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.

A social matching system : using implicit and explicit information for personalized recommendation in online dating service

Online dating websites enable a specific form of social networking and their efficiency can be increased by supporting proactive recommendations based on participants' preferences with the use of data mining. This research develops two-way recommendation methods for people-to-people recommendation for large online social networks such as online dating networks. This research discovers the characteristics of the online dating networks and utilises these characteristics in developing efficient people-to-people recommendation methods. Methods developed support improved recommendation accuracy, can handle data sparsity that often comes with large data sets and are scalable for handling online networks with a large number of users.

The health outcomes and costs of people attending an interdisciplinary chronic disease service in regional Australia : protocol for a longitudinal cohort investigation

Background Rates of chronic disease are escalating around the world. To date health service evaluations have focused on interventions for single chronic diseases. However, evaluations of the effectiveness of new intervention strategies that target single chronic diseases as well as multimorbidity are required, particularly in areas outside major metropolitan centres where access to services, such as specialist care, is difficult and where the retention and recruitment of health professionals affects service provision. Methods This study is a longitudinal investigation with a baseline and three follow-up assessments comparing the health and health costs of people with chronic disease before and after intervention at a chronic disease clinic, in regional Australia. The clinic is led by students under the supervision of health professionals. The study will provide preliminary evidence regarding the effectiveness of the intervention, and evaluate the influence of a range of factors on the health outcomes and costs of the patients attending the clinic. Patients will be evaluated at baseline (intake to the service), and at 3-, 6-, and 12-months after intake to the service. Health will be measured using the SF-36 and health costs will be measured using government and medical record sources. The intervention involves students and health professionals from multiple professions working together to treat patients with programs that include education and exercise therapy programs for back pain, and Healthy Lifestyle programs; as well as individual consultations involving single professions. Discussion Understanding the effect of a range of factors on the health state and health costs of people attending an interdisciplinary clinic will inform health service provision for this clinical group and will determine which factors need to be controlled for in future observational studies. Preliminary evidence regarding changes in health and health costs associated with the intervention will be a platform for future clinical trials of intervention effectiveness. The results will be of interest to teams investigating new chronic disease programs particularly for people with multimorbidity, and in areas outside major metropolitan centres.

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.

GO423 - the second Game On / brIGDA Independant Game Symposium

GO423 was initiated in 2012 as part of a community effort to ensure the vitality of the Queensland Games Sector. In common with other industrialised nations, the game industry in Australia is a reasonably significant contributor to Gross National Product (GNP). Games are played in 92% of Australian homes and the average adult player has been playing them for at least twelve years with 26% playing for more than thirty years (Brand, 2011). Like the games and interactive entertainment industries in other countries, the Australian industry has its roots in the small team model of the 1980s. So, for example, Beam Software, which was established in Melbourne in 1980, was started by two people and Krome Studios was started in 1999 by three. Both these companies grew to employing over 100 people in their heydays (considered large by Antipodean standards), not by producing their own intellectual property (IP) but by content generation for off shore parent companies. Thus our bigger companies grew on a model of service provision and tended not to generate their own IP (Darchen, 2012). There are some no-table exceptions where IP has originated locally and been ac-quired by international companies but in the case of some of the works of which we are most proud, the Australian company took on the role of “Night Elf” – a convenience due to affordances of the time zone which allowed our companies to work while the parent companies slept in a different time zone. In the post GFC climate, the strong Australian dollar and the vulnerability of such service provision means that job security is virtually non-existent with employees invariably being on short-term contracts. These issues are exacerbated by the decline of middle-ground games (those which fall between the triple-A titles and the smaller games often produced for a casual audience). The response to this state of affairs has been the change in the Australian games industry to new recognition of its identity as a wider cultural sector and the rise (or return) of an increasing number of small independent game development companies. ’In-dies’ consist of small teams, often making games for mobile and casual platforms, that depend on producing at least one if not two games a year and who often explore more radical definitions of games as designed cultural objects. The need for innovation and creativity in the Australian context is seen as a vital aspect of the current changing scene where we see the emphasis on the large studio production model give way to an emerging cultural sector model where small independent teams are engaged in shorter design and production schedules driven by digital distribution. In terms of Quality of Life (QoL) this new digital distribution brings with it the danger of 'digital isolation' - a studio can work from home and deliver from home. Community events thus become increasingly important. The GO423 Symposium is a response to these perceived needs and the event is based on the understanding that our new small creative teams depend on the local community of practice in no small way. GO423 thus offers local industry participants the opportunity to talk to each other about their work, to talk to potential new members about their work and to show off their work in a small intimate situation, encouraging both feedback and support.

Review: "Health service frameworks for small rural and remote communities: issues and options" by J. Humphreys, S. Mathews-Cowey, F. Rolley 1996

This monograph is a welcome investigation of current issues in rural health service delivery in smaller communities. The underlying assumption is that existing health service frameworks for rural and remote communities with populations of less than 230 are simply- not appropriate for their needs. With this in mind, the authors identify the strengths and weaknesses of frameworks presently utilised, and offer viable alternatives. They have made information accessible to those who wish to improve the delivery of rural health care, and have provided a catalyst for further research and dialogue on rural health issues...

Effects of size of health service on scope of rural nursing practice

This paper presents the findings of an analysis of the activities of rural nurses from a national audit of the role and function of the rural nurse (Hegney, Pearson and McCarthy 1997). The results suggest that the size of the health service (defined by the number of acute beds) influences the activities of rural nurses. Further, the study reports on the differences of the context of practice between different size rural health services and the impact this has on the scope of rural nursing practice. The paper will conclude that the size of the health service is an outcome of rurality (small population densities, distance from larger health facilities, lack of on-site medical and allied health staff). It also notes that the size of the health service is a major contextual determinant of patient acuity and staff skill-mix in small rural hospitals, and therefore the scope of rural nursing practice.

