Privacy and trust management for electronic health records

Establishing a nationwide Electronic Health Record system has become a primary objective for many countries around the world, including Australia, in order to improve the quality of healthcare while at the same time decreasing its cost. Doing so will require federating the large number of patient data repositories currently in use throughout the country. However, implementation of EHR systems is being hindered by several obstacles, among them concerns about data privacy and trustworthiness. Current IT solutions fail to satisfy patients’ privacy desires and do not provide a trustworthiness measure for medical data. This thesis starts with the observation that existing EHR system proposals suer from six serious shortcomings that aect patients’ privacy and safety, and medical practitioners’ trust in EHR data: accuracy and privacy concerns over linking patients’ existing medical records; the inability of patients to have control over who accesses their private data; the inability to protect against inferences about patients’ sensitive data; the lack of a mechanism for evaluating the trustworthiness of medical data; and the failure of current healthcare workflow processes to capture and enforce patient’s privacy desires. Following an action research method, this thesis addresses the above shortcomings by firstly proposing an architecture for linking electronic medical records in an accurate and private way where patients are given control over what information can be revealed about them. This is accomplished by extending the structure and protocols introduced in federated identity management to link a patient’s EHR to his existing medical records by using pseudonym identifiers. Secondly, a privacy-aware access control model is developed to satisfy patients’ privacy requirements. The model is developed by integrating three standard access control models in a way that gives patients access control over their private data and ensures that legitimate uses of EHRs are not hindered. Thirdly, a probabilistic approach for detecting and restricting inference channels resulting from publicly-available medical data is developed to guard against indirect accesses to a patient’s private data. This approach is based upon a Bayesian network and the causal probabilistic relations that exist between medical data fields. The resulting definitions and algorithms show how an inference channel can be detected and restricted to satisfy patients’ expressed privacy goals. Fourthly, a medical data trustworthiness assessment model is developed to evaluate the quality of medical data by assessing the trustworthiness of its sources (e.g. a healthcare provider or medical practitioner). In this model, Beta and Dirichlet reputation systems are used to collect reputation scores about medical data sources and these are used to compute the trustworthiness of medical data via subjective logic. Finally, an extension is made to healthcare workflow management processes to capture and enforce patients’ privacy policies. This is accomplished by developing a conceptual model that introduces new workflow notions to make the workflow management system aware of a patient’s privacy requirements. These extensions are then implemented in the YAWL workflow management system.

Work-related driving safety in light vehicle fleets : a review of past research and the development of an intervention framework

This paper presents a critical review of past research in the work-related driving field in light vehicle fleets (e.g., vehicles < 4.5 tonnes) and an intervention framework that provides future direction for practitioners and researchers. Although work-related driving crashes have become the most common cause of death, injury, and absence from work in Australia and overseas, very limited research has progressed in establishing effective strategies to improve safety outcomes. In particular, the majority of past research has been data-driven, and therefore, limited attention has been given to theoretical development in establishing the behavioural mechanism underlying driving behaviour. As such, this paper argues that to move forward in the field of work-related driving safety, practitioners and researchers need to gain a better understanding of the individual and organisational factors influencing safety through adopting relevant theoretical frameworks, which in turn will inform the development of specifically targeted theory-driven interventions. This paper presents an intervention framework that is based on relevant theoretical frameworks and sound methodological design, incorporating interventions that can be directed at the appropriate level, individual and driving target group.

Multi-linear strategies for (re)presenting the complexity of young people in research

Within the current climate of unpredictability and constant change, young people at school are faced with a multitude of choices and contradictory influences. In this article, I argue that (re)presentations of young people in youth research need to reflect the complexity and multiplicity of their lives and changing priorities, and I attempt to (re)present a small group of young people in this particular milieu. I illustrate some of the competing influences in their lives, and I outline some specific strategies that are useful for (re)presenting these contextual worlds. The strategies I advocate disrupt the homogenous representations of ‘youth’ as a developmental phase and instead reflect the diverse spheres of influence which shape their subjectivities and practices.

