Hospital to home outreach for malnourished elders (HHOME) : a feasibility pilot

Objectives: Malnutrition is common in older hospitalised patients, and barriers to adequate intake in hospital limit the effectiveness of hospital-based nutrition interventions. This pilot study was undertaken to determine whether nutrition-focussed care at discharge and in the early post-hospital period is feasible and acceptable to patients and carers, and improves nutritional status. Design: Prospective cohort study Setting: Internal medicine wards of a tertiary teaching hospital in Brisbane, Australia Participants: Patients aged 65 and older admitted for at least 3 days, identified as malnourished or at risk of malnutrition using Mini Nutritional Assessment (MNA). Interventions: An interdisciplinary discharge team (specialist discharge planning nurse and accredited practicing dietitian) provided nutrition-focussed education, advice, service coordination and follow-up (home visits and telephone) for 6 weeks following hospitalisation Measurements: Nutritional intake, weight, functional status and MNA were recorded 6 and 12 weeks after discharge. Service intensity and changes to care were noted, and hospital readmissions recorded. Service feedback from patients and carers was sought using a brief questionnaire. Results: 12 participants were enrolled during the 6 week pilot (mean age 82 years, 50% male). All received 1-2 home visits, and 3-8 telephone calls. Four participants had new community services arranged, 4 were commenced on oral nutritional supplements, and 7 were referred to community dietetics services for follow-up. Two participants had a decline in MNA score of more than 10% at 12 week follow-up, while the remainder improved by at least 10%. Individualised care including community service coordination was valued by participants. Conclusion: The proposed model of care for older adults was feasible, acceptable to patients and carers, and associated with improved nutritional status at 12 weeks for most participants. The pilot data will be useful for design of intervention trials.

School-community engagement : a critical approach to involving young people in an urban planning project

This study examines the participation of a group of high school students in designing a Heritage Journey as part of an urban redevelopment project in their community. School-community engagement offers young people an opportunity to engage in community life and influence decisions that affect them. Forging links between community and school is becoming more important for teachers as they attempt to create new authentic learning opportunities for young people within a changing world. Increasingly, researchers and urban planners are including children and young people as active decision makers and participants in community engagement projects. However, models of participation tend to be adult-focussed, conceive participation in terms of low to high graduated levels and lack a clearly articulated theoretical basis. The research problem in this study focuses on investigating whether the inclusion of young people in school-community engagement results in value adding to urban planning and is an example of genuine participation. The aim of the study is to provide a theoretically informed, empirically rich understanding of the inclusion of young people in a community engagement strategy for an urban planning project. Theories of space developed by Henri Lefebvre and Edward Soja are drawn upon for understanding how space is understood, used, and redeveloped by the students and other stakeholders. The study also draws on David Harvey’s notion of utopia and space to consider the imaginative possibilities of the students’ designs and ideas. The study uses a participatory research approach and documents the opportunities and challenges of this methodology. The thesis argues that school-community engagement within a "Thirdspace" offers many new opportunities for the emergence of authentic learning situations. Key findings from the study show young people’s participation in an urban planning project can achieve successful results when young people are given opportunities for full participation in decision-making processes; multiple pathways for active engagement are incorporated into the research design; opportunities for mentoring are provided; realistic timelines are communicated to all stakeholders and the needs and social practices of the local community are acknowledged. A new spatial model of community engagement is proposed as an outcome of the study. Unlike previous models of participation, this model demonstrates how exclusion and inclusion can be conceived visually, and may prove effective for conceptualising future community engagement projects that involve young people.

Negative change and job outcomes : the impact of subjective fit in public sector health care organization

There is an ongoing level of organizational-wide change (such as empowerment and downsizing) occurring within the Australian health care sector. However, there is a paucity of empirical evidence on how public and nonprofit sector nurses cope with these organizational-wide change initiatives and their consequences on individual and work outcomes. This will be the primary aim of the current paper. To this end, a path model is developed base on an integration of existing theoretical perspectives on occupational stress, change management, and person-organizational fit. Data were collected from 252 public and not-for-profit sector nurses. The path analysis suggests that public and nonprofit nurses experience positive and negative change initiatives. Negative change initiatives resulted in an increase in the level of administrative-related stressors. Nurses with more congruent values report less experience with administrative stressors. As nurses experienced more administrative stressors, they tend to report more job dissatisfaction. Nurses whose values were more congruent during organizational change reported higher level of psychological wellbeing. Nurses who were had higher level of psychological wellbeing were found to have higher job satisfaction, which subsequently led to a higher level of organizational commitment.

