Is age a factor in the success or failure of remote monitoring in heart failure? Telemonitoring and structured telephone support in elderly heart failure patients

Background There are few data regarding the effectiveness of remote monitoring for older people with heart failure. We conducted a post-hoc sub-analysis of a previously published large Cochrane systematic review and meta-analysis of relevant randomized controlled trials to determine whether structured telephone support and telemonitoring were effective in this population. Methods A post hoc sub-analysis of a systematic review and meta-analysis that applied the Cochrane methodology was conducted. Meta-analyses of all-cause mortality, all-cause hospitalizations and heart failure-related hospitalizations were performed for studies where the mean or median age of participants was 70 or more years. Results The mean or median age of participants was 70 or more years in eight of the 16 (n=2,659/5,613; 47%) structured telephone support studies and four of the 11 (n=894/2,710; 33%) telemonitoring studies. Structured telephone support (RR 0.80; 95% CI=0.63-1.00) and telemonitoring (RR 0.56; 95% CI=0.41-0.76) interventions reduced mortality. Structured telephone support interventions reduced heart failure-related hospitalizations (RR 0.81; 95% CI=0.67-0.99). Conclusion Despite a systematic bias towards recruitment of individuals younger than the epidemiological average into the randomized controlled trials, older people with heart failure did benefit from structured telephone support and telemonitoring. These post-hoc sub-analysis results were similar to overall effects observed in the main meta-analysis. While further research is required to confirm these observational findings, the evidence at hand indicates that discrimination by age alone may be not be appropriate when inviting participation in a remote monitoring service for heart failure.

Prevalence of undiagnosed urinary tract infections on admission to a rehabilitation unit

Background Through clinical observation nursing staff of an inpatient rehabilitation unit identified a link between incontinence and undiagnosed urinary tract infections (UTIs). Further, clinical observation and structured continence management led to the realisation that urinary incontinence often improved, or resolved completely, after treatment with antibiotics. In 2009 a small study found that 30% of admitted rehabilitation patients had an undiagnosed UTI, with the majority admitted post-orthopaedic fracture. We suspected that the frequent use of indwelling urinary catheters (IDCs) in the orthopaedic environment may have been a contributing factor. Therefore, a second, more thorough, study was commenced in 2010 and completed in 2011. Aim The aim of this study was to identify what proportion of patients were admitted to one rehabilitation unit with an undiagnosed UTI over a 12-month period. We wanted to identify and highlight the presence of known risk factors associated with UTI and determine whether urinary incontinence was associated with the presence of UTI. Methods Data were collected from every patient that was admitted over a 12-month period (n=140). The majority of patients were over the age of 65 and had an orthopaedic fracture (36.4%) or stroke (27.1%). Mid-stream urine (MSU) samples, routinely collected and sent for culture and sensitivity as part of standard admission procedure, were used by the treating medical officer to detect the presence of UTI. A data collection sheet was developed, reviewed and trialled, before official data collection commenced. Data were collected as part of usual practice and collated by a research assistant. Inferential statistics were used to analyse the data. Results This study found that 25 (17.9%) of the 140 patients admitted to rehabilitation had an undiagnosed UTI, with a statistically significant association between prior presence of an IDC and the diagnosis of UTI. Urinary incontinence improved after the completion of treatment with antibiotics. Results further demonstrated a significant association between the confirmation of a UTI on culture and sensitivity and the absence of symptoms usually associated with UTI, such as burning or stinging on urination. Overall, this study suggests careful monitoring of urinary symptoms in patients admitted to rehabilitation, especially in patients with a prior IDC, is warranted.

How much geological detail is needed for gasifier success?

The incipient Underground Coal Gasification (UCG) industry in Queensland, Australia, undertook three trial projects in two Mesozoic basins of southeast Queensland. The experiences of these three operations provide useful retrospective insight into gasifier productivity. This paper identifies key output measures of gasifier ‘success’ including output gas composition, presence of contaminants in groundwater and consistency of chamber operation. Likewise, a review of the geological and hydrogeological understanding of each site prior to gasifier commissioning was undertaken. Productivity parameters from gasification were then correlated against the level of baseline geological/hydrogeological understanding for each site. The aim of the study was to identify the optimum scope of geological and hydrogeological understanding required at the site assessment phase to ensure safe, maximum gasifier output during production phase. This approach allows identification of poor or unexpected performance that is attributable to pre-existing uncertainty. A historical review of gasifier conditions inferred from the three trial projects is presented. Hence from the Queensland experiences it is possible to identify what aspects of baseline geological understanding should be clearly understood at the site selection phase in order to limit anomalous gasifier performance and undesirable deviations, and maximise production output.

