Pandemic (H1N1) 2009 Influenza Outbreak in Australia: Impact on Emergency Departments.

Executive summary Objective: The aims of this study were to identify the impact of Pandemic (H1N1) 2009 Influenza on Australian Emergency Departments (EDs) and their staff, and to inform planning, preparedness, and response management arrangements for future pandemics, as well as managing infectious patients presenting to EDs in everyday practice. Methods This study involved three elements: 1. The first element of the study was an examination of published material including published statistics. Standard literature research methods were used to identify relevant published articles. In addition, data about ED demand was obtained from Australian Government Department of Health and Ageing (DoHA) publications, with several state health departments providing more detailed data. 2. The second element of the study was a survey of Directors of Emergency Medicine identified with the assistance of the Australasian College for Emergency Medicine (ACEM). This survey retrieved data about demand for ED services and elicited qualitative comments on the impact of the pandemic on ED management. 3. The third element of the study was a survey of ED staff. A questionnaire was emailed to members of three professional colleges—the ACEM; the Australian College of Emergency Nursing (ACEN); and the College of Emergency Nursing Australasia (CENA). The overall response rate for the survey was 18.4%, with 618 usable responses from 3355 distributed questionnaires. Topics covered by the survey included ED conditions during the (H1N1) 2009 influenza pandemic; information received about Pandemic (H1N1) 2009 Influenza; pandemic plans; the impact of the pandemic on ED staff with respect to stress; illness prevention measures; support received from others in work role; staff and others’ illness during the pandemic; other factors causing ED staff to miss work during the pandemic; and vaccination against Pandemic (H1N1) 2009 Influenza. Both qualitative and quantitative data were collected and analysed. Results: The results obtained from Directors of Emergency Medicine quantifying the impact of the pandemic were too limited for interpretation. Data sourced from health departments and published sources demonstrated an increase in influenza-like illness (ILI) presentations of between one and a half and three times the normal level of presentations of ILIs. Directors of Emergency Medicine reported a reasonable level of preparation for the pandemic, with most reporting the use of pandemic plans that translated into relatively effective operational infection control responses. Directors reported a highly significant impact on EDs and their staff from the pandemic. Growth in demand and related ED congestion were highly significant factors causing distress within the departments. Most (64%) respondents established a ‘flu clinic’ either as part of Pandemic (H1N1) 2009 Influenza Outbreak in Australia: Impact on Emergency Departments. the ED operations or external to it. They did not note a significantly higher rate of sick leave than usual. Responses relating to the impact on staff were proportional to the size of the colleges. Most respondents felt strongly that Pandemic (H1N1) 2009 Influenza had a significant impact on demand in their ED, with most patients having low levels of clinical urgency. Most respondents felt that the pandemic had a negative impact on the care of other patients, and 94% revealed some increase in stress due to lack of space for patients, increased demand, and filling staff deficits. Levels of concern about themselves or their family members contracting the illness were less significant than expected. Nurses displayed significantly higher levels of stress overall, particularly in relation to skill-mix requirements, lack of supplies and equipment, and patient and patients’ family aggression. More than one-third of respondents became ill with an ILI. Whilst respondents themselves reported taking low levels of sick leave, respondents cited difficulties with replacing absent staff. Ranked from highest to lowest, respondents gained useful support from ED colleagues, ED administration, their hospital occupational health department, hospital administration, professional colleges, state health department, and their unions. Respondents were generally positive about the information they received overall; however, the volume of information was considered excessive and sometimes inconsistent. The media was criticised as scaremongering and sensationalist and as being the cause of many unnecessary presentations to EDs. Of concern to the investigators was that a large proportion (43%) of respondents did not know whether a pandemic plan existed for their department or hospital. A small number of staff reported being redeployed from their usual workplace for personal risk factors or operational reasons. As at the time of survey (29 October –18 December 2009), 26% of ED staff reported being vaccinated against Pandemic (H1N1) 2009 Influenza. Of those not vaccinated, half indicated they would ‘definitely’ or ‘probably’ not get vaccinated, with the main reasons being the vaccine was ‘rushed into production’, ‘not properly tested’, ‘came out too late’, or not needed due to prior infection or exposure, or due to the mildness of the disease. Conclusion: Pandemic (H1N1) 2009 Influenza had a significant impact on Australian Emergency Departments. The pandemic exposed problems in existing plans, particularly a lack of guidelines, general information overload, and confusion due to the lack of a single authoritative information source. Of concern was the high proportion of respondents who did not know if their hospital or department had a pandemic plan. Nationally, the pandemic communication strategy needs a detailed review, with more engagement with media networks to encourage responsible and consistent reporting. Also of concern was the low level of immunisation, and the low level of intention to accept vaccination. This is a problem seen in many previous studies relating to seasonal influenza and health care workers. The design of EDs needs to be addressed to better manage infectious patients. Significant workforce issues were confronted in this pandemic, including maintaining appropriate staffing levels; staff exposure to illness; access to, and appropriate use of, personal protective equipment (PPE); and the difficulties associated with working in PPE for prolonged periods. An administrative issue of note was the reporting requirement, which created considerable additional stress for staff within EDs. Peer and local support strategies helped ensure staff felt their needs were provided for, creating resilience, dependability, and stability in the ED workforce. Policies regarding the establishment of flu clinics need to be reviewed. The ability to create surge capacity within EDs by considering staffing, equipment, physical space, and stores is of primary importance for future pandemics.

