Using a public key registry for improved trust and scalability in national E-health systems

An increasing number of countries are faced with an aging population increasingly needing healthcare services. For any e-health information system, the need for increased trust by such clients with potentially little knowledge of any security scheme involved is paramount. In addition notable scalability of any system has become a critical aspect of system design, development and ongoing management. Meanwhile cryptographic systems provide the security provisions needed for confidentiality, authentication, integrity and non-repudiation. Cryptographic key management, however, must be secure, yet efficient and effective in developing an attitude of trust in system users. Digital certificate-based Public Key Infrastructure has long been the technology of choice or availability for information security/assurance; however, there appears to be a notable lack of successful implementations and deployments globally. Moreover, recent issues with associated Certificate Authority security have damaged trust in these schemes. This paper proposes the adoption of a centralised public key registry structure, a non-certificate based scheme, for large scale e-health information systems. The proposed structure removes complex certificate management, revocation and a complex certificate validation structure while maintaining overall system security. Moreover, the registry concept may be easier for both healthcare professionals and patients to understand and trust.

Health monitoring of short-and medium-spen bridges using an improved modal strain energy method

Increasing the importance and use of infrastructures such as bridges, demands more effective structural health monitoring (SHM) systems. SHM has well addressed the damage detection issues through several methods such as modal strain energy (MSE). Many of the available MSE methods either have been validated for limited type of structures such as beams or their performance is not satisfactory. Therefore, it requires a further improvement and validation of them for different types of structures. In this study, an MSE method was mathematically improved to precisely quantify the structural damage at an early stage of formation. Initially, the MSE equation was accurately formulated considering the damaged stiffness and then it was used for derivation of a more accurate sensitivity matrix. Verification of the improved method was done through two plane structures: a steel truss bridge and a concrete frame bridge models that demonstrate the framework of a short- and medium-span of bridge samples. Two damage scenarios including single- and multiple-damage were considered to occur in each structure. Then, for each structure, both intact and damaged, modal analysis was performed using STRAND7. Effects of up to 5 per cent noise were also comprised. The simulated mode shapes and natural frequencies derived were then imported to a MATLAB code. The results indicate that the improved method converges fast and performs well in agreement with numerical assumptions with few computational cycles. In presence of some noise level, it performs quite well too. The findings of this study can be numerically extended to 2D infrastructures particularly short- and medium-span bridges to detect the damage and quantify it more accurately. The method is capable of providing a proper SHM that facilitates timely maintenance of bridges to minimise the possible loss of lives and properties.

The effect of procurement on competition and flexibility : determining the suitability of public-private partnerships in major infrastructure projects

A procurement decision-making model is developed based on a novel integration of leading-edge microeconomic theory and empirically tested in major road and health projects. The model provides a more reliable approach to identifying projects suited to Public-Private-Partnerships (PPPs) and it is expected that the model will enable government to deliver improved value-for-money from their portfolio of PPP projects.

A framework to analyze the impact of sustainable infrastructure on human productivity

The built environment has a profound impact on our natural environment, economy, health and productivity. As the majority of the people spent most of their time inside buildings, the environment in which they perform their daily activities will have an impact on their health and productivity. Studies have been conducted about the negative impacts of presence of non-favorable conditions to human health and well being. The term "Sick Building Syndrome" (SBS) is used to describe situations in which building occupants experience acute health and comfort problems that appear to be linked to their time spent in a building. Sustainable infrastructure rating systems have requirements intended to improve occupant productivity and health.While the impact of Sustainable Infrastructure in energy consumption and waste/water reduction can be measured using available tools, the impact on productivity remained as an assumption that is not clearly measured. The purpose of this research is to develop a framework to assess whether the impacts of the incorporation of features intended to improve occupants’ performance and health such as: increased ventilation, lightning and thermal comfort serve their intended purpose.