Automatic classification of free-text radiology reports to identify limb fractures using machine learning and the SNOMED CT ontology

Objective To develop and evaluate machine learning techniques that identify limb fractures and other abnormalities (e.g. dislocations) from radiology reports. Materials and Methods 99 free-text reports of limb radiology examinations were acquired from an Australian public hospital. Two clinicians were employed to identify fractures and abnormalities from the reports; a third senior clinician resolved disagreements. These assessors found that, of the 99 reports, 48 referred to fractures or abnormalities of limb structures. Automated methods were then used to extract features from these reports that could be useful for their automatic classification. The Naive Bayes classification algorithm and two implementations of the support vector machine algorithm were formally evaluated using cross-fold validation over the 99 reports. Result Results show that the Naive Bayes classifier accurately identifies fractures and other abnormalities from the radiology reports. These results were achieved when extracting stemmed token bigram and negation features, as well as using these features in combination with SNOMED CT concepts related to abnormalities and disorders. The latter feature has not been used in previous works that attempted classifying free-text radiology reports. Discussion Automated classification methods have proven effective at identifying fractures and other abnormalities from radiology reports (F-Measure up to 92.31%). Key to the success of these techniques are features such as stemmed token bigrams, negations, and SNOMED CT concepts associated with morphologic abnormalities and disorders. Conclusion This investigation shows early promising results and future work will further validate and strengthen the proposed approaches.

Evaluation and social impact measurement amongst small to medium social enterprises : process, purpose and value

In recent years, the imperative to communicate organisational impacts to a variety of stakeholders has gained increasing importance within all sectors. Despite growing external demands for evaluation and social impact measurement, there has been limited critically informed analysis about the presumed importance of these activities to organisational success and the practical challenges faced by organisations in undertaking such assessment. In this paper, we present the findings from an action research study of five Australian small to medium social enterprises’ practices and use of evaluation and social impact analysis. Our findings have implications for social enterprise operators, policy makers and social investors regarding when, why and at what level these activities contribute to organisational performance and the fulfilment of mission.

Using pulse transit delay in Z-scan to discriminate between excited-state absorption and other nonlinear processes in ZnO nanocones

We report a new approach that uses the single beam Z-scan technique, to discriminate between excited state absorption (ESA) and two and three photon nonlinear absorption. By measuring the apparent delay or advance of the pulse in reaching the detector, the nonlinear absorption can be unambiguously identified as either instantaneous or transient. The simple method does not require a large range of input fluences or sophisticated pulse-probe experimental apparatus. The technique is easily extended to any absorption process dependent on pulse width and to nonlinear refraction measurements. We demonstrate in particular, that the large nonlinear absorption in ZnO nanocones when exposed to nanosecond 532 nm pulses, is due mostly to ESA, not pure two-photon absorption.

We have a lot to learn yet : a postcolonial lens in health promotion

Health promotion progresses a social justice and empowerment agenda and thus emphasises working with people to increase their control over their health. Certainly, Australia has experienced much success in this endeavour and is internationally recognised as a leader. However, health promotion has failed Indigenous Australians; a fact that is echoed in the health outcomes that ironically provide us with the “moral imperative” to act. Further investigation has also revealed health promotion’s foundation in colonial imaginings. Thus, this paper calls for the culture of health promotion to be examined as a risk factor for poor Indigenous health. To complement this call, this paper presents findings of an ethnographic study of Indigenous health promotion practice, undertaken from a postcolonial and critical whiteness framework. These findings provide a narrative of strength and innovative approaches, highlighting the value of Indigenous knowledge. These findings also contradict the biomedical tendency to construct culture as illness-producing. More broadly, this study’s findings entail important lessons for health promotion to consider, if it is to move beyond the rhetoric, to truly increase people’s control over their health.

Defence industry projects : investigating the impact of major project manager attributes on stakeholder relationships and project success

This thesis identifies attributes, skills and behaviours that major project managers require for stakeholder relationships competence and project success within a major project environment. It develops valid and reliable measures of internal and external stakeholder relationships competence, tests a complex conceptual model and explores the effectiveness of the QUT Executive Masters of Complex Project Management and Strategic Procurement in developing major project managers' stakeholder relationships competence. Implications of this thesis are for government and industry in identifying factors associated with major project success, as this will lead to better major project outcomes potentially resulting in time and monetary savings of years and billions of dollars.

Critical reflections on the use of participatory methodologies to build evaluation capacities in international development organisations

There has been a greater focus on strengthening evaluation capacity building (ECB) within development organisations in recent years. This can be attributed in part to the growing appreciation of the value of participatory and collaborative forms of evaluation. Evaluation is increasingly seen as an ongoing learning process and an important means of strengthening capacity and improving organisational performance (Horton et al., 2003:7). While there are many benefits of using participatory methodologies in ECB projects, our experiences and a review of the literature in this area highlight the many challenges, issues and contradictions that can affect the success of such ECB efforts. We discuss these issues, drawing on our learnings from the ongoing participatory action research (PAR) project 'Assessing Communication for Social Change’ (AC4SC). This four year project, which began in 2007, is a collaboration between communication and development academics and evaluation specialists from two Australian universities and communication for development practitioners and monitoring and evaluation (M&E) staff in the NGO Equal Access Nepal (EAN). The aim is to develop, implement, and evaluate a participatory methodology for assessing the social change impacts of community radio programs produced by EAN. It builds on previous projects that used ethnographic action research (EAR) methodology (Tacchi et al., 2007).

