Framework for assessing the influence of critical infrastructure interdependencies in post-disaster reconstruction management

Due to ever increasing climate instability, the number of natural disasters affecting society and communities is expected to increase globally in the future, which will result in a growing number of casualties and damage to property and infrastructure. Such damage poses crucial challenges for recovery of interdependent critical infrastructures. Post-disaster reconstruction is a complex undertaking as it is not only closely linked to the well-being and essential functioning of society, but also requires a large financial commitment. Management of critical infrastructure during post-disaster recovery needs to be underpinned by a holistic recognition that the recovery of each individual infrastructure system (e.g. energy, water, transport and information and communication technology) can be affected by the interdependencies that exist between these different systems. A fundamental characteristic of these interdependencies is that failure of one critical infrastructure system can result in the failure of other interdependent infrastructures, leading to a cascade of failures, which can impede post-disaster recovery and delay the subsequent reconstruction process. Consequently, there is a critical need for developing a holistic strategy to assess the influence of infrastructure interdependencies, and for incorporating these interdependencies into a post-disaster recovery strategy. This paper discusses four key dimensions of interdependencies that need to be considered in a post-disaster reconstruction planning. Using key concepts and sub-concepts derived from the notion of interdependency, the paper examines how critical infrastructure interdependencies affect the recovery processes of damaged infrastructures.

Assessing testamentary and decision-making capacity: Approaches and models

The need for better and more accurate assessments of testamentary and decision-making capacity grows as Australian society ages and incidences of mentally disabling conditions increase. Capacity is a legal determination, but one on which medical opinion is increasingly being sought. The difficulties inherent within capacity assessments are exacerbated by the ad hoc approaches adopted by legal and medical professionals based on individual knowledge and skill, as well as the numerous assessment paradigms that exist. This can negatively affect the quality of assessments, and results in confusion as to the best way to assess capacity. This article begins by assessing the nature of capacity. The most common general assessment models used in Australia are then discussed, as are the practical challenges associated with capacity assessment. The article concludes by suggesting a way forward to satisfactorily assess legal capacity given the significant ramifications of getting it wrong.

Assessing testamentary capacity – who does it better? Lawyers or doctors?

The effects of mentally disabling conditions on legal capacity are escalating, particularly given the ageing Australian demographic. Wills, enduring powers of attorney, and advance health directives are coming to the fore as a means of ensuring that the wishes of people with regard to their property, finances and health care needs are respected should they become legally incapable of making their own decisions. Assessing when a person has lost legal capacity in this context is an ever-increasing concern facing society as a whole but, in particular, the legal and medical professionals conducting the assessments. Empirical and doctrinal research has been undertaken which canvassed legal and medical opinions about the relationship between members of these professions when assessing legal capacity. This research supports the hypothesis that tensions exist when assessing capacity, especially testamentary capacity. One source of tension is the effect of conflicting evidence about the loss of legal capacity given by legal and medical professionals in court, which raises questions such as: which evidence is, and should be, preferred; and who should be responsible? The exploration of these issues will be conducted with reference to the empirical data collected, and a review of the relevant Australian case law.

Assessing specific deterrence effects of increased speeding penalties using four measures of recidivism

