The influence of family history of hypertension on disease prevalence and associated metabolic risk factors among Sri Lankan adults

Background Hypertension is a major contributor to the global non-communicable disease burden. Family history is an important non-modifiable risk factor for hypertension. The present study aims to describe the influence of family history (FH) on hypertension prevalence and associated metabolic risk factors in a large cohort of South Asian adults, from a nationally representative sample from Sri Lanka. Methods A cross-sectional survey among 5,000 Sri Lankan adults, evaluating FH at the levels of parents, grandparents, siblings and children. A binary logistic regression analysis was performed in all patients with ‘presence of hypertension’ as dichotomous dependent variable and using family history in parents, grandparents, siblings and children as binary independent variables. The adjusted odds ratio controlling for confounders (age, gender, body mass index, diabetes, hyperlipidemia and physical activity) are presented below. Results In all adults the prevalence of hypertension was significantly higher in patients with a FH (29.3 %, n = 572/1951) than those without (24.4 %, n = 616/2530) (p < 0.001). Presence of a FH significantly increased the risk of hypertension (OR:1.29; 95 % CI:1.13-1.47), obesity (OR:1.36; 95 % CI: 1.27–1.45), central obesity (OR:1.30; 95 % CI 1.22–1.40) and metabolic syndrome (OR:1.19; 95 % CI: 1.08–1.30). In all adults presence of family history in parents (OR:1.28; 95 % CI: 1.12–1.48), grandparents (OR:1.34; 95 % CI: 1.20–1.50) and siblings (OR:1.27; 95 % CI: 1.21–1.33) all were associated with significantly increased risk of developing hypertension. Conclusions Our results show that the prevalence of hypertension was significantly higher in those with a FH of hypertension. FH of hypertension was also associated with the prevalence of obesity, central obesity and metabolic syndrome. Individuals with a FH of hypertension form an easily identifiable group who may benefit from targeted interventions.

Risk factors for hospital re-presentation among older adults following fragility fractures: Protocol for a systematic review

Background After being discharged from hospital following the acute management of a fragility fracture, older adults may re-present to hospital emergency departments in the post-discharge period. Early re-presentation to hospital, which includes hospital readmissions, and emergency department presentations without admission, may be considered undesirable for individuals, hospital institutions and society. The identification of modifiable risk factors for hospital re-representation following initial fracture management may prove useful for informing policy or practice initiatives that seek to minimise the need for older adults to re-present to hospital early after they have been discharged from their initial inpatient care. The purpose of this systematic review is to identify correlates of hospital re-presentation in older patients who have been discharged from hospital following clinical management of fragility fractures. Methods/Design The review will follow the PRISMA-P reporting guidelines for systematic reviews. Four electronic databases (Pubmed, CINAHL, Embase, and Scopus) will be searched. A suite of search terms will identify peer-reviewed articles that have examined the correlates of hospital re-presentation in older adults (mean age of 65 years or older) who have been discharged from hospital following treatment for fragility fractures. The Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies will be used to assess the quality of the studies. The strength of evidence will be assessed through best evidence synthesis. Clinical and methodological heterogeneity across studies are likely to impede meta-analyses. Discussion The best evidence synthesis will outline correlates of hospital re-presentations in this clinical group. This synthesis will take into account potential risks of bias for each study, while permitting inclusion of findings from a range of quantitative study designs. It is anticipated that findings from the review will be useful in identifying potentially modifiable risk factors that have relevance in policy, practice and research priorities to improve the management of patients with fragility fractures. Systematic Review Registration PROSPERO CRD42015019379

Pedestrian Crashes in Ethiopia: Identification of contributing factors through modelling of exposure and road environment variables

Pedestrian safety is a critical issue in Ethiopia. Reports show that 50 to 60% of traffic fatality victims in the country are pedestrians. The primary aim of this research was to examine the possible causes of and contributing factors to crashes with pedestrians in Ethiopia, and improve pedestrian safety by recommending possible countermeasures. The secondary aim was to develop appropriate pedestrian crash models for two-way two-lane rural roads and roundabouts in the capital city of Ethiopia. This research uses quantitative methods throughout the process of the investigation. The research has applied various statistical methods. The results of this research support the idea that geometric and operational features have significant influence on pedestrian safety and crashes. Accordingly, policies and strategies are needed to safeguard pedestrians in Ethiopia.