Expected safety performance of rural signalized intersections in South Korea

Understanding the expected safety performance of rural signalized intersections is critical for (a) identifying high-risk sites where the observed safety performance is substantially worse than the expected safety performance, (b) understanding influential factors associated with crashes, and (c) predicting the future performance of sites and helping plan safety-enhancing activities. These three critical activities are routinely conducted for safety management and planning purposes in jurisdictions throughout the United States and around the world. This paper aims to develop baseline expected safety performance functions of rural signalized intersections in South Korea, which to date have not yet been established or reported in the literature. Data are examined from numerous locations within South Korea for both three-legged and four-legged configurations. The safety effects of a host of operational and geometric variables on the safety performance of these sites are also examined. In addition, supplementary tables and graphs are developed for comparing the baseline safety performance of sites with various geometric and operational features. These graphs identify how various factors are associated with safety. The expected safety prediction tables offer advantages over regression prediction equations by allowing the safety manager to isolate specific features of the intersections and examine their impact on expected safety. The examination of the expected safety performance tables through illustrated examples highlights the need to correct for regression-to-the-mean effects, emphasizes the negative impacts of multicollinearity, shows why multivariate models do not translate well to accident modification factors, and illuminates the need to examine road safety carefully and methodically. Caveats are provided on the use of the safety performance prediction graphs developed in this paper.

Integrating information security policy management with corporate risk management for strategic alignment

Information security policy defines the governance and implementation strategy for information security in alignment with the corporate risk policy objectives and strategies. Research has established that alignment between corporate concerns may be enhanced when strategies are developed concurrently using the same development process as an integrative relationship is established. Utilizing the corporate risk management framework for security policy management establishes such an integrative relationship between information security and corporate risk management objectives and strategies. There is however limitation in the current literature on presenting a definitive approach that fully integrates security policy management with the corporate risk management framework. This paper presents an approach that adopts a conventional corporate risk management framework for security policy development and management to achieve alignment with the corporate risk policy. A case example is examined to illustrate the alignment achieved in each process step with a security policy structure being consequently derived in the process. It is shown that information security policy management outcomes become both integral drivers and major elements of the corporate-level risk management considerations. Further study should involve assessing the impact of the use of the proposed framework in enhancing alignment as perceived in this paper.

Developing risk assessment tools for fleet settings : where to from here?

The costs of work-related crashes In Australia and overseas, fleet safety or work-related road safety is an issue gaining increased attention from researchers, organisations, road safety practitioners and the general community. This attention is primarily in response to the substantial physical, emotional and economic costs associated with work-related road crashes. The increased risk factors and subsequent costs of work-related driving are also now well documented in the literature. For example, it is noteworthy that research has demonstrated that work-related drivers on average report a higher level of crash involvement compared to personal car drivers (Downs et al., 1999; Kweon and Kockelman, 2003) and in particular within Australia, road crashes are the most common form of work-related fatalities (Haworth et al., 2000).

A systematic review of the association between physical activity and colorectal cancer risk

This review evaluated the strength of the evidence for a causal relationship between physical activity (PA) and colorectal cancer (CRC). A systematic review of databases through February 2008 was conducted to identify studies that assessed the association between total or recreational PA and incidence or mortality of CRC (including CRC, rectal cancer, colon cancer, and proximal or distal colon cancer). Studies were evaluated for significant associations between PA and risk of CRC endpoints and for evidence of dose–response relationships in the highest quality studies. Twenty cohort studies were evaluated; 11 were high-quality. Fifty percent of all studies and 64%of highest quality studies reported at least one significant association between PA and risk of a CRC endpoint (Po0.05).However, only 28%of all analyses (31% of analyses of highest quality studies) were significant (Po0.05). Only 40% of analyses of highest quality studies resulted in a significant P for trend (Po0.05); however, a non-significant inverse linear association between PA and colon cancer riskwas apparent.Heterogeneity in the evidence from all studies and from the highest quality studies was evident. Evidence from cohort studies is not sufficient to claim a convincing relationship exists between PA and CRC risk.