Scenes, quarters and clusters : new experiments in the formation and governance of creative places in China

This thesis examines the formation and governance patterns of the social and spatial concentration of creative people and creative business in cities. It develops a typology for creative places, adding the terms 'scene' and 'quarter' to 'clusters', to fill in the literature gap of partial emphasis on the 'creative clusters' model as an organising mechanism for regional and urban policy. In this framework, a cluster is the gathering of firms with a core focus on economic benefits; a quarter is the urban milieu usually driven by a growth coalition consisting of local government, real estate agents and residential communities; and a scene is the spontaneous assembly of artists, performers and fans with distinct cultural forms. The framework is applied to China, specifically to Hangzhou – a second-tier city in central eastern China that is ambitious to become a 'national cultural and creative industries centre'. The thesis selects three cases – Ideal & Silian 166 Creative Industries Park, White-horse Lake Eco-creative City and LOFT49 Creative Industries Park – to represent scene, quarter and cluster respectively. Drawing on in-depth interviews with initiators, managers and creative professionals of these places, together with extensive documentary analysis, the thesis investigates the composition of actors, characteristics of the locality and the diversity of activities. The findings illustrate that, in China, planning and government intervention is the key to the governance of creative space; spontaneous development processes exist, but these need a more tolerant environment, a greater diversity of cultural forms and more time to develop. Moreover, the main business development model is still real estate based: this model needs to incorporate more mature business models and an enhanced IP protection system. The thesis makes a contribution to literature on economic and cultural geography, urban planning and creative industries theory. It advocates greater attention to self-management, collaborative governance mechanisms and business strategies for scenes, quarters and clusters. As intersections exist in the terms discussed, a mixed toolkit of the three models is required to advance the creative city discourse in China.

Business planning in emerging firms : do nascent and young firms use business planning differently

Previous research suggested that due to the uncertainties surrounding the venture creation process, planning activities may be more valuable for already operating firms than for emerging ventures (McGrath and MacMillan, 1995). Business planning may serve different purposes during the early stages of the venture development process. Early planning during the nascent stage may be used to marshal the resources toward the achievement of preliminary goals (Locke and Latham, 2000), to gain external legitimization and funding (Karlssson & Honig, 2009; Stinchcombe, 1965). Planning may reduce the risk of future failure by facilitating the decision making process of launching -or not- the venture (Chwolka & Raith, 2011) by analysing the opportunity and its market potential (Boyd, 1991; Delmar & Shane, 2003). In later stages, planning may have a more internal role and may act as a strategic implementation tool (Brews & Hunt, 1999). However, if the reasons why ventures should engage (Frese, 2009) –or not- (Honig, 2004) in business planning have been investigated quite extensively (Brinckmann et al., 2010), how business plans are actually used over time by new ventures at different stages of their development and how these uses impact the performance of the firms are still unclear.

Virtual prototyping for planning bridge construction

4D simulation, building information modeling, virtual construction, computer simulation and virtual prototyping are emerging topics in the building construction industry. These techniques not only relate to the buildings themselves, but can also be applied to other forms of construction, including bridges. Since bridge construction is a complex process involving multiple types of plant and equipment, applying such virtual methods benefits the understanding of all parties in construction practice. This paper describes the relationship between temporary platforms, plant and equipment resources and a proposed-built model in the construction planning and use of Virtual Prototyping Simulation (VPS) to implement different construction scenarios in order to help planners identify an optimal construction plan. A case study demonstrates the use of VPS integrated with temporary platform design and plant and equipment-resource allocation to generate different construction scenarios.

Malnutrition screening tools : comparison against two validated nutrition assessment methods in older medical inpatients

Objective Although several validated nutritional screening tools have been developed to “triage” inpatients for malnutrition diagnosis and intervention, there continues to be debate in the literature as to which tool/tools clinicians should use in practice. This study compared the accuracy of seven validated screening tools in older medical inpatients against two validated nutritional assessment methods. Methods This was a prospective cohort study of medical inpatients at least 65 y old. Malnutrition screening was conducted using seven tools recommended in evidence-based guidelines. Nutritional status was assessed by an accredited practicing dietitian using the Subjective Global Assessment (SGA) and the Mini-Nutritional Assessment (MNA). Energy intake was observed on a single day during first week of hospitalization. Results In this sample of 134 participants (80 ± 8 y old, 50% women), there was fair agreement between the SGA and MNA (κ = 0.53), with MNA identifying more “at-risk” patients and the SGA better identifying existing malnutrition. Most tools were accurate in identifying patients with malnutrition as determined by the SGA, in particular the Malnutrition Screening Tool and the Nutritional Risk Screening 2002. The MNA Short Form was most accurate at identifying nutritional risk according to the MNA. No tool accurately predicted patients with inadequate energy intake in the hospital. Conclusion Because all tools generally performed well, clinicians should consider choosing a screening tool that best aligns with their chosen nutritional assessment and is easiest to implement in practice. This study confirmed the importance of rescreening and monitoring food intake to allow the early identification and prevention of nutritional decline in patients with a poor intake during hospitalization.

