How do Australasian hospitals identify and manage malnutrition in their acute care wards?

One aim of the Australasian Nutrition Care Day Survey was to explore nutrition care practices in acute care hospital wards across Australia and New Zealand. Managers of Dietetic departments completed a questionnaire regarding ward nutrition care practices. Overall, 370 wards from 56 hospitals participated. The median ward size was 28 beds (range: 8–60 beds). Although there was a wide variation in full-time equivalent availability of dietitians (median: 0.3; range: 0–1.4), their involvement in providing nutrition care across ward specialities was signifi cantly higher than other staff members (χ2, p < 0.01). Feeding assistance, available in 89% of the wards, was provided mainly by nursing staff and family members (χ2, p < 0.01). Protected meal times were implemented in 5% (n = 18) of the wards. Fifty-three percent of the wards (n = 192) weighed patients on request and 40% (n = 148) on admission. Routine malnutrition screening was conducted in 63% (n = 232) of the wards and 79% (n = 184) of these wards used the Malnutrition Screening Tool, 16% (n = 37) the Malnutrition Universal Screening Tool, and 5% (n = 11) other tools. Nutrition rescreening was routinely conducted in 20% of the wards. Among wards that implemented nutrition screening, 41% (n = 100) routinely referred patients “at risk” of malnutrition to dietitians as part of their standard protocol for malnutrition management. Results of this study provide new knowledge regarding current nutrition care practice, highlight gaps in existing practice, and can be used to inform improved nutrition care in acute care wards across Australia and New Zealand.

Do the skeletons in the hospital closet still exist? What do they eat?

One aim of the Australasian Nutrition Care Day Survey (ANCDS) was to explore dietary intake and nutritional status of acute care hospital patients. Dietitians from 56 hospitals in Australia and New Zealand completed a 24-hour nutritional status and dietary intake audit of 3000 adult patients. Participants were evaluated for nutritional risk using the Malnutrition Screening Tool (MST). Those ‘at risk’ underwent nutritional assessment using Subjective Global Assessment (SGA). Dietitians observed participants’ dietary intake at each main meal and recorded mid-meal intake via participant interviews. Intakes were recorded as 0%, 25%, 50%, 75%, or 100% of that offered for each meal during the 24-hour audit. Preliminary results for 1550 participants (males = 853; females = 697), age = 64 ± 17 years and BMI = 27 ± 7 kg/m2. Fifty-five percent (n = 853) of the participants had BMI > 25 kg/m2. The MST identified 41% (n = 636) ‘at risk’ for malnutrition. Of those ‘at risk’, 70% were assessed as malnourished resulting in an overall malnutrition prevalence of 30% (25% moderately malnourished, 5% severely malnourished). One-quarter of malnourished participants (n = 118) were on standard hospital diets without additional nutritional support. Fifty percent of malnourished patients (n = 235) and 40% of all patients (n = 620) had an overall 24-hour food consumption of ≤50% during the 24-hour audit. The ANCDS found that skeletons in the hospital closet continue to exist and that acute care patients continue to have suboptimal dietary intake. The ANCDS provides valuable insight into gaps in existing nutrition care practices.

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.

The Yonder project : literacy and social competency development in primary school students through co-creation of live performance

Since 2007 Kite Arts Education Program (KITE), based at Queensland Performing Arts Centre (QPAC), has been engaged in delivering a series of theatre-based experiences for children in low socio-economic primary schools in Queensland. The artist in residence (AIR) project titled Yonder includes performances developed by the children with the support and leadership of teacher artists from KITE for their community and parents/carers,supported by a peak community cultural institution. In 2009,Queensland Performing Arts Centre partnered with Queensland University of Technology (QUT) Creative Industries Faculty (Drama) to conduct a three-year evaluation of the Yonder project to understand the operational dynamics, artistic outputs and the educational benefits of the project. This paper outlines the research findings for children engaged in the Yonder project in the interrelated areas of literacy development and social competencies. Findings are drawn from six iterations of the project in suburban locations on the edge of Brisbane city and in regional Queensland.