Traffic law enforcement sanctions can impact on road user behaviour through general and specific deterrence mechanisms. The manner in which specific deterrence can influence recidivist behaviour can be conceptualised in different ways. While any reduction in speeding will have road safety benefits, the ways in which a ‘reduction’ is determined deserves greater methodological attention and has implications for countermeasure evaluation more generally. The primary aim of this research was to assess the specific deterrent impact of penalty increases for speeding offences in Queensland, Australia, in 2003 on two cohorts of drivers detected for speeding prior to and after the penalty changes were investigated. Since the literature is relatively silent on how to assess recidivism in the speeding context, the secondary research aim was to contribute to the literature regarding ways to conceptualise and measure specific deterrence in the speeding context. We propose a novel way of operationalising four measures which reflect different ways in which a specific deterrence effect could be conceptualised: (1) the proportion of offenders who re-offended in the follow up period; (2) the overall frequency of re-offending in the follow up period; (3) the length of delay to re-offence among those who re-offended; and (4) the average number of re-offences during the follow up period among those who re-offended. Consistent with expectations, results suggested an absolute deterrent effect of penalty changes, as evidenced by significant reductions in the proportion of drivers who re-offended and the overall frequency of re-offending, although effect sizes were small. Contrary to expectations, however, there was no evidence of a marginal specific deterrent effect among those who re-offended, with a significant reduction in the length of time to re-offence and no significant change in the average number of offences committed. Additional exploratory analyses investigating potential influences of the severity of the index offence, offence history, and method of detection revealed mixed results. Access to additional data from various sources suggested that the main findings were not influenced by changes in speed enforcement activity, public awareness of penalty changes, or driving exposure during the study period. Study limitations and recommendations for future research are discussed with a view to promoting more extensive evaluations of penalty changes and better understanding of how such changes may impact on motorists’ perceptions of enforcement and sanctions, as well as on recidivist behaviour.

Assessing a statistical inquiry

As statistical education becomes more firmly embedded in the school curriculum and its value across the curriculum is recognised, attention moves from knowing procedures, such as calculating a mean or drawing a graph, to understanding the purpose of a statistical investigation in decision making in many disciplines. As students learn to complete the stages of an investigation, the question of meaningful assessment of the process arises. This paper considers models for carrying out a statistical inquiry and, based on a four-phase model, creates a developmental squence that can be used for the assessment of outcomes from each of the four phases as well as for the complete inquiry. The developmental sequence is based on the SOLO model, focussing on the "observed" outcomes during the inquiry process.

MicroRNA regulation of epithelial-to-mesenchymal transition during re-epithelialisation: Assessing an open wound

It is becoming increasing clear that microRNAs contribute to the regulation of many biological processes, including wound healing. After injury, keratinocytes need to undergo what is known as an epithelial-to-mesenchymal transition (EMT) to initiate re-epithelialisation. During this process, keratinocytes reduce their attachment to the underlying matrix, extend membrane protrusions, become motile and migrate over the wound bed, affecting wound closure. MicroRNAs that regulate EMT are aberrantly upregulated in keratinocytes at the edge of non-healing wounds and potentially play a role in the chronicity of these wounds. In vitro and in vivo, downregulation of these microRNAs promotes EMT and migration, facilitating re-epithelialisation in wound models. This review will focus on the role of microRNAs that regulate or have potential to regulate EMT and re-epithelialisation during wound healing

Monitoring substance use in prisons: Assessing the potential value of wastewater analysis

Prison substance use is a major concern for prison authorities and the wider community. Australia has responded to this problem by implementing the National Corrections Drug Strategy. Across Australia, the true extent of prison substance use cannot be determined. As a result, the effectiveness of the interventions employed as part of this strategy cannot be properly assessed. This has important implications for the allocation of corrective services resources and future policy development. This article explores the benefits and limitations, as well as the ethical and practical issues in using wastewater analysis (WWA) to measure levels of substance use in prisons. It reports results from the first application of WWA to an Australian prison, which supports the use of WWA in this context. Given the increasing concern for prescription misuse in prisons, we also highlight the novel use of WWA to measure the extent of prescription misuse by prisoners. The article concludes that as a result of its objectivity, sensitivity and cost-effectiveness, the use of WWA in prisons warrants further consideration in Australia.