“Who decides?” Security and privacy in the wild

Even though web security protocols are designed to make computer communication secure, it is widely known that there is potential for security breakdowns at the human-machine interface. This paper examines findings from a qualitative study investigating the identification of security decisions used on the web. The study was designed to uncover how security is perceived in an individual user's context. Study participants were tertiary qualified individuals, with a focus on HCI designers, security professionals and the general population. The study identifies that security frameworks for the web are inadequate from an interaction perspective, with even tertiary qualified users having a poor or partial understanding of security, of which they themselves are acutely aware. The result is that individuals feel they must protect themselves on the web. The findings contribute a significant mapping of the ways in which individuals reason and act to protect themselves on the web. We use these findings to highlight the need to design for trust at three levels, and the need to ensure that HCI design does not impact on the users' main identified protection mechanism: separation.

Formalising human recognition : a fundamental building block for security proofs

A fundamental part of many authentication protocols which authenticate a party to a human involves the human recognizing or otherwise processing a message received from the party. Examples include typical implementations of Verified by Visa in which a message, previously stored by the human at a bank, is sent by the bank to the human to authenticate the bank to the human; or the expectation that humans will recognize or verify an extended validation certificate in a HTTPS context. This paper presents general definitions and building blocks for the modelling and analysis of human recognition in authentication protocols, allowing the creation of proofs for protocols which include humans. We cover both generalized trawling and human-specific targeted attacks. As examples of the range of uses of our construction, we use the model presented in this paper to prove the security of a mutual authentication login protocol and a human-assisted device pairing protocol.

Quality demand in vaccination and how to improve service quality under Total Quality Control [论全面质量管理模式下预防接种工作的质量要求与改进对策]

Under the concept of Total Quality Control, based on their experience, the authors discussed potential demand for quality of immunization services and possible solutions to these demands. Abstract in Chinese 全面质量管理(total quality control,TQC)是在20世纪60年代由美国人V,Feigonbaum和J.unan先后提出的新的质量管理观念,众所周知的ISO9000族标准即建立在TQC理念下的质量管理标准,该标准已成为当今世界全球一致、最具权威的质量管理和质量保证的国际规则[1-2].21世纪是质量世纪,推行TQC,不断改进产品和服务质量,目前已成为我国各行各业在不断激烈的市场竞争下完善自我、保证生存和发展的重要手段.实施预防接种是预防和控制传染病,保护人群健康的重要措施,预防接种工作中,产品即预防接种服务,需方(顾客)为接受预防接种服务的广大人群,是产品的消费者.随社会的迅速发展,人们对健康需求的不断提高,对预防接种工作也提出了更高的质量要求.本文对TQC模式下顾客对预防接种服务的质量要求进行了综合分析,并对如何改进服务质量进行了初步探讨.

Intrusion detection in distributed systems, an approach based on taint marking

This paper presents a new framework for distributed intrusion detection based on taint marking. Our system tracks information flows between applications of multiple hosts gathered in groups (i.e., sets of hosts sharing the same distributed information flow policy) by attaching taint labels to system objects such as files, sockets, Inter Process Communication (IPC) abstractions, and memory mappings. Labels are carried over the network by tainting network packets. A distributed information flow policy is defined for each group at the host level by labeling information and defining how users and applications can legally access, alter or transfer information towards other trusted or untrusted hosts. As opposed to existing approaches, where information is most often represented by two security levels (low/high, public/private, etc.), our model identifies each piece of information within a distributed system, and defines their legal interaction in a fine-grained manner. Hosts store and exchange security labels in a peer to peer fashion, and there is no central monitor. Our IDS is implemented in the Linux kernel as a Linux Security Module (LSM) and runs standard software on commodity hardware with no required modification. The only trusted code is our modified operating system kernel. We finally present a scenario of intrusion in a web service running on multiple hosts, and show how our distributed IDS is able to report security violations at each host level.

Security analysis of linearly filtered NLFSRs

Non-linear feedback shift register (NLFSR) ciphers are cryptographic tools of choice of the industry especially for mobile communication. Their attractive feature is a high efficiency when implemented in hardware or software. However, the main problem of NLFSR ciphers is that their security is still not well investigated. The paper makes a progress in the study of the security of NLFSR ciphers. In particular, we show a distinguishing attack on linearly filtered NLFSR (or LF-NLFSR) ciphers. We extend the attack to a linear combination of LF-NLFSRs. We investigate the security of a modified version of the Grain stream cipher and show its vulnerability to both key recovery and distinguishing attacks.

Giving voice to service providers who work with survivors of torture and trauma

Clinicians who support people from refugee and asylum seeking backgrounds are routinely exposed to stories of trauma as part of their work. Hearing these stories can be highly distressing for clinicians, but simultaneously provide opportunities for positive personal growth. Adopting a longitudinal qualitative design, we interviewed twelve service providers at two time points a year apart. We used a semistructured interview protocol and analyzed the data according to interpretative phenomenological analysis. Five superordinate and 19 constituent themes emerged from the analysis at Time 1 and Time 2. We found that participants were both positively and negatively affected by their work, and their experiences remained relatively stable across time. The participants highlighted the use of organizational and personal coping strategies to help minimize distress and maximize wellbeing. Adopting a broad repertoire of such strategies is not only advantageous for the service providers, but ultimately for those people they seek to assist.