Arts-health intersections : a model of practice for consistency in the arts-health sector

The field of Arts-Health practice and research has grown exponentially in the past 30 years. While researchers are using applied arts as the subject of investigation in research, the evaluation of practice and participant benefits has a limited general focus. In recent years, the field has witnessed a growing concentration on the evaluation of health outcomes, outputs and tangential benefits for participants engaging in Arts-Health practice. The wide range of methodological approaches applied arts practitioners implement make the field difficult to define. This article introduces the term Arts-Health intersections as a model of practice and framework to promote consistency in design, implementation and evaluative processes in applied arts programmes promoting health outcomes. The article challenges the current trend to solely evaluate health outcomes in the field, and promotes a concurrent and multidisciplinary methodological approach that can be adopted to promote evaluation, consistency and best practice in the field of Arts-Health intersections. The article provides a theoretical overview of Arts-Health intersections, and then takes this theoretical platform and details a best model of practice for developing Arts-Health intersections and presents this model as a guide.

Destination know-where : a road map of a PhD journey in theatre for young people

Within contemporary performance arenas young people are fast becoming part of the vanguard of contemporary performance. Performativity, convergence and openness of form are key animating concepts in the landscape of Theatre for Young People (TYP). To ignore what is taking place in the making of performance for and by young people is to ignore the new possibilities in meaning-making and theatrical form. This thesis investigates the contemporary practice within the field of Theatre for Young People. Pivotal to the study are three hallmarks of contemporary performance – shifting notions of performativity; convergence articulated in the use of technology and theatrical genres; and Umberto Eco’s realisation of openness in form and authorship. The thesis draws from theatre and performance studies, globalisation theory and youth studies. Using interviews of Theatre for Young People practitioners and observation of thirty-nine performances, this thesis argues that young people and Theatre for Young People companies are among the leaders of a paradigm shift in developing and delivering performance works. In this period of rapid technological change young people are embracing and manipulating technology (sound, image, music) to represent whom they are and what they want to say. Positioned as ‘cultural catalysts’ (McRobbie, 1999), ‘the new pioneers’ (Mackay, 1993) and ‘first navigators’ (Rushkoff, 1996) young people are using mediatised culture and digital technologies with ease, placing them at the forefront of a shift in cultural production. The processes of deterritorialisation allows for the synthesis of new cultural and performance genres by fragmenting and hybridising traditional cultural categories and forms including the use of new media technologies. Almost half of all TYP performances now incorporate the technologies of reproduction. The relationship between live and mediatised forms, the visceral and the virtual is allowing young people to navigate and make meaning of cultural codes and cultural forms as well as to engage in an open dialogue with their audiences. This thesis examines the way young people are using elements of deterritorialisation to become producers of new performance genres. The thesis considers the contemporary situation in relation to issues of performance making and performance delivery within a global, networked and technology-driven society.

Grey St. Xchange 2.0 by QUT

Partnerships between universities and public institutions such as this offer the beginning of a long term relationship to actively influence public policy, procedures and new ways to engage the many diverse communities to be integral in shaping the environments in which they live. It offers an opportunity to apply authentic positioning of research theories and build new methodologies for consulting, analysing and implementing innovation. SBC, as an established corporation offers a unique precinct to research and develop models with its different offers of tourism, leisure and neighbourhood. The Parklands and Little Stanley Street are well advanced in the goals however Grey Street, which connects the precinct to the greater surrounds, has been a complex issue that is now ready to be addressed. This project offers the ability to be of real worth at this critical time of development with the history of the past development combined with the desire for future visioning to be realised over the next 5 years. QUT has the unique opportunity to be part of this future.

Learning beyond books : strategies for ambient media to improve libraries and collaboration spaces as interfaces for social learning

With the advent of digital media and online information resources, public libraries as physical destinations for information access are being increasingly challenged. As a response, many libraries follow the trend of removing bookshelves in order to provide more floorspace for social interaction and collaboration. Such spaces follow a Commons 2.0 model: they are designed to support collaborative work and social learning. The acquisition of skills and knowledge is facilitated as a result of being surrounded by and interacting with a community of likeminded others. Based on the results of a case study on a Commons 2.0 library space, this paper describes several issues of collaboration and social learning in public library settings. Acknowledging the significance of the architectural characteristics of the physical space, we discuss opportunities for ambient media to better reflect the social attributes of the library as a place; i.e. amplify the sense of other co-present library visitors and provide opportunities for shared encounters and conversations, which would remain invisible otherwise. We present the design of a user check-in system for improving the library as a physical destination for social learning, sharing, and inspiration for and by the community.

Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010 : a systematic analysis for the Global Burden of Disease Study 2010

Background Non-fatal health outcomes from diseases and injuries are a crucial consideration in the promotion and monitoring of individual and population health. The Global Burden of Disease (GBD) studies done in 1990 and 2000 have been the only studies to quantify non-fatal health outcomes across an exhaustive set of disorders at the global and regional level. Neither effort quantified uncertainty in prevalence or years lived with disability (YLDs). Methods Of the 291 diseases and injuries in the GBD cause list, 289 cause disability. For 1160 sequelae of the 289 diseases and injuries, we undertook a systematic analysis of prevalence, incidence, remission, duration, and excess mortality. Sources included published studies, case notification, population-based cancer registries, other disease registries, antenatal clinic serosurveillance, hospital discharge data, ambulatory care data, household surveys, other surveys, and cohort studies. For most sequelae, we used a Bayesian meta-regression method, DisMod-MR, designed to address key limitations in descriptive epidemiological data, including missing data, inconsistency, and large methodological variation between data sources. For some disorders, we used natural history models, geospatial models, back-calculation models (models calculating incidence from population mortality rates and case fatality), or registration completeness models (models adjusting for incomplete registration with health-system access and other covariates). Disability weights for 220 unique health states were used to capture the severity of health loss. YLDs by cause at age, sex, country, and year levels were adjusted for comorbidity with simulation methods. We included uncertainty estimates at all stages of the analysis. Findings Global prevalence for all ages combined in 2010 across the 1160 sequelae ranged from fewer than one case per 1 million people to 350 000 cases per 1 million people. Prevalence and severity of health loss were weakly correlated (correlation coefficient −0·37). In 2010, there were 777 million YLDs from all causes, up from 583 million in 1990. The main contributors to global YLDs were mental and behavioural disorders, musculoskeletal disorders, and diabetes or endocrine diseases. The leading specific causes of YLDs were much the same in 2010 as they were in 1990: low back pain, major depressive disorder, iron-deficiency anaemia, neck pain, chronic obstructive pulmonary disease, anxiety disorders, migraine, diabetes, and falls. Age-specific prevalence of YLDs increased with age in all regions and has decreased slightly from 1990 to 2010. Regional patterns of the leading causes of YLDs were more similar compared with years of life lost due to premature mortality. Neglected tropical diseases, HIV/AIDS, tuberculosis, malaria, and anaemia were important causes of YLDs in sub-Saharan Africa. Interpretation Rates of YLDs per 100 000 people have remained largely constant over time but rise steadily with age. Population growth and ageing have increased YLD numbers and crude rates over the past two decades. Prevalences of the most common causes of YLDs, such as mental and behavioural disorders and musculoskeletal disorders, have not decreased. Health systems will need to address the needs of the rising numbers of individuals with a range of disorders that largely cause disability but not mortality. Quantification of the burden of non-fatal health outcomes will be crucial to understand how well health systems are responding to these challenges. Effective and affordable strategies to deal with this rising burden are an urgent priority for health systems in most parts of the world. Funding Bill & Melinda Gates Foundation.

Private health insurance status and utilisation of dental services in Australia

This article focuses on the relationship between private insurance status and dental service utilisation in Australia using data between 1995 and 2001. This article employs joint maximum likelihood to estimate models of time since last dental visit treating private ancillary health insurance (PAHI) as endogenous. The sensitivity of results to the choice between two different but related types of instrumental variables is examined. We find robust evidence in both 1995 and 2001 that individuals with a PAHI policy make significantly more frequent dental consultations relative to those without such coverage. A comparison of the 1995 and 2001 results, however, suggests that there has been an increasing role of PAHI in terms of the frequency of dental consultations over time. This seems intuitive given the trends in the price of unsubsidised private dental consultations. In terms of policy, our results suggest that while government measures to increase private health insurance coverage in Australia has been successful to a significant degree, it may have come at some cost in terms of socio-economic inequality as the privately insured are provided much better access to care and financial protection.

