Contribution of thickened drinks, food and enteral and parenteral fluids to fluid intake in hospitalised patients with dysphagia

Background Studies amongst older people with acute dysphagic stroke requiring thickened fluids have assessed fluid intakes from combinations of beverage, food, enteral and parenteral sources, but not all sources simultaneously. The study aimed to comprehensively assess total water intake from food, beverages, enteral and parenteral sources amongst dysphagic adult in-patients receiving thickened fluids. Methods Patients requiring thickened fluid following dysphagia diagnosis were recruited consecutively from a tertiary teaching hospital’s medical and neurosurgical wards. Fluid intake from food and beverages was assessed by wastage, direct observation and quantified from enteral and parenteral sources through clinical medical records. Results No patients achieved their calculated fluid requirements unless enteral or parenteral fluids were received. The mean daily fluid intake from food was greater than from beverages whether receiving diet alone (food 807±363mL, food and beverages 370±179mL, p<0.001) or diet with enteral or parenteral fluid support (food 455±408mL, food and beverages 263±232mL, p<0.001). Greater daily fluid intakes occurred when receiving enteral and parenteral fluid in addition to oral dietary intake, irrespective of age group, whether assistance was required, diagnosis and whether stage 3 or stage 2 thickened fluids were required (p<0.05). After enteral and parenteral sources, food provided the most important contribution to daily fluid intakes. Conclusions The greatest contribution to oral fluid intake was from food, not beverages. Designing menus and food services which promote and encourage the enjoyment of fluid dense foods, in contrast to thickened beverages, may present an important way to improve fluid intakes of those with dysphagia. Supplemental enteral or parenteral fluid may be necessary to achieve minimum calculated fluid requirements.

Adaptation of Sudanese refugees in an Australian context : investigating helps and hindrances

The present study investigates the experiences of Sudanese refugees by exploring the themes that characterise participants’ experiences in Sudan, en route, and at their Australian destination. In particular, the research identifies several factors that may be seen as ‘helps’ or ‘hindrances’ to Sudanese refugees’ adaptation. Participants were 12 Sudanese refugees aged between 19 and 40 years who had been residing in Australia for five years or less. A qualitative phenomenological approach to data collection and analysis was employed. Examination of the interview transcripts revealed that all participants identified both ‘hindrances’ and ‘helps’ toward adaptation and indicated that positive adaptation is not only possible, but probable for Sudanese refugees in spite of their past experiences of trauma and present resettlement difficulties. Several practical implications were elicited from the research including a need for programs that actively promote refugees’ adaptation by encouraging the broadening of social networks.

Framework and processes for enhancing sustainability deliverables in Australian road infrastructure projects

Road and highway infrastructure provides the backbone for a nation’s economic growth. The versatile dispersion of population in Australia and its resource boom, coupled with improved living standards and growing societal expectations, calls for continuing development and improvement of road infrastructure under the current local, state and federal governments’ policies and strategic plans. As road infrastructure projects involve huge resources and mechanisms, achieving sustainability not only on economic scales but also through environmental and social responsibility becomes a crucial issue. While sustainability is a logical link to infrastructure development, literature study and consultation with the industry found that there is a lack of common understanding on what constitutes sustainability in the infrastructure context. Its priorities are often interpreted differently among multiple stakeholders. For road infrastructure projects which typically span over long periods of time, achieving tangible sustainability outcomes during the lifecycle of development remains a formidable task. Sustainable development initiatives often remain ideological as in macro-level policies and broad-based concepts. There were little elaboration and exemplar cases on how these policies and concepts can be translated into practical decision-making during project implementation. In contrast, there seemed to be over commitment on research and development of sustainability assessment methods and tools. Between the two positions, there is a perception-reality gap and mismatch, specifically on how to enhance sustainability deliverables during infrastructure project delivery. Review on past research in this industry sector also found that little has been done to promote sustainable road infrastructure development; this has wide and varied potential impacts. This research identified the common perceptions and expectations by different stakeholders towards achieving sustainability in road and highway infrastructure projects. Face to face interviews on selected representatives of these stakeholders were carried out in order to select and categorize, confirm and prioritize a list of sustainability performance targets identified through literature and past research. A Delphi study was conducted with the assistance of a panel of senior industry professionals and academic experts, which further considered the interrelationship and influence of the sustainability indicators, and identified critical sustainability indicators under ten critical sustainability criteria (e.g. Environmental, Health & Safety, Resource Utilization & Management, Social & Cultural, Economic, Public Governance & Community Engagement, Relations Management, Engineering, Institutional and Project Management). This presented critical sustainability issues that needed to be addressed at the project level. Accordingly, exemplar highway development projects were used as case studies to elicit solutions for the critical issues. Through the identification and integration of different perceptions and priority needs of the stakeholders, as well as key sustainability indicators and solutions for critical issues, a set of decision-making guidelines was developed to promote and drive consistent sustainability deliverables in road infrastructure projects.