Multiple indicators of ambient and personal ultraviolet radiation exposure and risk of non-Hodgkin lymphoma (United States)

Recent epidemiologic studies have suggested that ultraviolet radiation (UV) may protect against non-Hodgkin lymphoma (NHL), but few, if any, have assessed multiple indicators of ambient and personal UV exposure. Using the US Radiologic Technologists study, we examined the association between NHL and self-reported time outdoors in summer, as well as average year-round and seasonal ambient exposures based on satellite estimates for different age periods, and sun susceptibility in participants who had responded to two questionnaires (1994–1998, 2003–2005) and who were cancer-free as of the earlier questionnaire. Using unconditional logistic regression, we estimated the odds ratio (OR) and 95% confidence intervals for 64,103 participants with 137 NHL cases. Self-reported time outdoors in summer was unrelated to risk. Lower risk was somewhat related to higher average year-round and winter ambient exposure for the period closest in time, and prior to, diagnosis (ages 20–39). Relative to 1.0 for the lowest quartile of average year-round ambient UV, the estimated OR for successively higher quartiles was 0.68 (0.42–1.10); 0.82 (0.52–1.29); and 0.64 (0.40–1.03), p-trend = 0.06), for this age period. The lower NHL risk associated with higher year-round average and winter ambient UV provides modest additional support for a protective relationship between UV and NHL.

Understanding the impact of strategic alignment on the operational performance of post implemented technological innovations

Purpose – The purpose of this paper is to examine the role of three strategies - organisational, business and information system – in post implementation of technological innovations. The findings reported in the paper are that improvements in operational performance can only be achieved by aligning technological innovation effectiveness with operational effectiveness. Design/methodology/approach – A combination of qualitative and quantitative methods was used to apply a two-stage methodological approach. Unstructured and semi structured interviews, based on the findings of the literature, were used to identify key factors used in the survey instrument design. Confirmatory factor analysis (CFA) was used to examine structural relationships between the set of observed variables and the set of continuous latent variables. Findings – Initial findings suggest that organisations looking for improvements in operational performance through adoption of technological innovations need to align with operational strategies of the firm. Impact of operational effectiveness and technological innovation effectiveness are related directly and significantly to improved operational performance. Perception of increase of operational effectiveness is positively and significantly correlated with improved operational performance. The findings suggest that technological innovation effectiveness is also positively correlated with improved operational performance. However, the study found that there is no direct influence of strategiesorganisational, business and information systems (IS) - on improvement of operational performance. Improved operational performance is the result of interactions between the implementation of strategies and related outcomes of both technological innovation and operational effectiveness. Practical implications – Some organisations are using technological innovations such as enterprise information systems to innovate through improvements in operational performance. However, they often focus strategically only on effectiveness of technological innovation or on operational effectiveness. Such a focus will be detrimental in the long-term of the enterprise. This research demonstrated that it is not possible to achieve maximum returns through technological innovations as dimensions of operational effectiveness need to be aligned with technological innovations to improve their operational performance. Originality/value – No single technological innovation implementation can deliver a sustained competitive advantage; rather, an advantage is obtained through the capacity of an organisation to exploit technological innovations’ functionality on a continuous basis. To achieve sustainable results, technology strategy must be aligned with organisational and operational strategies. This research proposes the key performance objectives and dimensions that organisations should focus to achieve a strategic alignment. Research limitations/implications – The principal limitation of this study is that the findings are based on investigation of small sample size. There is a need to explore the appropriateness of influence of scale prior to generalizing the results of this study.