Reconciling the supply of and demand for carbon cycle science in the US agricultural sector

When asking the question, ``How can institutions design science policies for the benefit of decision makers?'' Sarewitz and Pielke Sarewitz, D., Pielke Jr., R.A., this issue. The neglected heart of science policy: reconciling supply of and demand for science. Environ. Sci. Policy 10] posit the idea of ``reconciling supply and demand of science'' as a conceptual tool for assessment of science programs. We apply the concept to the U.S. Department of Agriculture's (USDA) carbon cycle science program. By evaluating the information needs of decision makers, or the ``demand'', along with the supply of information by the USDA, we can ascertain where matches between supply and demand exist, and where science policies might miss opportunities. We report the results of contextual mapping and of interviews with scientists at the USDA to evaluate the production and use of current agricultural global change research, which has the stated goal of providing ``optimal benefit'' to decision makers on all levels. We conclude that the USDA possesses formal and informal mechanisms by which scientists evaluate the needs of users, ranging from individual producers to Congress and the President. National-level demands for carbon cycle science evolve as national and international policies are explored. Current carbon cycle science is largely derived from those discussions and thus anticipates the information needs of producers. However, without firm agricultural carbon policies, such information is currently unimportant to producers. (C) 2006 Elsevier Ltd. All rights reserved.

Advanced Gen-1, 2 and 3 biofuels research in Australia - Fuelling advanced biofuels training for international scientists

Flinders University and Queensland University of Technology, biofuels research interests cover a broad range of activities. Both institutions are seeking to overcome the twin evils of "peak oil" (Hubbert 1949 & 1956) and "global warming" (IPPC 2007, Stern 2006, Alison 2010), through development of Generation 1, 2 and 3 (Gen-1, 2 & 3) biofuels (Clarke 2008, Clarke 2010). This includes development of parallel Chemical Biorefinery, value-added, co-product chemical technologies, which can underpin the commercial viability of the biofuel industry. Whilst there is a focused effort to develop Gen-2 & 3 biofuels, thus avoiding the socially unacceptable use of food based Gen-1 biofuels, it must also be recognized that as yet, no country in the world has produced sustainable Gen-2 & 3 biofuel on a commercial basis. For example, in 2008 the United States used 38 billion litres (3.5% of total fuel use) of Gen-1 biofuel; in 2009/2010 this will be 47.5 billion litres (4.5% of fuel use) and in 2018 this has been estimated to rise to 96 billion litres (9% of total US fuel use). Brazil in 2008 produced 24.5 billion litres of ethanol, representing 37.3% of the world’s ethanol use for fuel and Europe, in 2008, produced 11.7 billion litres of biofuel (primarily as biodiesel). Compare this to Australia’s miserly biofuel production in 2008/2009 of 180 million litres of ethanol and 75 million litres of biodiesel, which is 0.4% of our fuel consumption! (Clarke, Graiver and Habibie 2010) To assist in the development of better biofuels technologies in the Asian developing regions the Australian Government recently awarded the Materials & BioEnergy Group from Flinders University, in partnership with the Queensland University of Technology, an Australian Leadership Award (ALA) Biofuel Fellowship program to train scientists from Indonesia and India about all facets of advanced biofuel technology.

Using digital rights management for securing data in a medical research environment

We propose a digital rights management approach for sharing electronic health records in a health research facility and argue advantages of the approach. We also give an outline of the system under development and our implementation of the security features and discuss challenges that we faced and future directions.

Collaborative research to develop a specialist, post-graduate competency-based education curriculum and continuing professional development structure for health librarians in Australia

Through a grant received from the Australian Library and Information Association (ALIA), members of Health Libraries Australia (HLA) are collaborating with a researcher/educator to conduct a twelve month research project with the goal of developing an educational framework for the Australian health librarianship workforce of the future. The collaboration comprises the principal researcher and a representative group of practitioners from different sectors of the health industry who are affiliated with ALIA in various committees, advisory groups and roles. The research has two main aims: to determine the future skills requirements for the health librarian workforce in Australia; and to develop a structured, modular education framework for specialist post-graduate qualifications together with a structure for ongoing continuing professional development. The paper highlights some of the major trends in the health sector and some of the main environmental influences that may act as drivers for change for health librarianship as a profession, and particularly for educating the future workforce. The research methodology is outlined and the main results are described; the findings are discussed with regard to their implications for the development of a structured, competency-based education framework.

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.

Identifying child sexual abuse within school contexts : policy problems and solutions, and a landmark case

As a strategy to identify child sexual abuse, most Australian States and Territories have enacted legislation requiring teachers to report suspected cases. Some Australian State and non-State educational authorities have also created policy-based obligations to report suspected child sexual abuse. Significantly, these can be wider than non-existent or limited legislative duties, and therefore are a crucial element of the effort to identify sexual abuse. Yet, no research has explored the existence and nature of these policy-based duties. The first purpose of this paper is to report the results of a three-State study into policy-based reporting duties in State and non-State schools in Australia. In an extraordinary coincidence, while conducting the study, a case of failure to comply with reporting policy occurred with tragic consequences. This led to a rare example in Australia (and one of only a few worldwide) of a professional being prosecuted for failure to comply with a legislative duty. It also led to disciplinary proceedings against school staff. The second purpose of this paper is to describe this case and connect it with findings from our policy analysis.

