically ill patients.---------- Background: Diarrhoea is a common gastrointestinal problem seen in ETF patients. The incidence of diarrhoea in tube fed patients varies from 2% to 68% across all patients. Despite extensive investigation, the pathogenesis surrounding ETF diarrhoea remains unclear. Evidence to support probiotics to manage ETF diarrhoea in critically ill patients remains sparse.---------- Method: Literature on ETF diarrhoea and probiotics in critically ill, adult patients was reviewed from 1980 to 2010. The Cochrane Library, Pubmed, Science Direct, Medline and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) electronic databases were searched using specific inclusion/exclusion criteria. Key search terms used were: enteral nutrition, diarrhoea, critical illness, probiotics, probiotic species and randomised clinical control trial (RCT).---------- Results: Four RCT papers were identified with two reporting full studies, one reporting a pilot RCT and one conference abstract reporting an RCT pilot study. A trend towards a reduction in diarrhoea incidence was observed in the probiotic groups. However, mortality associated with probiotic use in some severely and critically ill patients must caution the clinician against its use.---------- Conclusion: Evidence to support probiotic use in the management of ETF diarrhoea in critically ill patients remains unclear. This paper argues that probiotics should not be administered to critically ill patients until further research has been conducted to examine the causal relationship between probiotics and mortality, irrespective of the patient's disease state or projected prophylactic benefit of probiotic administration.

Asset identification : addressing the climate change in public asset management process

Climate change is becoming increasingly apparent that is largely caused by human activities such as asset management processes, from planning to disposal, of property and infrastructure. One essential component of asset management process is asset identification. The aims of the study are to identify the information needed in asset identification and inventory as one of public asset management process in addressing the climate change issue; and to examine its deliverability in developing countries’ local governments. In order to achieve its aims, this study employs a case study in Indonesia. This study only discusses one medium size provincial government in Indonesia. The information is gathered through interviews of the local government representatives in South Sulawesi Province, Indonesia and document analysis provided by interview participants. The study found that for local government, improving the system in managing their assets is one of emerging biggest challenge. Having the right information in the right place and at the right time are critical factors in response to this challenge. Therefore, asset identification as the frontline step in public asset management system is holding an important and critical role. Furthermore, an asset identification system should be developed to support the mainstream of adaptation to climate change vulnerability and to help local government officers to be environmentally sensitive. Finally, findings from this study provide useful input for the policy makers, scholars and asset management practitioners to develop an asset inventory system as a part of public asset management process in addressing the climate change.

The application of public asset management in Indonesian local government : a case study in South Sulawesi Province

Purpose To identify the challenges faced by local government in Indonesia when adopting a Public Asset Management Framework. Design A Case Study in South Sulawesi Provincial Government was used as the approach to achieving the research objective. The case study involved two data collection techniques - interviews and document analysis. Findings The result of the study indicates there are significant challenges that the Indonesian local government need to manage when adopting a public asset management framework. Those challenges are: absence of an institutional and legal framework to support the asset management application; non-profit principle of public assets; multiple jurisdictions involved in the public asset management processes; the complexity of local government objectives; unavailability of data for managing public property; and limited human resources. Research Limitation This research is limited to one case study. It is a preliminary study from larger research that uses multiple case studies. The main research also investigates opportunities for local government by adopting and implementing public asset management. Originality/Value Findings from this study provide useful input for the policy makers, academics and asset management practitioners in Indonesia to establish a public asset management framework resulting in efficient and effective organizations, as well as an increase of public services quality. This study has a potential application for other developing countries.

Sustainable urban infrastructure management : integration of urban computer modelling

Purpose - This paper seeks to examine the complex relationships between urban planning, infrastructure management, sustainable urban development, and to illustrate why there is an urgent need for local governments to develop a robust planning support system which integrates with advance urban computer modelling tools to facilitate better infrastructure management and improve knowledge sharing between the community, urban planners, engineers and decision makers. Design/methodology/approach - The methods used in this paper includes literature review and practical project case observations. Originality/value - This paper provides an insight of how the Brisbane's planning support system established by Brisbane City Council has significantly improved the effectiveness of urban planning, infrastructure management and community engagement through better knowledge management processes. Practical implications - This paper presents a practical framework for setting up a functional planning support system within local government. The integration of the Brisbane Urban Growth model, Virtual Brisbane and the Brisbane Economic Activity Monitoring (BEAM) database have proven initially successful to provide a dynamic platform to assist elected officials, planners and engineers to understand the limitations of the local environment, its urban systems and the planning implications on a city. With the Brisbane's planning support system, planners and decision makers are able to provide better planning outcomes, policy and infrastructure that adequately address the local needs and achieve sustainable spatial forms.

