Scandals, public inquiries and health professional regulation

Since 1980 there has been an increasing incidence of the use of public inquiries as a process through which scandals raising patient safety and health care quality concerns can be subject to highly public scrutiny. The use of public inquiries and their impact on the governance of health or social systems, especially around issues of patient or client safety, has been examined by a number of commentators (Butler and Drakeford 2003, Masso and Eager 2009, Stanley and Manthorpe 2004, Walshe and Higgins 2002) but public inquiries into scandals in the health system also raise a question about the impact of these inquiries on public perceptions about the adequacy of the various mechanisms for health professional regulation...

Assessing the effectiveness of the child safety net : linkage of hospital and child protection services data on ‘maltreated’ and ‘unintentionally injured' children

-International recognition of need for public health response to child maltreatment -Need for early intervention at health system level -Important role of health professionals in identifying, reporting, documenting suspician of maltreatment -Up to 10% of all children presenting at ED’s are victims and without identification, 35% reinjured and 5% die -In Qld, mandatory reporting requirement for doctors and nurses for suspected abuse or neglect

Stop and revive? : the effectiveness of nap and active rest breaks for reducing driver sleepiness

The incidence of sleep-related crashes has been estimated to account for approximately 20% of all fatal and severe crashes. The use of sleepiness countermeasures by drivers is an important component to reduce the incidence rates of sleep-related crashes. Taking a brief nap and stopping for a rest break are two highly publicised countermeasures for driver sleepiness and are also believed by drivers to be the most effective countermeasures. Despite this belief, there is scarce evidence to support the utility of these countermeasures for reducing driver sleepiness levels. Therefore, determining the effectiveness of these countermeasures is an important road safety concern. The current study utilised a young adult sample (N = 20) to investigate the effectiveness of a nap and an active rest break. The countermeasures effects were evaluated by physiological, behavioural (hazard perception skill), and subjective measures previously found sensitive to sleepiness. Participants initially completed two hours of a simulated driving task followed by a 15 minute nap opportunity or a 15 minute active rest break that included 10 minutes of brisk walking. After the break, participants completed one final hour of the simulated driving task. A within-subjects design was used so that each participant completed both the nap and the active rest break conditions on separate occasions. The analyses revealed that only the nap break provided any meaningful reduction in physiological sleepiness, reduced subjective sleepiness levels, and maintained hazard perception performance. In contrast, the active rest break had no effect for reducing physiological sleepiness and resulted in a decrement in hazard perception performance (i.e., an increase of reaction time latencies), with a transient reduction in subjective sleepiness levels. A number of theoretical, empirical and practical issues were identified by the current study.

Assisting ICU training management with virtual worlds

Conventional training methods for nurses involve many physical factors that place limits on potential class sizes. Alternate training methods with lower physical requirements may support larger class sizes, but given the tactile quality of nurse training, are most appropriately applied to supplement the conventional methods. However, where the importance of physical factors are periphery, such alternate training methods can provide an important way to increase upper class-size limits and therefore the rate of trained nurses entering the important role of critical care. A major issue in ICU training is that the trainee can be released into a real-life intensive care scenario with sub optimal preparation and therefore a level of anxiety for the student concerned, and some risk for the management level nurses, as patient safety is paramount. This lack of preparation places a strain on the allocation of human and non-human resources to teaching, as students require greater levels of supervision. Such issues are a concern to ICU management, as they relate to nursing skill development and patient health outcomes, as nursing training is potentially dangerous for patients who are placed in the care of inexperienced staff. As a solution to this problem, we present a prototype ICU handover training environment that has been developed in a socially interactive virtual world. Nurses in training can connect remotely via the Internet to this environment and engage in collaborative ICU handover training classes.