ACE's role in developing Australia's human capital : a structural analysis

This project explored ways in which Adult and Community Education (ACE) could make a greater contribution to the human capital development outcome under the National Reform Agenda (NRA), and increase the number of skilled workers in Australia. Data on current vocational and non-vocational ACE programs was analysed. Strategies to improve ACE were collated for consideration by government authorities and ACE providers. There is much diversity in the perceived role and activities of ACE. Researchers have found it challenging to create a profile that depicts the whole sector, particularly in the absence of much reliable, valid and comparable data on ACE activities and outcomes. However, there is evidence indicative of ACE’s assistance in re-engaging with learning and training, and initiating pathways to further training or employment. The potential for ACE to make a bigger contribution to skilling Australia is recognised by governments across the nation (Senate Employment, Workplace Relations, Small Business and Education Committee, 1997). Yet policy changes to facilitate an increased role of ACE in the skilling process, and resourcing for ACE programs continue to receive less attention. This project explored three research questions: • What does the current profile of the ACE sector look like? • How is ACE contributing to reducing the skills deficit? • How can ACE enhance its contributions to reduce the skills deficit and achieve the human capital development outcome of the National Reform Agenda? The responsiveness

The conceptualisation, sensitivity and measurement of holding costs and other selected elements impacting housing affordability (Literature review and research methodology for confirmation of PhD candidature)

It is widely held that strong relationships exist between housing, economic status, and well being. This is exemplified by widespread housing stock surpluses in many countries which threaten to destabilise numerous aspects related to individuals and community. However, the position of housing demand and supply is not consistent. The Australian position provides a distinct contrast whereby seemingly inexorable housing demand generally remains a critical issue affecting the socio-economic landscape. Underpinned by high levels of immigration, and further buoyed by sustained historically low interest rates, increasing income levels, and increased government assistance for first home buyers, this strong housing demand ensures elements related to housing affordability continue to gain prominence. A significant, but less visible factor impacting housing affordability – particularly new housing development – relates to holding costs. These costs are in many ways “hidden” and cannot always be easily identified. Although it is only one contributor, the nature and extent of its impact requires elucidation. In its simplest form, it commences with a calculation of the interest or opportunity cost of land holding. However, there is significantly more complexity for major new developments - particularly greenfield property development. Preliminary analysis conducted by the author suggests that even small shifts in primary factors impacting holding costs can appreciably affect housing affordability – and notably, to a greater extent than commonly held. Even so, their importance and perceived high level impact can be gauged from the unprecedented level of attention policy makers have given them over recent years. This may be evidenced by the embedding of specific strategies to address burgeoning holding costs (and particularly those cost savings associated with streamlining regulatory assessment) within statutory instruments such as the Queensland Housing Affordability Strategy, and the South East Queensland Regional Plan. However, several key issues require investigation. Firstly, the computation and methodology behind the calculation of holding costs varies widely. In fact, it is not only variable, but in some instances completely ignored. Secondly, some ambiguity exists in terms of the inclusion of various elements of holding costs, thereby affecting the assessment of their relative contribution. Perhaps this may in part be explained by their nature: such costs are not always immediately apparent. Some forms of holding costs are not as visible as the more tangible cost items associated with greenfield development such as regulatory fees, government taxes, acquisition costs, selling fees, commissions and others. Holding costs are also more difficult to evaluate since for the most part they must be ultimately assessed over time in an ever-changing environment, based on their strong relationship with opportunity cost which is in turn dependant, inter alia, upon prevailing inflation and / or interest rates. By extending research in the general area of housing affordability, this thesis seeks to provide a more detailed investigation of those elements related to holding costs, and in so doing determine the size of their impact specifically on the end user. This will involve the development of soundly based economic and econometric models which seek to clarify the componentry impacts of holding costs. Ultimately, there are significant policy implications in relation to the framework used in Australian jurisdictions that promote, retain, or otherwise maximise, the opportunities for affordable housing.