Persons with age-related maculopathy risk genotypes and clinically normal eyes have reduced mesopic vision

PURPOSE: To determine if participants with normal visual acuity, no ophthalmoscopically signs of age-related maculopathy (ARM) in both eyes and who are carriers of the CFH, LOC387715 and HRTA1 high-risk genotypes (“gene-positive”) have impaired rod- and cone-mediated mesopic visual function compared to persons who do not carry the risk genotypes (“gene-negative”).---------- METHODS: Fifty-three Caucasian study participants (mean 55.8 ± 6.1) were genotyped for CFH, LOC387715/ARMS2 and HRTA1 polymorphisms. We genotyped single nucleotide polymorphisms (SNPs) in the CFH (rs380390), LOC387715/ARMS2 (rs10490924) and HTRA1 (rs11200638) genes using Applied Biosystems optimised TaqMan assays. We determined the critical fusion frequency (CFF) mediated by cones alone (Long, Middle and Short wavelength sensitive cones; LMS) and by the combined activities of cones and rods (LMSR). The stimuli were generated using a 4-primary photostimulator that provides independent control of the photoreceptor excitation under mesopic light levels. Visual function was further assessed using standard clinical tests, flicker perimetry and microperimetry.---------- RESULTS: The mesopic CFF mediated by rods and cones (LMSR) was significantly reduced in gene-positive compared to gene-negative participants after correction for age (p=0.03). Cone-mediated CFF (LMS) was not significantly different between gene-positive and -negative participants. There were no significant associations between flicker perimetry and microperimetry and genotype.---------- CONCLUSIONS: This is the first study to relate ARM risk genotypes with mesopic visual function in clinically normal persons. These preliminary results could become of clinical importance as mesopic vision may be used to document sub-clinical retinal changes in persons with risk genotypes and to determine whether those persons progress into manifest disease.

Fashion as consumer entrepreneurship : emergent risk culture, social network markets, and the launch of Vogue in China

China has a reputation as an economy based on utility: the large-scale manufacture of low-priced goods. But useful values like functionality, fitness for purpose and efficiency are only part of the story. More important are what Veblen called ‘honorific’ values, arguably the driving force of development, change and value in any economy. To understand the Chinese economy therefore, it is not sufficient to point to its utilitarian aspect. Honorific status-competition is a more fundamental driver than utilitarian cost-competition. We argue that ‘social network markets’ are the expression of these honorific values, relationships and connections that structure and coordinate individual choices. This paper explores how such markets are developing in China in the area of fashion and fashion media. These, we argue, are an expression of ‘risk culture’ for high-end entrepreneurial consumers and producers alike, providing a stimulus to dynamic innovation in the arena of personal taste and comportment, as part of an international cultural system based on constant change. We examine the launch of Vogue China in 2005, and China’s reception as a fashion player among the international editions of Vogue, as an expression of a ‘decisive moment’ in the integration of China into an international social network market based on honorific values.

Turn-around pedagogies: improving the education of at-risk students

Internationally, normative discourses about literacy standards have rapidly proliferated, and spaces for teachers to engage in serious intellectual inquiry seem to be shutting down. Our concern about the impact of these forces on teachers led us to design a cross-generational teacher research project across two states of Australia to tackle some of the toughest challenges teachers face in their workplaces, including the issue of unequal outcomes in literacy achievement. In this article we report on how the project design sustained an intellectual community of inquiry and fostered ‘turn-around pedagogies'. We include excerpts from recent teacher writing (Comber and Kamler, 2005) to illustrate how teachers used technology and popular culture to reengage their most at-risk students. We argue that crossgenerational models of practitioner inquiry hold great promise for improving the learning engagement of students, the productivity of schools and the professional renewal of the teacher workforce.

Crash risk estimation and assessment tool

Currently in Australia, there are no decision support tools for traffic and transport engineers to assess the crash risk potential of proposed road projects at design level. A selection of equivalent tools already exists for traffic performance assessment, e.g. aaSIDRA or VISSIM. The Urban Crash Risk Assessment Tool (UCRAT) was developed for VicRoads by ARRB Group to promote methodical identification of future crash risks arising from proposed road infrastructure, where safety cannot be evaluated based on past crash history. The tool will assist practitioners with key design decisions to arrive at the safest and the most cost -optimal design options. This paper details the development and application of UCRAT software. This professional tool may be used to calculate an expected mean number of casualty crashes for an intersection, a road link or defined road network consisting of a number of such elements. The mean number of crashes provides a measure of risk associated with the proposed functional design and allows evaluation of alternative options. The tool is based on historical data for existing road infrastructure in metropolitan Melbourne and takes into account the influence of key design features, traffic volumes, road function and the speed environment. Crash prediction modelling and risk assessment approaches were combined to develop its unique algorithms. The tool has application in such projects as road access proposals associated with land use developments, public transport integration projects and new road corridor upgrade proposals.