Proactive communication management beats hostile media exposure : training for multi-cultural community leaders in living with mass media

Proactive communication management instead of mortification in the glare of hostile media attention became the theme of a four-day training program for multi-cultural community leaders, the object of this research. The program in Brisbane from December 2009 through to February this year was conducted under auspices of a Community Media Link grant program shared by Griffith University and the Queensland Ethnic Communities Council, together with Journalism academics from the Queensland University of Technology. Twenty-eight participants from 23 organisations took part, with a team of nine facilitators from the host organisations, and guest presenters from the news media. This paper reviews the process, taking into account: its objectives, to empower participants by showing how Australian media operate and introducing participants to journalists; pedagogical thrust, where overview talks, with role play seminars with guest presenters from the media, were combined with practice in interviews and writing for media; and outcomes, assessed on the basis of participants’ responses. The research methodology is qualitative, in that the study is based on discussions to review the planning and experience of sessions, and anonymous, informal feed-back questionnaires distributed to the participants. Background literature on multiculturalism and community media was referred to in the study. The findings indicate positive outcomes for participants from this approach to protection of persons unversed in living in the Australian “mediatised” environment. Most affirmed that the “production side” perspective of the exercise had informed and motivated them effectively, such that henceforth they would venture far more into media management, in their community leadership roles.

Empirical comparison of machine learning algorithms for image texture classification with application to vegetation management in power line corridors

This paper reports on the empirical comparison of seven machine learning algorithms in texture classification with application to vegetation management in power line corridors. Aiming at classifying tree species in power line corridors, object-based method is employed. Individual tree crowns are segmented as the basic classification units and three classic texture features are extracted as the input to the classification algorithms. Several widely used performance metrics are used to evaluate the classification algorithms. The experimental results demonstrate that the classification performance depends on the performance matrix, the characteristics of datasets and the feature used.

Advances in vegetation management for power line corridor monitoring using aerial remote sensing techniques

This paper presents a comprehensive discussion of vegetation management approaches in power line corridors based on aerial remote sensing techniques. We address three issues 1) strategies for risk management in power line corridors, 2) selection of suitable platforms and sensor suite for data collection and 3) the progress in automated data processing techniques for vegetation management. We present initial results from a series of experiments and, challenges and lessons learnt from our project.

Knowledge management competence for Enterprise System success

This study conceptualizes, operationalises and validates the concept of Knowledge Management Competence as a four-phase multidimensional formative index. Employing survey data from 310 respondents representing 27 organizations using the SAP Enterprise System Financial module, the study results demonstrate a large, significant, positive relationship between Knowledge Management Competence and Enterprise Systems Success (ES-success, as conceived by Gable Sedera and Chan (2008)); suggesting important implications for practice. Strong evidence of the validity of Knowledge Management Competence as conceived and operationalised, too suggests potential from future research evaluating its relationships with possible antecedents and consequences.

Enhancing agrobacterium-mediated transformation efficiency of sugarcane : progress towards an efficient, genotype-independent method

Several key issues need to be resolved before an efficient and reproducible Agrobacterium-mediated sugarcane transformation method can be developed for a wider range of sugarcane cultivars. These include loss of morphogenetic potential in sugarcane cells after Agrobacterium-mediated transformation, effect of exposure to abiotic stresses during in vitro selection, and most importantly the hypersensitive cell death response of sugarcane (and other nonhost plants) to Agrobacterium tumefaciens. Eight sugarcane cultivars (Q117, Q151, Q177, Q200, Q208, KQ228, QS94-2329, and QS94-2174) were evaluated for loss of morphogenetic potential in response to the age of the culture, exposure to Agrobacterium strains, and exposure to abiotic stresses during selection. Corresponding changes in the polyamine profiles of these cultures were also assessed. Strategies were then designed to minimize the negative effects of these factors on the cell survival and callus proliferation following Agrobacterium-mediated transformation. Some of these strategies, including the use of cell death protector genes and regulation of intracellular polyamine levels, will be discussed.