Efficient safety message dissemination for cooperative collision warning via context modelling

A Cooperative Collision Warning System (CCWS) is an active safety techno- logy for road vehicles that can potentially reduce traffic accidents. It provides a driver with situational awareness and early warnings of any possible colli- sions through an on-board unit. CCWS is still under active research, and one of the important technical problems is safety message dissemination. Safety messages are disseminated in a high-speed mobile environment using wireless communication technology such as Dedicated Short Range Communication (DSRC). The wireless communication in CCWS has a limited bandwidth and can become unreliable when used inefficiently, particularly given the dynamic nature of road traffic conditions. Unreliable communication may significantly reduce the performance of CCWS in preventing collisions. There are two types of safety messages: Routine Safety Messages (RSMs) and Event Safety Messages (ESMs). An RSM contains the up-to-date state of a vehicle, and it must be disseminated repeatedly to its neighbouring vehicles. An ESM is a warning message that must be sent to all the endangered vehi- cles. Existing RSM and ESM dissemination schemes are inefficient, unscalable, and unable to give priority to vehicles in the most danger. Thus, this study investigates more efficient and scalable RSM and ESM dissemination schemes that can make use of the context information generated from a particular traffic scenario. Therefore, this study tackles three technical research prob- lems, vehicular traffic scenario modelling and context information generation, context-aware RSM dissemination, and context-aware ESM dissemination. The most relevant context information in CCWS is the information about possible collisions among vehicles given a current vehicular traffic situation. To generate the context information, this study investigates techniques to model interactions among multiple vehicles based on their up-to-date motion state obtained via RSM. To date, there is no existing model that can represent interactions among multiple vehicles in a speciffic region and at a particular time. The major outcome from the first problem is a new interaction graph model that can be used to easily identify the endangered vehicles and their danger severity. By identifying the endangered vehicles, RSM and ESM dis- semination can be optimised while improving safety at the same time. The new model enables the development of context-aware RSM and ESM dissemination schemes. To disseminate RSM efficiently, this study investigates a context-aware dis- semination scheme that can optimise the RSM dissemination rate to improve safety in various vehicle densities. The major outcome from the second problem is a context-aware RSM dissemination protocol. The context-aware protocol can adaptively adjust the dissemination rate based on an estimated channel load and danger severity of vehicle interactions given by the interaction graph model. Unlike existing RSM dissemination schemes, the proposed adaptive scheme can reduce channel congestion and improve safety by prioritising ve- hicles that are most likely to crash with other vehicles. The proposed RSM protocol has been implemented and evaluated by simulation. The simulation results have shown that the proposed RSM protocol outperforms existing pro- tocols in terms of efficiency, scalability and safety. To disseminate ESM efficiently, this study investigates a context-aware ESM dissemination scheme that can reduce unnecessary transmissions and deliver ESMs to endangered vehicles as fast as possible. The major outcome from the third problem is a context-aware ESM dissemination protocol that uses a multicast routing strategy. Existing ESM protocols use broadcast rout- ing, which is not efficient because ESMs may be sent to a large number of ve- hicles in the area. Using multicast routing improves efficiency because ESMs are sent only to the endangered vehicles. The endangered vehicles can be identified using the interaction graph model. The proposed ESM protocol has been implemented and evaluated by simulation. The simulation results have shown that the proposed ESM protocol can prevent potential accidents from occurring better than existing ESM protocols. The context model and the RSM and ESM dissemination protocols can be implemented in any CCWS development to improve the communication and safety performance of CCWS. In effect, the outcomes contribute to the realisation of CCWS that will ultimately improve road safety and save lives.

Development issues for the creative economy in Malaysia

Cultural tourism and creative industries have intersecting policy agendas and economic interdependencies. Most studies of the creative industries have focused on western countries. Cultural tourism is rarely included. However the arrival of the creative economy and its movement through developing countries has changed the relationship. Supporters of the creative economy now see fit to include tourism. This thesis addresses the development of the creative economy in Malaysia. The thesis conducted case studies on animation and museum sectors in Malaysia. These two case studies provide information on the development of creative economy in Malaysia. The study found that a top-down cultural management approach is being practised but that Malaysia is now influenced by new ideas concerning innovation and technical creativity. The study examined whether or not technical innovation by itself is enough. The reference points here are the Multimedia Super Corridor in Cyberjaya and other similar projects in the region. The museum case study was situated in Malacca. It showed that museums needed to adapt new media and new experiences to remain relevant in today’s world. In applying a case study approach, the thesis made use of interviews with key stakeholders, as well consulting numerous policy documents and web sites. Both case studies imitated similar products and services in the market but added local characteristics. This research project contributes significantly to the existing body of knowledge in the field of creative economy within the context of developing countries. Finally the thesis makes recommendations for Malaysia to better position itself in the regional economy while retaining its distinctive cultural identity.