Equity and research design

This chapter recognizes that research is a cultural invention and explains why. It discusses what equity, research and research design mean, and suggests that the concept of equity is enriched considerably when ideas from Indigenous, critical and politically committed research traditions are involved in research design. When research design and the processes of research are guided by principles of equity, several issues warrant investigation. These include power relations, deficit models of research, homogeneity and reflexivity. Research design that is informed by principles of equity is explicit in its political purpose of seeking socially just outcomes for the short and long term.

Healthy sexual development : a multidisciplinary framework for research

A group of Australian researchers from a range of disciplines involved in studying children's sexual development developed a framework for researching healthy sexual development that was acceptable to all disciplines involved. The 15 domains identified were: freedom from unwanted activity; an understanding of consent; education about biological aspects; understanding of safety; relationship skills; agency; lifelong learning; resilience; open communication; sexual development should not be “aggressive, coercive or joyless;” self-acceptance; awareness and acceptance that sex is pleasurable; understanding of parental and societal values; awareness of public/private boundaries; and being competent in mediated sexuality.

Governors highway safety associations and transportation planning: Exploratory factor analysis and structural equation modeling

The Intermodal Surface Transportation Efficiency Act (ISTEA) of 1991 mandated the consideration of safety in the regional transportation planning process. As part of National Cooperative Highway Research Program Project 8-44, "Incorporating Safety into the Transportation Planning Process," we conducted a telephone survey to assess safety-related activities and expertise at Governors Highway Safety Associations (GHSAs), and GHSA relationships with metropolitan planning organizations (MPOs) and state departments of transportation (DOTs). The survey results were combined with statewide crash data to enable exploratory modeling of the relationship between GHSA policies and programs and statewide safety. The modeling objective was to illuminate current hurdles to ISTEA implementation, so that appropriate institutional, analytical, and personnel improvements can be made. The study revealed that coordination of transportation safety across DOTs, MPOs, GHSAs, and departments of public safety is generally beneficial to the implementation of safety. In addition, better coordination is characterized by more positive and constructive attitudes toward incorporating safety into planning.

The impact of gender diversity on turnover : the moderating effect of human resource policies and practices

Demography theory suggests that high gender diversity leads to high turnover. As turnover is costly for organizations, we examined whether HR policies and practices influence the expected gender diversity-turnover relationship. Survey data were collected from 198 HR decision makers at publicly listed organizations. We found that HR policies and practices that are supportive of diversity moderate the gender diversity-turnover relationship, such that high gender diversity leads to low turnover in organizations with many diversity supportive policies and practices. Results suggest that organizations can avoid the negative consequences of high gender diversity by implementing diversity supportive HR polices and practices.

Strategising knowledge-based urban development : knowledge city transformations of Brisbane, Australia

In the global knowledge economy, knowledge-intensive industries and knowledge workers are extensively seen as the primary factors to improve the welfare and competitiveness of cities. To attract and retain such industries and workers, cities produce knowledge-based urban development strategies, and therefore such strategising has become an important development mechanism for cities and their economies. The paper discusses the critical connections between knowledge city foundations and integrated knowledge-based urban development mechanisms in both the local and regional level. In particular, the paper investigates Brisbane’s knowledge-based urban development strategies that support gentrification, attraction, and retention of investment and talent. Furthermore, the paper develops a knowledge-based urban development assessment framework to provide a clearer understanding of the local and regional policy frameworks, and relevant applications of Brisbane’s knowledge-based urban development experience, in becoming a prosperous knowledge city. The paper, with its knowledge-based urban development assessment framework, scrutinises Brisbane’s four development domains in detail: economy; society; institutional; built and natural environments. As part of the discussion of the case study findings, the paper describes the global orientation of Brisbane within the frame of regional and local level knowledge-based urban development strategies performing well. Although several good practices from Brisbane have already been internationally acknowledged, the research reveals that Brisbane is still in the early stages of its knowledge-based urban development implementation. Consequently, the development of a monitoring system for all knowledge-based urban development at all levels is highly crucial in accurately measuring the success and failure of specific knowledge-based urban development policies, and Brisbane’s progress towards a knowledge city transformation.