Strategic planning in a non profit organistion : valuing the process

Non-profit organisations by their very nature are staffed by a variety of different people with a range of backgrounds, experiences and reasons for participation. These differences can lead to “distancing” of certain groups and with little time or money for boundary spanning the organisation can find itself in a fractured state that hampers not just its goal realisation, but its goal determination. Strategic planning is often seen as an expensive, time consuming process that many smaller non-profit organisations can little afford to indulge in. In addition, the ruling elite, whether historical or professional may view the process as unnecessary or threatening. However, strategic planning can offer processes and potential outcomes that non profit organisations can not afford to ignore. This paper provides an analysis through one case study involving a non-profit, health related organisation that moved through a process of strategic planning that ultimately encouraged development and group cohesion through goal identification and determination as well as strategy formulation. The results indicate the importance of valuing the strategic planning process itself rather than the form it takes. Challenging the rulership of the historical or professional elite can be difficult in a non-profit organisation, but diversity of involvement rather than uniformity proved to be a successful strategy. Organisational cohesion through consensus building was the ultimate outcome.

The emerging role of private health care provision in China : a critical analysis of the current health system

China continues to face great challenges in meeting the health needs of its large population. The challenges are not just lack of resources, but also how to use existing resources more efficiently, more effectively, and more equitably. Now a major unaddressed challenge facing China is how to reform an inefficient, poorly organized health care delivery system. The objective of this study is to analyze the role of private health care provision in China and discuss the implications of increasing private-sector development for improving health system performance. This study is based on an extensive literature review, the purpose of which was to identify, summarize, and evaluate ideas and information on private health care provision in China. In addition, the study uses secondary data analysis and the results of previous study by the authors to highlight the current situation of private health care provision in one province of China. This study found that government-owned hospitals form the backbone of the health care system and also account for most health care service provision. However, even though the public health care system is constantly trying to adapt to population needs and improve its performance, there are many problems in the system, such as limited access, low efficiency, poor quality, cost inflation, and low patient satisfaction. Currently, private hospitals are relatively rare, and private health care as an important component of the health care system in China has received little policy attention. It is argued that policymakers in China should recognize the role of private health care provision for health system performance, and then define and achieve an appropriate role for private health care provision in helping to respond to the many challenges facing the health system in present-day China.

Embedding human expert cognition and real-time trajectory planning in autonomous UAS

This thesis presents a new approach to compute and optimize feasible three dimensional (3D) flight trajectories using aspects of Human Decision Making (HDM) strategies, for fixed wing Unmanned Aircraft (UA) operating in low altitude environments in the presence of real time planning deadlines. The underlying trajectory generation strategy involves the application of Manoeuvre Automaton (MA) theory to create sets of candidate flight manoeuvres which implicitly incorporate platform dynamic constraints. Feasible trajectories are formed through the concatenation of predefined flight manoeuvres in an optimized manner. During typical UAS operations, multiple objectives may exist, therefore the use of multi-objective optimization can potentially allow for convergence to a solution which better reflects overall mission requirements and HDM preferences. A GUI interface was developed to allow for knowledge capture from a human expert during simulated mission scenarios. The expert decision data captured is converted into value functions and corresponding criteria weightings using UTilite Additive (UTA) theory. The inclusion of preferences elicited from HDM decision data within an Automated Decision System (ADS) allows for the generation of trajectories which more closely represent the candidate HDM’s decision strategies. A novel Computationally Adaptive Trajectory Decision optimization System (CATDS) has been developed and implemented in simulation to dynamically manage, calculate and schedule system execution parameters to ensure that the trajectory solution search can generate a feasible solution, if one exists, within a given length of time. The inclusion of the CATDS potentially increases overall mission efficiency and may allow for the implementation of the system on different UAS platforms with varying onboard computational capabilities. These approaches have been demonstrated in simulation using a fixed wing UAS operating in low altitude environments with obstacles present.