A case of community safety : displacing complex ‘social’ problems in Fortitude Valley

Public dialogue regarding the high concentration of drug use and crime in inner city locations is frequently legitimised through visibility of drug-using populations and a perception of high crime rates. The public space known as the Brunswick Street Mall (Valley mall), located in the inner city Brisbane suburb of Fortitude Valley, has long provided the focal point for discussions regarding the problem of illicit drug use and antisocial behaviour in Brisbane. During the late 1990s a range of stakeholders in Fortitude Valley became mobilised to tackle crime and illicit drugs. In particular they wanted to dismantle popular perceptions of the area as representing the dark and unsafe side of Brisbane. The aim of this campaign was to instil a sense of safety in the area and dislodge Fortitude Valley from its reputation as a =symbolic location of danger‘. This thesis is a case study about an urban site that became contested by the diverse aims of a range of stakeholders who were invested in an urban renewal program and community safety project. This case study makes visible a number of actors that were lured from their existing roles in an indeterminable number of heterogeneous networks in order to create a community safety network. The following analysis of the community safety network emphasises some specific actors: history, ideas, technologies, materialities and displacements. The case study relies on the work of Foucault, Latour, Callon and Law to draw out the rationalities, background contingencies and the attempts to impose order and translate a number of entities into the community safety project in Fortitude Valley. The results of this research show that the community safety project is a case of ontological politics. Specifically the data indicates that both the (reality) problem of safety and the (knowledge) solution to safety were created simultaneously. This thesis explores the idea that while violence continues to occur in the Valley, evidence that community safety got done is located through mapping its displacement and eventual disappearance. As such, this thesis argues that community safety is a =collateral reality‘.

Decision support for the safe design and operation of unmanned aircraft systems

Unmanned Aircraft Systems (UAS) describe a diverse range of aircraft that are operated without a human pilot on-board. Unmanned aircraft range from small rotorcraft, which can fit in the palm of your hand, through to fixed wing aircraft comparable in size to that of a commercial passenger jet. The absence of a pilot on-board allows these aircraft to be developed with unique performance capabilities facilitating a wide range of applications in surveillance, environmental management, agriculture, defence, and search and rescue. However, regulations relating to the safe design and operation of UAS first need to be developed before the many potential benefits from these applications can be realised. According to the International Civil Aviation Organization (ICAO), a Risk Management Process (RMP) should support all civil aviation policy and rulemaking activities (ICAO 2009). The RMP is described in International standard, ISO 31000:2009 (ISO, 2009a). This standard is intentionally generic and high-level, providing limited guidance on how it can be effectively applied to complex socio-technical decision problems such as the development of regulations for UAS. Through the application of principles and tools drawn from systems philosophy and systems engineering, this thesis explores how the RMP can be effectively applied to support the development of safety regulations for UAS. A sound systems-theoretic foundation for the RMP is presented in this thesis. Using the case-study scenario of a UAS operation over an inhabited area and through the novel application of principles drawn from general systems modelling philosophy, a consolidated framework of the definitions of the concepts of: safe, risk and hazard is made. The framework is novel in that it facilitates the representation of broader subjective factors in an assessment of the safety of a system; describes the issues associated with the specification of a system-boundary; makes explicit the hierarchical nature of the relationship between the concepts and the subsequent constraints that exist between them; and can be evaluated using a range of analytic or deliberative modelling techniques. Following the general sequence of the RMP, the thesis explores the issues associated with the quantified specification of safety criteria for UAS. A novel risk analysis tool is presented. In contrast to existing risk tools, the analysis tool presented in this thesis quantifiably characterises both the societal and individual risk of UAS operations as a function of the flight path of the aircraft. A novel structuring of the risk evaluation and risk treatment decision processes is then proposed. The structuring is achieved through the application of the Decision Support Problem Technique; a modelling approach that has been previously used to effectively model complex engineering design processes and to support decision-making in relation to airspace design. The final contribution made by this thesis is in the development of an airworthiness regulatory framework for civil UAS. A novel "airworthiness certification matrix" is proposed as a basis for the definition of UAS "Part 21" regulations. The outcome airworthiness certification matrix provides a flexible, systematic and justifiable method for promulgating airworthiness regulations for UAS. In addition, an approach for deriving "Part 1309" regulations for UAS is presented. In contrast to existing approaches, the approach presented in this thesis facilitates a traceable and objective tailoring of system-level reliability requirements across the diverse range of UAS operations. The significance of the research contained in this thesis is clearly demonstrated by its practical real world outcomes. Industry regulatory development groups and the Civil Aviation Safety Authority have endorsed the proposed airworthiness certification matrix. The risk models have also been used to support research undertaken by the Australian Department of Defence. Ultimately, it is hoped that the outcomes from this research will play a significant part in the shaping of regulations for civil UAS, here in Australia and around the world.