Strengthening and formally verifying privacy in identity management systems

In a digital world, users’ Personally Identifiable Information (PII) is normally managed with a system called an Identity Management System (IMS). There are many types of IMSs. There are situations when two or more IMSs need to communicate with each other (such as when a service provider needs to obtain some identity information about a user from a trusted identity provider). There could be interoperability issues when communicating parties use different types of IMS. To facilitate interoperability between different IMSs, an Identity Meta System (IMetS) is normally used. An IMetS can, at least theoretically, join various types of IMSs to make them interoperable and give users the illusion that they are interacting with just one IMS. However, due to the complexity of an IMS, attempting to join various types of IMSs is a technically challenging task, let alone assessing how well an IMetS manages to integrate these IMSs. The first contribution of this thesis is the development of a generic IMS model called the Layered Identity Infrastructure Model (LIIM). Using this model, we develop a set of properties that an ideal IMetS should provide. This idealized form is then used as a benchmark to evaluate existing IMetSs. Different types of IMS provide varying levels of privacy protection support. Unfortunately, as observed by Jøsang et al (2007), there is insufficient privacy protection in many of the existing IMSs. In this thesis, we study and extend a type of privacy enhancing technology known as an Anonymous Credential System (ACS). In particular, we extend the ACS which is built on the cryptographic primitives proposed by Camenisch, Lysyanskaya, and Shoup. We call this system the Camenisch, Lysyanskaya, Shoup - Anonymous Credential System (CLS-ACS). The goal of CLS-ACS is to let users be as anonymous as possible. Unfortunately, CLS-ACS has problems, including (1) the concentration of power to a single entity - known as the Anonymity Revocation Manager (ARM) - who, if malicious, can trivially reveal a user’s PII (resulting in an illegal revocation of the user’s anonymity), and (2) poor performance due to the resource-intensive cryptographic operations required. The second and third contributions of this thesis are the proposal of two protocols that reduce the trust dependencies on the ARM during users’ anonymity revocation. Both protocols distribute trust from the ARM to a set of n referees (n > 1), resulting in a significant reduction of the probability of an anonymity revocation being performed illegally. The first protocol, called the User Centric Anonymity Revocation Protocol (UCARP), allows a user’s anonymity to be revoked in a user-centric manner (that is, the user is aware that his/her anonymity is about to be revoked). The second protocol, called the Anonymity Revocation Protocol with Re-encryption (ARPR), allows a user’s anonymity to be revoked by a service provider in an accountable manner (that is, there is a clear mechanism to determine which entity who can eventually learn - and possibly misuse - the identity of the user). The fourth contribution of this thesis is the proposal of a protocol called the Private Information Escrow bound to Multiple Conditions Protocol (PIEMCP). This protocol is designed to address the performance issue of CLS-ACS by applying the CLS-ACS in a federated single sign-on (FSSO) environment. Our analysis shows that PIEMCP can both reduce the amount of expensive modular exponentiation operations required and lower the risk of illegal revocation of users’ anonymity. Finally, the protocols proposed in this thesis are complex and need to be formally evaluated to ensure that their required security properties are satisfied. In this thesis, we use Coloured Petri nets (CPNs) and its corresponding state space analysis techniques. All of the protocols proposed in this thesis have been formally modeled and verified using these formal techniques. Therefore, the fifth contribution of this thesis is a demonstration of the applicability of CPN and its corresponding analysis techniques in modeling and verifying privacy enhancing protocols. To our knowledge, this is the first time that CPN has been comprehensively applied to model and verify privacy enhancing protocols. From our experience, we also propose several CPN modeling approaches, including complex cryptographic primitives (such as zero-knowledge proof protocol) modeling, attack parameterization, and others. The proposed approaches can be applied to other security protocols, not just privacy enhancing protocols.

Effect of group formation on performance, task management and social loafing

Engineering graduates of today are required to adapt to a rapidly changing work environment. In particular, they are expected to demonstrate enhanced capabilities in both mono-disciplinary and multi-disciplinary teamwork environments. Engineering education needs, as a result, to further focus on developing group work capabilities amongst engineering graduates. Over the last two years, the authors trialed various group work strategies across two engineering disciplines. In particular, the effect of group formation on students' performance, task management, and social loafing was analyzed. A recently developed online teamwork management tool, Teamworker, was used to collect students' experience of the group work. Analysis showed that students who were allowed to freely allocate to any group were less likely to report loafing from other team members, than students who were pre-allocated to a group. It also showed that performance was more affected by the presence or absence of a leader in pre-allocated rather than free-allocated groups.