Working in partnership to develop engineering capability in energy efficiency

Energy efficiency is a complex topic to integrate into higher education curricula, with limited success internationally or in Australia. This paper discusses one of the successful initiatives within the Energy Efficiency Training Program, which was jointly managed and implemented by the New South Wales Office of Environment and Heritage and Department of Education and Communities. The state government initiative aimed to increase the knowledge and skills of the New South Wales workforce, help business to identify and implement energy efficiency projects, and provide professional development for the training providers. Key sectors targeted included property, construction, manufacturing and services. The Program was externally evaluated over the three years 2011 to 2013 and a range of insights were gained through these facilitated reflective opportunities, confirming and building upon literature on the topic to date. This paper presents lessons learned from the engineering part of the program (‘the project’), spanning government agencies, academic institutions, and academia. The paper begins with a contextual summary, followed by a synthesis of key learnings and implications for future training initiatives. It is intended that sharing these lessons will contribute to literature in the field, and assist other organisations in Australia and overseas planning similar initiatives.

goDesign Express 2011 Workshop

The goDesign Express 2011 Workshop was a design immersion workshop run by the Queensland University of Technology (QUT) Built Environment and Engineering Faculty during three weeks of 70-minute art class periods/sessions in August/September 2011 at Morayfield State High School, for 80 Grade 10 and 64 Grade 11 art students and two teachers, and October 2011 at Narangba Valley State High School for 60 Grade 10 and 30 Grade 11 art students and two teachers. Funded and administrated through QUT’s Widening Participation Program, which supports outreach activities to increase tertiary enrolments for under represented groups (such as low-SES, rural and indigenous students), the program utilised two activities from Day 1 of the highly successful 3-day goDesign Travelling Workshop Program for Regional Secondary Students (http://eprints.qut.edu.au/47747/). In contrast to this program, which was facilitated by two tertiary design educators, the goDesign Express 2011 Workshop was facilitated primarily by three tertiary interior design/architecture students, with assistance from a design educator. This action research study aimed to facilitate an awareness in young people, of the value of design thinking skills in generating strategies to solve local community challenges. It also aimed to investigate the value of collaboration between secondary school students and teachers, and tertiary design students and educators, in inspiring post-secondary pathways for school students, professional development for schoolteachers, and alternative career prospects and leadership skills for tertiary design students. During the workshop, secondary students and teachers explored, analysed and reimagined their local community through a series of scaffolded problem solving activities around the theme of ‘place’. Students worked individually and in groups designing graphics, fashion and products, and utilising sketching, making, communication, collaboration and presentation skills to improve their design process, while considering social, cultural and environmental opportunities for their local community. The workshop was mentioned in a news article in the local Caboolture Shire Herald newspaper.

Preparing for success in the new year

The beginning of a New Year brings with it many opportunities. Not only can you improve on the previous year, but you can also start afresh, set new goals and prepare to achieve the success you desire. Smart dancers know how important it is to consider all aspects of their dance training, especially when preparing to return to classes after the Christmas break. This includes spending some time thinking about what you want to achieve in the New Year, and what to do if challenges arise...

Extension of constructability to include operation and maintenance for infrastructure projects

This project was a step forward in developing an extension of the concept of constructability to include the post-occupancy stages of operation and maintenance. This was through an in-depth study of Australian health projects and interviews with professionals in the field. The thesis investigated how the operation and maintenance stakeholders can enter the initial planning, design and construction phases resulting in more efficient and effective delivery of infrastructure projects.

Using visualization tool to help engineering students learning dynamics

Dynamics is an essential core engineering subject. It includes high level mathematical and theoretical contents, and basic concepts which are abstract in nature. Hence, Dynamics is considered as one of the hardest subjects in the engineering discipline. To assist our students in learning this subject, we have conducted a Teaching & Learning project to study ways and methods to effectively teach Dynamics based on visualization techniques. The research project adopts the five basic steps of Action Learning Cycle. It is found that visualization technique is a powerful tool for students learning Dynamics and helps to break the barrier of students who perceived Dynamics as a hard subject.

Using a smartphone application for customer-centric banking

The banking industry is under pressure. In order to compete, banks should adapt to concentrating on the specific customer needs, following an outside-in perspective. This paper presents the design of a business model for banks that considers this development by providing flexible and comprehensive support for retail banking clients. It is demonstrated that the identification of customer processes and the consequent alignment of banking services to those processes implies great potential to increase customer retention in banking. It will be shown that information technology – especially smartphones – can serve as an interface between customer and suppliers to enable an alignment of offerings to customer processes. This approach enables the integration of banks into their customers’ lifestyle, creating emotional value added, improving the personal relationship and the customers’ affiliation with the bank. The paper presents the design of such a customer-process-centric smartphone application and derives success factors for implementation.