Value of total body potassium in assessing the nutritional status of children with end-stage liver disease

Malnutrition is a common problem in children with end-stage liver disease (ESLD), and accurate assessment of nutritional status is essential in managing these children. In a retrospective study, we compared nutritional assessment by anthropometry with that by body composition. We analyzed all consecutive measurements of total body potassium (TBK, n = 186) of children less than 3 years old with ESLD awaiting transplantation found in our database. The TBK values obtained by whole body counting of 40K were compared with reference TRK values of healthy children. The prevalence of malnutrition, as assessed by weight (weight Z score < -2) was 28%, which was significantly lower (chi-square test, p < 0.0001) than the prevalence of malnutrition (76%) assessed by TBK (< 90% of expected TRK for age). These results demonstrated that body weight underestimated the nutritional deficit and stressed the importance of measuring body composition as part of assessing nutritional status of children with ESLD.

Assessing environmental inequalities in ambient air pollution across urban Australia

Identifying inequalities in air pollution levels across population groups can help address environmental justice concerns. We were interested in assessing these inequalities across major urban areas in Australia. We used a land-use regression model to predict ambient nitrogen dioxide (NO2) levels and sought the best socio-economic and population predictor variables. We used a generalised least squares model that accounted for spatial correlation in NO2 levels to examine the associations between the variables. We found that the best model included the index of economic resources (IER) score as a non-linear variable and the percentage of non-Indigenous persons as a linear variable. NO2 levels decreased with increasing IER scores (higher scores indicate less disadvantage) in almost all major urban areas, and NO2 also decreased slightly as the percentage of non-Indigenous persons increased. However, the magnitude of differences in NO2 levels was small and may not translate into substantive differences in health.

Multidisciplinary review of teaching and assessing competency attainment by non-medical prescribers

Background Prescribing is a complex task, requiring specific knowledge and skills, and the execution of effective, context-specific clinical reasoning. Systematic reviews indicate medical prescribing errors have a median rate of 7% [IQR 2%-14%] of medication orders [1-3]. For podiatrists pursuing prescribing rights, a clear need exists to ensure practitioners develop a well-defined set of prescribing skills, which will contribute to competent, safe and appropriate practice. Aim To investigate the methods employed to teach and assess the principles of effective prescribing in the undergraduate podiatry program and compare and contrast these findings with four other non-medical professions who undertake prescribing after training at Queensland University of Technology. Method The NPS National Prescribing Competency Standards were employed as the prescribing standard. A curriculum mapping exercise was undertaken to determine whether the prescribing principles articulated in the competency standards were addressed by each profession. Results A range of methods are currently utilised to teach prescribing across disciplines. Application of prescribing competencies to the context of each profession appears to influence the teaching methods used. Most competencies were taught using a multimodal format, including interactive lectures, self-directed learning, tutorial sessions and clinical placement. In particular clinical training was identified as the most consistent form of educating safe prescribers across all five disciplines. Assessment of prescribing competency utilised multiple techniques including written and oral examinations and research tasks, case studies, objective structured clinical examination exercises and the assessment of clinical practice. Effective and reliable assessment of prescribing undertaken by students in diverse settings remains challenging e.g. that occurring in the clinical practice environment. Conclusion Recommendations were made to refine curricula and to promote efficient cross-discipline teaching by staff from the disciplines of podiatry, pharmacy, nurse practitioner, optometry and paramedic science. Students now experience a sophisticated level of multidisciplinary learning in the clinical setting which integrates the expertise and skills of experience prescribers combined with innovative information technology platforms (CCTV and live patient assessments). Further work is required to establish a practical, effective approach to the assessment of prescribing competence especially between the university and clinical settings.

Assessing performance in critical care nursing practice using the Benner Novice to expert model: A pilot study