Road safety in Singapore

Singapore is a highly developed country that has a well connected island-wide road transport system including a network of expressways. The road standards of Singapore are generally good and road safety level is very high by international standards. This chapter discusses road safety status in Singapore and highlights the practices that have been undertaken to enhance the road safety. Statistics show that road traffic fatalities were decreasing over the years, albeit an increasing trend for total crashes. Motorcyclists and pedestrians were two vulnerable road user groups and shared significant proportions respectively about 49% and 28% of total road traffic deaths. In particular, young riders and pedestrians had a higher crash potential. To enhance safety of those vulnerable road users, Singapore has taken several initiatives including infrastructure improvements like paving better skid-resistant materials at crash-prone sites, providing more rain shelters for motorcyclists, and installation of reflective signs and markings near school zones; safety campaigns and awareness programs like ride safe programme, the road courtesy campaign, and the anti-drink drive campaign. While Land Transport Authority (LTA) looks into road safety through engineering solutions and road infrastructure developments, the Traffic Police of Singapore is responsible for law enforcements and regulations. A number of non-government organizations, private companies, and university research groups are also continuously working with the Traffic Police to study, promote, and educate the general public on road safety matters.

Developing targeted countermeasures to improve motorcycle safety

The fatality and injury rate of motorcyclists per registered vehicle are higher than those of other motor vehicles by 13 and 7 times respectively. The crash involvement rate of motorcyclists as a victim party is 58% at intersections and as an offending party is 67% at expressways. Previous research efforts showed that the motorcycle safety programs are not very effective in improving motorcycle safety. This is perhaps due to inefficient design of safety program as specific causal factors may not be well explored. The objective of this study is to propose more sophisticated countermeasures and awareness programs for improving motorcycle safety after analyzing specific causal factors for motorcycle crashes at intersections and expressways. Methodologically this study applies the binary logistic model to explore the at-fault or not-at-fault crash involvement of motorcyclists at those locations. A number of explanatory variables representing roadway characteristics, environmental factors, motorcycle descriptions, and rider demographics have been evaluated. Results shows that the night time crash occurrence, presence of red light camera, lane position, rider age, licence class, and multivehicle collision significantly affect the fault of motorcyclists involved in crashes at intersections. On the other hand, the night time crash occurrence, lane position, speed limit, rider age, licence class, engine capacity, riding with pillion passenger, foreign registered motorcycles, and multivehicle collision has been found to be significant at expressways. Legislate to wear reflective clothes and using reflective markings on the motorcycles and helmets are suggested as an effective countermeasure for reducing their vulnerability. The red light cameras at intersections reduce the vulnerability of motorcycles and hence motorcycle flow and motorcycle crashes should be considered during installation of red light cameras. At signalized intersections, motorcyclists may be taught to follow correct movement and queuing rather than weaving through the traffic as it leads them to become victims of other motorists. The riding simulators in the training centers can be useful to demonstrate the proper movement and queuing at junctions. Riding with pillion passenger and excess speed at expressways are found to significantly influence the at at-fault crash involvement of the motorcyclists. Hence the motorcyclists should be advised to concentrate more on riding while riding with pillion passenger and encouraged to avoid excess speed at expressways. Very young and very older group of riders are found to be at-fault than middle aged groups. Hence this group of riders should be targeted for safety improvement. This can be done by arranging safety talks and programs in motorcycling clubs in colleges and universities as well as community riding clubs with high proportion of elderly riders. It is recommended that the driving centers may use the findings of this study to include in licensure program to make motorcyclists more aware of the different factors which expose the motorcyclists to crash risks so that more defensive riding may be needed.