Factors affecting antihypertensive medications adherence among hypertensive patients in Saudi Arabia

Hypertension is a health problem that has increasing prevalence worldwide. Antihypertensive medications are the key for achieving controlled blood pressure. Little is known about predictors of antihypertensive medications adherence in Saudi Arabia. This is a cross-sectional study of 308 participants from a general hospital in Jeddah city, Saudi Arabia conducted between July 2013 and February 2014. Out of the 308 participants, the results showed that 27.9% were classified as perfect adherents and 72.1% were classified as non-perfect adherents to antihypertensive medications. Significant predictors of non-perfect antihypertensive medications in this study were having non-formal education (p=0.031, OR=2.3, 95%CI = [1.82-5]), reporting a poor relationship with physicians (p=0.004, OR=2.25, 95%CI= [1.29-3.9]), and having no co-morbidities (p=0.048, OR=1.86, 95%CI [1.00-3.46]). The outcome of this study highlights the need for policies and interventions that enhance the level of formal education at a population level and improve physician-patient relationships in health care settings.

Cultural factors: Understanding culture to design organisation structures and systems to optimise safety

Safety culture is a term with numerous definitions in the literature. Many authors advocate a prescriptive approach to safety culture in which if an organisation has certain levels of externally prescribed systems and structures in place it has a “good safety culture”. Conversely, other researchers suggest an anthropological approach of exploring deep meanings and understandings present within an organisation’s workforce. In a recent published review, the authors presented an alternative view to safety culture, in which the anthropological aspects of safety culture interact with the structures and systems in place within an organisation to result in behavioural patterns. This can be viewed as a human factors approach to safety culture in which, through understanding the specific interactions between the culture of a workforce and external organisational elements, organisational structures and systems can be optimised in order to shape worker behaviour and improve safety. This paper presents findings from a recent investigation of safety culture in the Australian heavy vehicle (transport) industry. Selected results are discussed to explore how understanding culture can provide direction to the optimisation of organisational structures and systems to match worker culture and thus improve safety. Specifically the value placed on personal experience and stories, as well as on both time and money are discussed, and interventions that are suited to these aspects of the culture are discussed. These findings demonstrate the importance of shifting beyond mere prescriptive and interpretive approaches to safety culture and instead to focus on the interaction between cultural and contextual elements to optimise organisational structures and systems.

Incidence and predictors of lower limb split-skin graft failure and primary closure dehiscence in day-case surgical patients

BACKGROUND After general surgery, the lower limb experiences some of the highest complication rates. However, little is known about contributing factors to surgical site failure in the lower limb dermatological surgery population. OBJECTIVE To determine the incidence of lower limb surgical site failure and to explore the predictors that contribute to surgical site failure. METHODS A prospective observational study design was used to collect data from 73 participants, from July 2010, to March 2012. Incidence was determined as a percentage of surgical site failure from the total population. Predictors were determined by the use of a binary logistic regression model. RESULTS The surgical site failure rate was 53.4%. Split-skin grafting had a higher failure rate than primary closures, 66% versus 26.1%. Predictors of lower limb surgical site failure were identified as increasing age (p = .04) and the presence of postoperative hematoma (p = .01), with all patients who developed surgical site infection experiencing surgical site failure (p = .01). CONCLUSION Findings from this study confirmed that the lower limb is at high risk of surgical site failure. Two predictors of surgical site failure from this cohort were determined. However, to understand this phenomenon and make recommendations to assist and reduce surgical site complications, further research in this field is required.