Background It is often believed that by ensuring the ongoing completion of competency documents and life-long learning in nursing practice guarantees quality patient care. This is probably true in most cases where it provides reassurances that the nursing team is maintaining a safe “generalised” level of practice. However, competency does not always promise quality performance. There are a number of studies that have reported differences in what practitioners know and what they actually do despite being deemed competent. Aim The aim of this study was to assess whether our current competency documentation is fit for purpose and to ascertain whether performance assessment needs to be a key component in determining competence. Method 15 nurses within a General ICU who had been on the unit <4 years agreed to participate in this project. Using participant observation and assessing performance against key indicators of the Benner Novice to Expert5 model the participants were supported and assessed over the course of a ‘normal’ nursing shift. Results The results were surprising both positively and negatively. First, the nurses felt more empowered in their clinical decision making skills; second, it identified individual learning needs and milestones in educational development. There were some key challenges identified which included 5 nurses over estimating their level of competence, practice was still very much focused on task acquisition and skill and surprisingly some nurses still felt dominated by the other health professionals within the unit. Conclusion We found that the capacity and capabilities of our nursing workforce needs continual ongoing support especially if we want to move our staff from capable task-doer to competent performers. Using the key novice to expert indicators identified the way forward for us in how we assess performance and competence in practice particularly where promotion to higher grades is based on existing documentation.

Examination of a scale assessing attitudes towards individuals with intellectual disability in China

This study examined the applicability of the four-factor structure of the short form of the Community Living Attitudes Scale-Intellectual disability1 (CLAS-ID) in China, using a sample of 325 Chinese community members. Confirmatory factor analysis revealed that the original structure of the short form of the CLAS-ID did not adequately fit the data from the current sample. Most items of the Exclusion and Similarity subscales were retained while items on the Empowerment and Sheltering subscales were removed. Chinese community members held generally positive attitudes towards people with intellectual disability. However, a measurement tool originating from the Chinese context is needed to provide a better understanding of attitudes towards individuals with intellectual disability in mainland China.

Assessing police classifications of sexual assault reports: A meta-analysis of false reporting rates

The objective of the study was to determine, through meta-analysis, the rate of confirmed false reports of sexual assault to police. The meta-analysis initially involved a search for relevant articles. The search revealed seven studies where researchers or their trained helpers evaluated reported sexual assault cases to determine the rate of confirmed false reports. The meta-analysis calculated an overall rate and tested for possible moderators of effect size. The meta-analytic rate of false reports of sexual assault was .052 (95% CIs .030, .089). The rates for the individual studies were heterogeneous, suggesting the possibility of moderators of rate. However, the four possible moderators examined, year of publication, whether the data set used had information in addition to police reports, whether the study was completed in the U.S. or elsewhere, and whether inter-rater reliabilities were reported, were all not significant. The meta-analysis of seven relevant studies shows that confirmed false allegations of sexual assault made to police occur at a significant rate. The total false reporting rate, including both confirmed and equivocal cases, would be greater than the 5 percent rate found here.

The development and preliminary testing of an instrument for assessing fatigue self-management outcomes in patients with advanced cancer

Background: Fatigue is one of the most distressing and commonly experienced symptoms in patients with advanced cancer. Although the self-management (SM) of cancer-related symptoms has received increasing attention, no research instrument assessing fatigue SM outcomes for patients with advanced cancer is available. Objectives: to describe the development and preliminary testing of an interviewer administered instrument for assessing the frequency, and perceived levels of effectiveness and self-efficacy associated with fatigue SM behaviors in patients with advanced cancer. Methods: The development and testing of the Self-efficacy in Managing Symptoms Scale- Fatigue Subscale for Patients with Advanced Cancer (SMSFS-A) involved a number of procedures: item-generation using a comprehensive literature review and semi-structured interviews, content validity evaluation using expert panel reviews, and face validity and test-retest reliability evaluation using pilot testing. Results: Initially, 23 items (22 specific behaviors with one global item) were generated from the literature review and semi-structured interviews. After two rounds of expert panel review, the final scale was reduced to 17 items (16 behaviors with one global item). Participants in the pilot test (n=10) confirmed that the questions in this scale were clear and easy to understand. Bland-Altman analysis showed agreement of results over a one-week interval. Conclusions: The SMSFS-A items were generated using multiple sources. This tool demonstrated preliminary validity and reliability. Implications for practice: The SMSFS-A has the potential to be used for clinical and research purposes. Nurses can use this instrument for collecting data to inform the initiation of appropriate fatigue SM support for this population.