Health risk from the use of roof-harvested rainwater in Southeast Queensland, Australia, as potable or nonpotable water, determined using quantitative microbial risk assessment

A total of 214 rainwater samples from 82 tanks were collected in urban Southeast Queensland (SEQ) in Australia and analysed for the zoonotic bacterial and protozoan pathogen using real-time binary PCR and quantitative PCR (qPCR). Quantitative Microbial Risk Assessment (QMRA) analysis was used to quantify the risk of infection associated with the exposure to potential pathogens from potable and non-potable uses of roof-harvested rainwater. Of the 214 samples tested, 10.7%, 9.8%, and 5.6%, and 0.4% samples were positive for Salmonella invA, Giardia lamblia β-giardin , Legionella pneumophila mip, and Campylobacter jejuni mapA genes. Cryptosporidium parvum could not be detected. The estimated numbers of viable Salmonella spp., G. lamblia β-giradin, and L. pneumophila genes ranged from 1.6 × 101 to 9.5 × 101 cells, 1.4 × 10-1 to 9.0 × 10-1 cysts, and 1.5 × 101 to 4.3 × 101 per 1000 ml of water, respectively. Six risk scenarios were considered from exposure to Salmonella spp., G. lamblia and L. pneumophila. For Salmonella spp., and G. lamblia, these scenarios were: (1) liquid ingestion due to drinking of rainwater on a daily basis (2) accidental liquid ingestion due to garden hosing twice a week (3) aerosol ingestion due to showering on a daily basis, and (4) aerosol ingestion due to hosing twice a week. For L. pneumophila, these scenarios were: (5) aerosol inhalation due to showering on a daily basis, and (6) aerosol inhalation due to hosing twice a week. The risk of infection from Salmonella spp., G. lamblia, and L. pneumophila associated with the use of rainwater for showering and garden hosing was calculated to be well below the threshold value of one extra infection per 10,000 persons per year in urban SEQ. However, the risk of infection from ingesting Salmonella spp. and G. lamblia via drinking exceeds this threshold value, and indicates that if undisinfected rainwater were ingested by drinking, then the gastrointestinal diseases of Salmonellosis and Giardiasis is expected to range from 5.0 × 100 to 2.8 × 101 (Salmonellosis) and 1.0 × 101 to 6.4 × 101 (Giardiasis) cases per 10,000 persons per year, respectively. Since this health risk seems higher than that expected from the reported incidences of gastroenteritis, the assumptions used to estimate these infection risks are critically examined. Nonetheless, it would seem prudent to disinfect rainwater for potable use.

The organisation : risk, resilience and governance

Tarrant argues that a solid risk management strategy is critical to building effective, transformational and adaptive organisations. Organisations are a fundamental part of our society and economic system whether they are private, public or not-for-profits. There are very few aspects of our society and economy that don’t rely wholly or in part on the performance of organisations. Disasters and crises are complex and very challenging environments for organisations. How can effective transformational and adaptive capacity become institutionalised and a core part of good governance of organisations? Effective risk management is a critical element in meeting organisational objectives in a turbulent and uncertain environment.

Diarrhoea risk factors in enterally tube fed critically ill patients : a retrospective audit

Objective: Diarrhoea in the enterally tube fed (ETF) intensive care unit (ICU) patient is a multifactorial problem. Diarrhoeal aetiologies in this patient cohort remain debatable; however, the consequences of diarrhoea have been well established and include electrolyte imbalance, dehydration, bacterial translocation, peri anal wound contamination and sleep deprivation. This study examined the incidence of diarrhoea and explored factors contributing to the development of diarrhoea in the ETF, critically ill, adult patient. ---------- Method: After institutional ethical review and approval, a single centre medical chart audit was undertaken to examine the incidence of diarrhoea in ETF, critically ill patients. Retrospective, non-probability sequential sampling was used of all emergency admission adult ICU patients who met the inclusion/exclusion criteria. ---------- Results: Fifty patients were audited. Faecal frequency, consistency and quantity were considered important criteria in defining ETF diarrhoea. The incidence of diarrhoea was 78%. Total patient diarrhoea days (r = 0.422; p = 0.02) and total diarrhoea frequency (r = 0.313; p = 0.027) increased when the patient was ETF for longer periods of time. Increased severity of illness, peripheral oxygen saturation (Sp02), glucose control, albumin and white cell count were found to be statistically significant factors for the development of diarrhoea. ---------- Conclusion: Diarrhoea in ETF critically ill patients is multi-factorial. The early identification of diarrhoea risk factors and the development of a diarrhoea risk management algorithm is recommended.