Human factors evaluation of a novel Australian approach for activating railway level crossings

There are currently 23,500 level crossings in Australia, broadly divided active level crossings with flashing lights; and passive level crossings controlled by stop and give way signs. The current strategy is to annually upgrade passive level crossings with active controls within a given budget, but the 5,900 public passive crossings are too numerous to be upgraded all. The rail industry is considering alternative options to treat more crossings. One of them is to use lower cost equipment with reduced safety integrity level, but with a design that would fail to a safe state: in case of the impossibility for the system to know whether a train is approaching, the crossing changes to a passive crossing. This is implemented by having a STOP sign coming in front of the flashing lights. While such design is considered safe in terms of engineering design, questions remain on human factors. In order to evaluate whether such approach is safe, we conducted a driving simulator study where participants were familiarized with the new active crossing, before changing the signage to a passive crossing. Our results show that drivers treated the new crossing as an active crossing after the novelty effect had passed. While most participants did not experience difficulties with the crossing being turned back to a passive crossing, a number of participants experienced difficulties stopping in time at the first encounter of such passive crossing. Worse, a number of drivers never realized the signage had changed, highlighting the link between the decision to brake and stop at an active crossing to the lights flashing. Such results show the potential human factor issues of changing an active crossing to a passive crossing in case of failure of the detection of the train.

Examining signs of driver sleepiness, usage of sleepiness countermeasures and the associations with sleepy driving behaviours and individual factors

The impairing effect from sleepiness is a major contributor to road crashes. The ability of a sleepy driver to perceive their level of sleepiness is an important consideration for road safety as well as the type of sleepiness countermeasure used by drivers as some sleepiness countermeasures are more effective than others. The aims of the current study were to determine the extent that the signs of driver sleepiness were associated with sleepy driving behaviours, as well as determining which individual factors (demographic, work, driving, and sleep-related factors) were associated with using a roadside or in-vehicle sleepiness countermeasure. A sample of 1518 Australian drivers from the Australian State of New South Wales and the neighbouring Australian Capital Territory took part in the study. The participants’ experiences with the signs of sleepiness were reasonably extensive. A number of the early signs of sleepiness (e.g., yawning, frequent eye blinks) were related with continuing to drive while sleepy, with the more advanced signs of sleepiness (e.g., difficulty keeping eyes open, dreamlike state of consciousness) associated with having a sleep-related close call. The individual factors associated with using a roadside sleepiness countermeasure included age (being older), education (tertiary level), difficulties getting to sleep, not continuing to drive while sleepy, and having experienced many signs of sleepiness. The results suggest that these participants have a reasonable awareness and experience with the signs of driver sleepiness. Factors related to previous experiences with sleepiness were associated with implementing a roadside countermeasure. Nonetheless, the high proportions of drivers performing sleepy driving behaviours, suggest that concerted efforts are needed with road safety campaigns regarding the dangers of driving while sleepy.

Complex Symbolic Sequence Encodings for Predictive Monitoring of Business Processes

This paper addresses the problem of predicting the outcome of an ongoing case of a business process based on event logs. In this setting, the outcome of a case may refer for example to the achievement of a performance objective or the fulfillment of a compliance rule upon completion of the case. Given a log consisting of traces of completed cases, given a trace of an ongoing case, and given two or more possible out- comes (e.g., a positive and a negative outcome), the paper addresses the problem of determining the most likely outcome for the case in question. Previous approaches to this problem are largely based on simple symbolic sequence classification, meaning that they extract features from traces seen as sequences of event labels, and use these features to construct a classifier for runtime prediction. In doing so, these approaches ignore the data payload associated to each event. This paper approaches the problem from a different angle by treating traces as complex symbolic sequences, that is, sequences of events each carrying a data payload. In this context, the paper outlines different feature encodings of complex symbolic sequences and compares their predictive accuracy on real-life business process event logs.

Pro-angiogenic and anti-angiogenic factors in the degradation of osteoarthritic cartilage

This project has determined angiogenic and anti-angiogenic factors in osteoarthritis cartilage. The work has expanded our knowledge and understanding of the importance of anti-angiogenic factors in maintaining cartilage homeostasis. This study also tested the concept of topical application of anti-angiogenic treatment strategy for osteoarthritis.