Libraries as co-working spaces : understanding user motivations and perceived barriers to social learning

This paper aims to inform design strategies for smart space technology to enhance libraries as environments for co-working and informal social learning. The focus is on understanding user motivations, behaviour, and activities in the library when there is no programmed agenda. The study analyses gathered data over five months of ethnographic research at ‘The Edge’ – a bookless library space at the State Library of Queensland in Brisbane, Australia, that is explicitly dedicated to co-working, social learning, peer collaboration, and creativity around digital culture and technology. The results present five personas that embody people’s main usage patterns as well as motivations, attitudes, and perceived barriers to social learning. It appears that most users work individually or within pre-organised groups, but usually do not make new connections with co-present, unacquainted users. Based on the personas, four hybrid design dimensions are suggested to improve the library as a social interface for shared learning encounters across physical and digital spaces. The findings in this paper offer actionable knowledge for managers, decision makers, and designers of technology-enhanced library spaces and similar collaboration and co-working spaces.

Achieving at university and beyond : does it help to be good looking?

Purpose – The purpose of this study is to examine the associations between attitudes to academic achievement and post university success using perceptions of attractiveness, gender, ethnic identity, personality, and social acceptance as antecedents. Design/methodology/approach – An online questionnaire was completed by male (N=116) and female (N=126) university students from various cultural backgrounds. To evaluate the proposed relationships, multiple regression analysis was used. Findings – The findings suggest that attractiveness is related to attitudes to academic achievement and success through its association with social appeal and acceptance. Ethnic identity is also related to both academic achievement and post university success. Personality is not positively related to academic achievement. Finally, social acceptance is positively related to academic achievement for males and to success for females. Research limitations/implications – Whilst the survey targeted students from various cultural backgrounds studying in Australia, it did not look at university students from other countries. A cross-cultural perspective could reveal further differences in attitudes. Originality/value – This study links attractiveness and academic achievement theories. The findings have implications for tertiary institutions and suggest academics and policy-makers to vigorously promote core personality and values such as intelligence, communication skills, and sincerity, rather than allow superficial values such as attractiveness to be placed at the centre stage of students' endeavour.

Sleep Disturbances and Nightmares in Combat Veterans

Book Description: Life is a mix of good and bad happenings and sometimes terrible things happen to people. Trauma is evident across our lifespan; it is part of our lives. Trauma may not exert the same demands on the individual when they get on with their lives or experience other positive aspects of what life has to offer; however, it does not change its form from trauma to growth – it stays there etched into our psyche as trauma. In simple terms, growth occurs alongside the traumatic etchings. This is a book that will provide some answers to psychologists, counselors, social workers and mental health workers about what happens to people who are traumatized and how they ‘get on with their lives’; it also gives some excellent examples of how therapies can assist them in moving forward in life’s journey.

From movie screens to moving screens : mapping qualities of new urban interactions

Next generation screens of diverse dimensions such as the Pebble e-paper watch, Google’s Project Glass, Microsoft’s Kinect and IllumiRoom, and large-scale multi-touch screen surface areas, increasingly saturate and diversify the urban mediascape. This paper seeks to contribute to media architecture and interaction design theory by starting to critically examine how these different screen formats are creating a ubiquitous screen mediascape across the city. We introduce next generation personal, domestic, and public screens. The paper critically challenges conventional dichotomies such as local / global, online / offline, private / public, large / small, mobile / static, that have been created in the past to describe some of the qualities and characteristics of interfaces and their usage. More and more scholars recognise that the black and white nature of these dichotomies does not adequately represent the fluid and agile capabilities of many new screen interfaces. With this paper, we hope to illustrate the more nuanced ‘trans-scalar’ qualities of these new urban interactions, that is, ways in which they provide a range functionality, without being locked into either end of a scale.

Street Computing : Urban Informatics and City Interfaces

This book develops tools and techniques that will help urban residents gain access to urban computing. Metaphorically speaking, it is taking computing to the street by giving the general public – rather than just researchers and professionals – the power to leverage available city infrastructure and create solutions tailored to their individual needs. It brings together five chapters that are based on presentations given at the Street Computing Workshop held on 24 November 2009 in Melbourne in conjunction with the Australian Computer-Human Interaction Conference (OZCHI 2009). This book focuses on applying urban informatics, urban and community sensing and open application programming interfaces (APIs) to the public space through the delivery of online services, on demand and in real time. It then offers a case study of how the city of Singapore has harnessed the potential of an online infrastructure so that residents and visitors can access services electronically. This book was published as a special issue of the Journal of Urban Technology, 19(2), 2012.