The land use and public transport accessibility index : phase two final report

The Urban Research Program (URP) was established in 2003 as strategic research and community engagement initiative of Griffith University. The strategic foci of the Urban Research Program are research and advocacy in an urban regional context. The Urban Research Program seeks to improve understanding of, and develop innovative responses to Australia's urban challenges and opportunities by providing training assistance. The authors aim to make the results of their research and advocacy work available as freely and widely as possible.

Coordinated research support services at Queensland University of Technology, Australia

Queensland University of Technology (QUT) is a large multidisciplinary university located in Brisbane, Queensland, Australia. QUT is increasing its research focus and is developing its research support services. It has adopted a model of collaboration between the Library, High Performance Computing and Research Support (HPC) and more broadly with Information Technology Services (ITS). Research support services provided by the Library include the provision of information resources and discovery services, bibliographic management software, assistance with publishing (publishing strategies, identifying high impact journals, dealing with publishers and the peer review process), citation analysis and calculating authors’ H Index. Research data management services are being developed by the Library and HPC working in collaboration. The HPC group within ITS supports research computing infrastructure, research development and engagement activities, researcher consultation, high speed computation and data storage systems , 2D/ 3D (immersive) visualisation tools, parallelisation and optimization of research codes, statistics/ data modeling training and support (both qualitative and quantitative) and support for the university’s central Access Grid collaboration facility. Development and engagement activities include participation in research grants and papers, student supervision and internships and the sponsorship, incubation and adoption of new computing technologies for research. ITS also provides other services that support research including ICT training, research infrastructure (networking, data storage, federated access and authorization, virtualization) and corporate systems for research administration. Seminars and workshops are offered to increase awareness and uptake of new and existing services. A series of online surveys on eResearch practices and skills and a number of focus groups was conducted to better inform the development of research support services. Progress towards the provision of research support is described within the context organizational frameworks; resourcing; infrastructure; integration; collaboration; change management; engagement; awareness and skills; new services; and leadership. Challenges to be addressed include the need to redeploy existing operational resources toward new research support services, supporting a rapidly growing research profile across the university, the growing need for the use and support of IT in research programs, finding capacity to address the diverse research support needs across the disciplines, operationalising new research support services following their implementation in project mode, embedding new specialist staff roles, cross-skilling Liaison Librarians, and ensuring continued collaboration between stakeholders.

Comprehensive evaluation of driver gaze pattern using fuzzy rules for driver training

The over representation of novice drivers in crashes is alarming. Research indicates that one in five drivers’ crashes within their first year of driving. Driver training is one of the interventions aimed at decreasing the number of crashes that involve young drivers. Currently, there is a need to develop comprehensive driver evaluation system that benefits from the advances in Driver Assistance Systems. Since driving is dependent on fuzzy inputs from the driver (i.e. approximate distance calculation from the other vehicles, approximate assumption of the other vehicle speed), it is necessary that the evaluation system is based on criteria and rules that handles uncertain and fuzzy characteristics of the drive. This paper presents a system that evaluates the data stream acquired from multiple in-vehicle sensors (acquired from Driver Vehicle Environment-DVE) using fuzzy rules and classifies the driving manoeuvres (i.e. overtake, lane change and turn) as low risk or high risk. The fuzzy rules use parameters such as following distance, frequency of mirror checks, gaze depth and scan area, distance with respect to lanes and excessive acceleration or braking during the manoeuvre to assess risk. The fuzzy rules to estimate risk are designed after analysing the selected driving manoeuvres performed by driver trainers. This paper focuses mainly on the difference in gaze pattern for experienced and novice drivers during the selected manoeuvres. Using this system, trainers of novice drivers would be able to empirically evaluate and give feedback to the novice drivers regarding their driving behaviour.

The nine lives of Vietnam's new competition law

Vietnam's present draft of the proposed new Law on Competition is currently in its ninth version. Although there is a need to enact legislation as quickly as possible, Vietnam cannot rush the drafting process. Under its Bilateral Trade Agreement with the USA, Vietnam has committed to improve the quality of its laws and consistency of its legislative framework. Since the Law on Competition will be fundamental in establishing the legal framework for a more coherent and effective competition regime, and will have profound influences on Vietnam's objective of becoming a socialist-oriented market economy, its provisions must be well constructed and well considered, and this takes time. This article shows how the proposed Law is being crafted as compared to older drafts which sheds light on changes in policy during the drafting process. Where possible, the Draft is also compared with the laws in other jurisdictions for any assistance they might lend. In this author's opinion not all the changes are positive but any defects in the draft are not intractable and can be remedied prior to promulgation.