Differences in Treatment and Management of Indigenous and Non-Indigenous Patients Presenting with Chest Pain: Results of the Heart Protection Partnership (HPP) Study

BACKGROUND: Indigenous patients with acute coronary syndromes represent a high-risk group. There are however few contemporary datasets addressing differences in the presentation and management of Indigenous and non-Indigenous patients with chest pain. METHODS: The Heart Protection Project, is a multicentre retrospective audit of consecutive medical records from patients presenting with chest pain. Patients were identified as Indigenous or non-Indigenous, and time to presentation and cardiac investigations as well as rates of cardiac investigations and procedures were compared between the two groups. RESULTS: Of the 2380 patients included, 199 (8.4%) identified as Indigenous, and 2174 (91.6%) as non-Indigenous. Indigenous patients were younger, had higher rates hyperlipidaemia, diabetes, smoking, known coronary artery disease and a lower rate of prior PCI; and were significantly less likely to have private health insurance, be admitted to an interventional facility or to have a cardiologist as primary physician. Following adjustment for difference in baseline characteristics, Indigenous patients had comparable rates of cardiac investigations and delay times to presentation and investigations. CONCLUSIONS: Although the Indigenous population was identified as a high-risk group, in this analysis of selected Australian hospitals there were no significant differences in treatment or management of Indigenous patients in comparison to non-Indigenous.

Business Process Quality Management

Process modeling is a central element in any approach to Business Process Management (BPM). However, what hinders both practitioners and academics is the lack of support for assessing the quality of process models – let alone realizing high quality process models. Existing frameworks are highly conceptual or too general. At the same time, various techniques, tools, and research results are available that cover fragments of the issue at hand. This chapter presents the SIQ framework that on the one hand integrates concepts and guidelines from existing ones and on the other links these concepts to current research in the BPM domain. Three different types of quality are distinguished and for each of these levels concrete metrics, available tools, and guidelines will be provided. While the basis of the SIQ framework is thought to be rather robust, its external pointers can be updated with newer insights as they emerge.

Business process management education in academia: Status, challenges, and recommendations

In response to the growing proliferation of Business Process Management (BPM) in industry and the demand this creates for BPM expertise, universities across the globe are at various stages of incorporating knowledge and skills in their teaching offerings. However, there are still only a handful of institutions that offer specialized education in BPM in a systematic and in-depth manner. This article is based on a global educators’ panel discussion held at the 2009 European Conference on Information Systems in Verona, Italy. The article presents the BPM programs of five universities from Australia, Europe, Africa, and North America, describing the BPM content covered, program and course structures, and challenges and lessons learned. The article also provides a comparative content analysis of BPM education programs illustrating a heterogeneous view of BPM. The examples presented demonstrate how different courses and programs can be developed to meet the educational goals of a university department, program, or school. This article contributes insights on how best to continuously sustain and reshape BPM education to ensure it remains dynamic, responsive, and sustainable in light of the evolving and ever-changing marketplace demands for BPM expertise.

Which components of heart failure programs are effective? A meta-analysis of the outcomes of structured telephone support or telemonitoring as the primary component of heart failure management in 9,560 patients (Abridged Cochrane Review)

Aims--Telemonitoring (TM) and structured telephone support (STS) have the potential to deliver specialised management to more patients with chronic heart failure (CHF), but their efficacy is still to be proven. Objectives To review randomised controlled trials (RCTs) of TM or STS on all- cause mortality and all-cause and CHF-related hospitalisations in patients with CHF, as a non-invasive remote model of specialised disease-management intervention.--Methods and Results--Data sources:We searched 15 electronic databases and hand-searched bibliographies of relevant studies, systematic reviews, and meeting abstracts. Two reviewers independently extracted all data. Study eligibility and participants: We included any randomised controlled trials (RCT) comparing TM or STS to usual care of patients with CHF. Studies that included intensified management with additional home or clinic visits were excluded. Synthesis: Primary outcomes (mortality and hospitalisations) were analysed; secondary outcomes (cost, length of stay, quality of life) were tabulated.--Results: Thirty RCTs of STS and TM were identified (25 peer-reviewed publications (n=8,323) and five abstracts (n=1,482)). Of the 25 peer-reviewed studies, 11 evaluated TM (2,710 participants), 16 evaluated STS (5,613 participants) and two tested both interventions. TM reduced all-cause mortality (risk ratio (RR 0•66 [95% CI 0•54-0•81], p<0•0001) and STS showed similar trends (RR 0•88 [95% CI 0•76-1•01], p=0•08). Both TM (RR 0•79 [95% CI 0•67-0•94], p=0•008) and STS (RR 0•77 [95% CI 0•68-0•87], p<0•0001) reduced CHF-related hospitalisations. Both interventions improved quality of life, reduced costs, and were acceptable to patients. Improvements in prescribing, patient-knowledge and self-care, and functional class were observed.--Conclusion: TM and STS both appear effective interventions to improve outcomes in patients with CHF.