A review of system safety failure probability objectives for Unmanned Aircraft Systems

Unmanned Aircraft Systems (UAS) are one of a number of emerging aviation sectors. Such new aviation concepts present a significant challenge to National Aviation Authorities (NAAs) charged with ensuring the safety of their operation within the existing airspace system. There is significant heritage in the existing body of aviation safety regulations for Conventionally Piloted Aircraft (CPA). It can be argued that the promulgation of these regulations has delivered a level of safety tolerable to society, thus justifying the “default position” of applying these same standards, regulations and regulatory structures to emerging aviation concepts such as UAS. An example of this is the proposed “1309” regulation for UAS, which is based on the 1309 regulation for CPA. However, the absence of a pilot on-board an unmanned aircraft creates a fundamentally different risk paradigm to that of CPA. An appreciation of these differences is essential to the justification of the “default position” and in turn, to ensure the development of effective safety standards and regulations for UAS. This paper explores the suitability of the proposed “1309” regulation for UAS. A detailed review of the proposed regulation is provided and a number of key assumptions are identified and discussed. A high-level model characterising the expected number of third party fatalities on the ground is then used to determine the impact of these assumptions. The results clearly show that the “one size fits all” approach to the definition of 1309 regulations for UAS, which mandates equipment design and installation requirements independent of where the UAS is to be operated, will not lead to an effective management of the risks.

Using game technologies to improve the safety of construction plant operations

Many accidents occur world-wide in the use of construction plant and equipment, and safety training is considered by many to be one of the best approaches to their prevention. However, current safety training methods/tools are unable to provide trainees with the hands-on practice needed. Game technology-based safety training platforms have the potential to overcome this problem in a virtual environment. One such platform is described in this paper - its characteristics are analysed and its possible contribution to safety training identified. This is developed and tested by means of a case study involving three major pieces of construction plant, which successfully demonstrates that the platform can improve the process and performance of the safety training involved in their operation. This research not only presents a new and useful solution to the safety training of construction operations, but illustrates the potential use of advanced technologies in solving construction industry problems in general.

Motorcycle safety at signalized intersections

Motorcycles are overrepresented in road traffic crashes and particularly vulnerable at signalized intersections. ‘Motorcycle safety at signalized intersections’ provides an in-depth understanding of hazards of motorcycles at signalized intersections and suggests some targeted countermeasures to alleviate the problem. Motorcycle safety has been examined by establishing innovative statistical models with detailed investigation on specific maneuver behavior of motorcycles at intersections. Results indicate that motorcyclists are over exposed at signalized intersections and the excess exposure is one of main contributors to their vulnerability at intersections. The presence of red light cameras at intersections not only lower motorcycle crashes due to reduced red-light running in the conflicting stream but also decrease their exposure and hence crashes due to a more restrained discharge pattern of motorcycles. Targeted countermeasures should include deployment of red-light cameras, improvement in motorcyclist visibility and increased awareness on motorcyclist vulnerability.