Development of a Resource for Parents with Advanced Cancer: What do Parents Want?

OBJECTIVE: Parents coping with a diagnosis of advanced cancer experience distress and guilt about the impact of the disease on their children but report that there are few resources specific to advanced disease to guide and support them in discussions with their children. Although some resources have been developed to assist parents with advanced cancer, it appears that these are not widely disseminated. METHODS: To determine the need for a brief resource that could be given to parents at the point of diagnosis of advanced cancer, including its content, in-depth interviews were conducted with eight women with advanced breast cancer. RESULTS: Women confirmed that they had received minimal assistance from health professionals in discussing the diagnosis with their children, and even when professional counselors were accessed they were not always attuned to the specific needs of parents with advanced cancer. Women felt frustrated that information they did access focused on early disease and lacked the details women felt they needed in coping with advanced cancer. Women felt that there was a need for a brief resource that reassured parents about the impact of the cancer on their children, including practical strategies to help them cope and examples of the ways other parents had responded to difficult questions such as about parental death. A draft resource was developed, critically reviewed by the participants, and their comments incorporated into a final version. SIGNIFICANCE OF RESULTS: This article expands on the themes highlighted by women as important to assist parents with advanced cancer, including the final resource that was developed.

Virtual product placement as a new approach to measure effectiveness of placements

Product placement is a fast growing multi-billion dollar industry yet measures of its effectiveness, which influence the critical area of pricing, have been problematic. Past attempts to measure the effect of a placement, and therefore provide a basis for pricing of placements, have been confounded by the effect on consumers of multiple prior exposures of a brand name in all marketing communications. Virtual product placement offers certain advantages: as a tool to measure the effectiveness of product placements; assistance with the problem of lack of audience selectivity in traditional product placement; testing different audiences for brands and addressing a gap in the existing academic literature by focusing on the impact of product placement on recall and recognition of new brands.

An investigation of foot and ankle problems experienced by nurses

Relatively little information has been reported about foot and ankle problems experienced by nurses, despite anecdotal evidence which suggests they are common ailments. The purpose of this study was to improve knowledge about the prevalence of foot and ankle musculoskeletal disorders (MSDs) and to explore relationships between these MSDs and proposed risk factors. A review of the literature relating to work-related MSDs, MSDs in nursing, foot and lower-limb MSDs, screening for work-related MSDs, foot discomfort, footwear and the prevalence of foot problems in the community was undertaken. Based on the review, theoretical risk factors were proposed that pertained to the individual characteristics of the nurses, their work activity or their work environment. Three studies were then undertaken. A cross-sectional survey of 304 nurses, working in a large tertiary paediatric hospital, established the prevalence of foot and ankle MSDs. The survey collected information about self-reported risk factors of interest. The second study involved the clinical examination of a subgroup of 40 nurses, to examine changes in body discomfort, foot discomfort and postural sway over the course of a single work shift. Objective measurements of additional risk factors, such as individual foot posture (arch index) and the hardness of shoe midsoles, were performed. A final study was used to confirm the test-retest reliability of important aspects of the survey and key clinical measurements. Foot and ankle problems were the most common MSDs experienced by nurses in the preceding seven days (42.7% of nurses). They were the second most common MSDs to cause disability in the last 12 months (17.4% of nurses), and the third most common MSDs experienced by nurses in the last 12 months (54% of nurses). Substantial foot discomfort (Visual Analogue Scale (VAS) score of 50mm or more) was experienced by 48.5% of nurses at sometime in the last 12 months. Individual risk factors, such as obesity and the number of self-reported foot conditions (e.g., callouses, curled toes, flat feet) were strongly associated with the likelihood of experiencing foot problems in the last seven days or during the last 12 months. These risk factors showed consistent associations with disabling foot conditions and substantial foot discomfort. Some of these associations were dependent upon work-related risk factors, such as the location within the hospital and the average hours worked per week. Working in the intensive care unit was associated with higher odds of experiencing foot problems within the last seven days, foot problems in the last 12 months and foot problems that impaired activity in the last 12 months. Changes in foot discomfort experienced within a day, showed large individual variability. Fifteen of the forty nurses experienced moderate/substantial foot discomfort at the end of their shift (VAS 25+mm). Analysis of the association between risk factors and moderate/substantial foot discomfort revealed that foot discomfort was less likely for nurses who were older, had greater BMI or had lower foot arches, as indicated by higher arch index scores. The nurses’ postural sway decreased over the course of the work shift, suggesting improved body balance by the end of the day. These findings were unexpected. Further clinical studies examining individual nurses on several work shifts are needed to confirm these results, particularly due to the small sample size and the single measurement occasion. There are more than 280,000 nurses registered to practice in Australia. The nursing workforce is ageing and the prevalence of foot problems will increase. If the prevalence estimates from this study are extrapolated to the profession generally, more than 70,000 hospital nurses have experienced substantial foot discomfort and 25-30,000 hospital nurses have been limited in their activity due to foot problems during the last 12 months. Nurses with underlying foot conditions were more likely to report having foot problems at work. Strategies to prevent or manage foot conditions exist and they should be disseminated to nurses. Obesity is a significant risk factor for foot and ankle MSDs and these nurses may need particular assistance to manage foot problems. The risk of foot problems for particular groups of nurses, e.g. obese nurses, may vary depending upon the location within the hospital. Further research is needed to confirm the findings of this study. Similar studies should be conducted in other occupational groups that require workers to stand for prolonged periods.