Exploring the influences of country-level factors on mature-aged women’s drink driving attitudes

The current study examined drink driving attitudes among mature-aged women in Sweden and Australia, two countries with a Blood Alcohol Concentration (BAC) limit of 0.02% and 0.05%, respectively. The study aimed to identify attitudes that might influence drink driving tendency among this group of women and further show how these attitudes vary across countries. Using an ethnographic approach, 15 mature-aged women (Sweden: mean age = 52.5years, SD = 4.8; Australia: mean age 52.2 years, SD = 3.4) were interviewed in each country. General patterns and themes from the data were developed using thematic analysis methods. The findings indicate that while women in both countries viewed drink driving negatively, the understanding of what the concept entailed differed between the two samples. The Swedish women appeared to cognitively separate alcohol consumption and driving, and consequently, drink driving was often spoken of as driving after any alcohol consumption. The Australian women’s understanding of drink driving was more closely related to the legal BAC limit. However, for some Australian women, a “Grey Zone” existed, which denoted driving with a BAC of just above the enforceable limit. While illegal, these instances were subjectively seen as similar to driving with a BAC of just under the legal limit and therefore not morally reprehensible. The practice of cognitively separating drinking from driving appeared to have implications for the tendency to drink and drive among the interviewed women. These findings are discussed in relation to current policy and legislation in Australia and the need for further research into mature-aged women’s drink driving is outlined.

Empirical investigation of factors contributing to the psychological safety climate on construction sites

Employees’ safety climate perceptions dictate their safety behavior because individuals act based on their perceptions of reality. Extensive empirical research in applied psychology has confirmed this relationship. However, rare efforts have been made to investigate the factors contributing to a favorable safety climate in construction research. As an initial effort to address the knowledge gap, this paper examines factors contributing to a psychological safety climate, an operationalization of a safety climate at the individual level, and, hence, the basic element of a safety climate at higher levels. A multiperspective framework of contributors to a psychological safety climate is estimated by a structural equation modeling technique using individual questionnaire responses from a random sample of construction project personnel. The results inform management of three routes to psychological safety climate: a client’s proactive involvement in safety management, a workforce-friendly workplace created by the project team, and transformational supervisors’ communication about safety matters with the workforce. This paper contributes to the field of construction engineering and management by highlighting a broader contextual influence in a systematic formation of psychological safety climate perceptions.

Household carbon emission research: An analytical review of measurement, influencing factors and mitigation prospects

Greenhouse gas (GHG) emissions are simultaneously exhausting the world's supply of fossil fuels and threatening the global climate. In many developing countries, significant improvement in living standards in recent years due to the accelerating development of their economies has resulted in a disproportionate increase in household energy consumption. Therefore, a major reduction in household carbon emissions (HCEs) is essential if global carbon reduction targets are to be met. To do this, major Organisation for Economic Co-operation and Development (OECD) states have already implemented policies to alleviate the negative environmental effects of household behaviors and less carbon-intensive technologies are also proposed to promote energy efficiency and reduce carbon emissions. However, before any further remedial actions can be contemplated, though, it is important to fully understand the actual causes of such large HCEs and help researchers both gain deep insights into the development of the research domain and identify valuable research topics for future study. This paper reviews existing literature focusing on the domain of HCEs. This critical review provides a systematic understanding of current work in the field, describing the factors influencing HCEs under the themes of household income, household size, age, education level, location, gender and rebound effects. The main quantification methodologies of input–output models, life cycle assessment and emission coefficient methods are also presented, and the proposed measures to mitigate HCEs at the policy, technology and consumer levels. Finally, the limitations of work done to date and further research directions are identified for the benefit of future studies.

Revisiting the Task-Capability interface model for incorporating human factors into car-following models

Human factors such as distraction, fatigue, alcohol and drug use are generally ignored in car-following (CF) models. Such ignorance overestimates driver capability and leads to most CF models’ inability in realistically explaining human driving behaviors. This paper proposes a novel car-following modeling framework by introducing the difficulty of driving task measured as the dynamic interaction between driving task demand and driver capability. Task difficulty is formulated based on the famous Task Capability Interface (TCI) model, which explains the motivations behind driver’s decision making. The proposed method is applied to enhance two popular CF models: Gipps’ model and IDM, and named as TDGipps and TDIDM respectively. The behavioral soundness of TDGipps and TDIDM are discussed and their stabilities are analyzed. Moreover, the enhanced models are calibrated with the vehicle trajectory data, and validated to explain both regular and human factor influenced CF behavior (which is distraction caused by hand-held mobile phone conversation in this paper). Both the models show better performance than their predecessors, especially in presence of human factors.