From ennui to enthusiasm : a playwright’s exploration of dramaturgy

In contemporary Australian theatre there seems to be no precise, universally accepted methodology that defines the dramaturgical process. There is not even agreement as to how a playwright might benefit from dramaturgy. Nevertheless, those engaged in creating original works for the Australian professional theatre have, to varying degrees, come to accept dramaturgical process as something of a necessity. Increasingly, dramaturgical process is evident in the development of new plays by state, flagship and project-based professional theatre producers. Many small to medium theatre companies provide dramaturgical assistance to playwrights although this often occurs in an ad hoc fashion, prescribed by economic restraint rather than artistic sensibility. Through an exploration of the dramaturgical development of two of his plays in several professional play development contexts, the researcher examines issues influencing contemporary dramaturgy in Australia. These plays are presented here as examinable components (weighted 70%) of the research as a whole, and they function in symbiotic relationship with the exegetical enquiry (weighted 30%). The research also presents the findings of a small-scale experiment which tests the hypothesis that a holistic approach to developing new plays might challenge conventional views on dramaturgical process. In terms of its overall conclusions, this research finds that while many playwrights and theatre professionals in Australia consider dramaturgy a distinct and important component of the creative development process, there exist substantial inconsistencies in relation to facilitating dramaturgical models that provide quality artistic outcomes for playwrights and their plays. The study presents unique qualitative and quantitative data as a contribution to knowledge in this field of enquiry, and it is anticipated that the research as a whole will be of interest to a variety of readers, including playwrights, dramaturgs, other theatre practitioners, students and teachers.

Re-envisioning sovereignty : the end of Westphalia?

Fables of sovereignty / Wayne Hudson Sovereignty discourse and practice : past and future / Joseph Camilleri Guises of sovereignty / Gerry Simpson Westphalian and Islamic concepts of sovereignty in the Middle East / Amin Saikal Wither sovereignty in Southeast Asia today? / See Seng Tan Ambivalent sovereignty : China and re-imagining the Westphalian ideal / Yongjin Zhang Confronting terrorism : dilemmas of principle and practice regarding sovereignty / Brian L. Job Sovereignty in the 21st century : security, immigration, and refugees / Howard Adelman State sovereignty and international refugee protection / Robyn Lui Do no harm : towards a Hippocratic standard for international civilisation / Neil Arya Sovereignty and the global politics of the environment : beyond Westphalia? / Lorraine Elliott Westphalian sovereignty in the shadow of international justice? a fresh coat of paint for a tainted concept / Jackson Nyamuya Maogoto Development assistance and the hollow sovereignty of the weak / Roland Rich Corruption and transparency in governance and development : reinventing sovereignty for promoting good governance / C. Raj Kumar Re-envisioning economic sovereignty : developing countries and the International Monetary Fund / Ross P. Buckley Trust, legitimacy, and the sharing of sovereignty / William Maley Sovereignty as indirect rule / Barry Hindess Indigenous sovereignty / Paul Keal Civil society in a post-statist circumstance / Jan Aart Scholte.