Progress and challenges of disaster health management in China : a scoping review

Background Despite the importance of an effective health system response to various disasters, relevant research is still in its infancy, especially in middle- and low-income countries. Objective This paper provides an overview of the status of disaster health management in China, with its aim to promote the effectiveness of the health response for reducing disaster-related mortality and morbidity. Design A scoping review method was used to address the recent progress of and challenges to disaster health management in China. Major health electronic databases were searched to identify English and Chinese literature that were relevant to the research aims. Results The review found that since 2003 considerable progress has been achieved in the health disaster response system in China. However, there remain challenges that hinder effective health disaster responses, including low standards of disaster-resistant infrastructure safety, the lack of specific disaster plans, poor emergency coordination between hospitals, lack of portable diagnostic equipment and underdeveloped triage skills, surge capacity, and psychological interventions. Additional challenges include the fragmentation of the emergency health service system, a lack of specific legislation for emergencies, disparities in the distribution of funding, and inadequate cost-effective considerations for disaster rescue. Conclusions One solution identified to address these challenges appears to be through corresponding policy strategies at multiple levels (e.g. community, hospital, and healthcare system level).

An investigation into the effect of infrastructure on fly-in fly-out mining workers

Objective: To explore fly-in fly-out (FIFO) mining workers' attitudes towards the leisure time they spend in mining camps, the recreational and social aspects of mining camp culture, the camps' communal and recreational infrastructure and activities, and implications for health. Design: In-depth semistructured interviews. Setting: Individual interviews at locations convenient for each participant. Participants: A total of seven participants, one female and six males. The age group varied within 20–59 years. Marital status varied across participants. Main outcome measures: A qualitative approach was used to interview participants, with responses thematically analysed. Findings highlight how the recreational infrastructure and activities at mining camps impact participants' enjoyment of the camps and their feelings of community and social inclusion. Results: Three main areas of need were identified in the interviews, as follows: (i) on-site facilities and activities; (ii) the role of infrastructure in facilitating a sense of community; and (iii) barriers to social interaction. Conclusion: Recreational infrastructure and activities enhance the experience of FIFO workers at mining camps. The availability of quality recreational facilities helps promote social interaction, provides for greater social inclusion and improves the experience of mining camps for their temporary FIFO residents. The infrastructure also needs to allow for privacy and individual recreational activities, which participants identified as important emotional needs. Developing appropriate recreational infrastructure at mining camps would enhance social interactions among FIFO workers, improve their well-being and foster a sense of community. Introducing infrastructure to promote social and recreational activities could also reduce alcohol-related social exclusion.

Portal-based support for mental health research

This paper describes experiences with the use of the Globus toolkit and related technologies for development of a secure portal that allows nationally-distributed Australian researchers to share data and application programs. The portal allows researchers to access infrastructure that will be used to enhance understanding of the causes of schizophrenia and advance its treatment, and aims to provide access to a resource that can expand into the world’s largest on-line collaborative mental health research facility. Since access to patient data is controlled by local ethics approvals, the portal must transparently both provide and deny access to patient data in accordance with the fine-grained access permissions afforded individual researchers. Interestingly, the access protocols are able to provide researchers with hints about currently inaccessible data that may be of interest to them, providing them the impetus to gain further access permissions.

Comparison of visual inspection and structural-health monitoring as bridge condition assessment methods

This paper presents the results of a research project aimed at examining the capabilities and challenges of two distinct but not mutually exclusive approaches to in-service bridge assessment: visual inspection and installed monitoring systems. In this study, the intended functionality of both approaches was evaluated on its ability to identify potential structural damage and to provide decision-making support. Inspection and monitoring are compared in terms of their functional performance, cost, and barriers (real and perceived) to implementation. Both methods have strengths and weaknesses across the metrics analyzed, and it is likely that a hybrid evaluation technique that adopts both approaches will optimize efficiency of condition assessment and ultimately lead to better decision making.

Chronicling the patient journey: Co-creating value with digital health ecosystems

With the introduction of the PCEHR (Personally Controlled Electronic Health Record), the Australian public is being asked to accept greater responsibility for the management of their health information. However, the implementation of the PCEHR has occasioned poor adoption rates underscored by criticism from stakeholders with concerns about transparency, accountability, privacy, confidentiality, governance, and limited capabilities. This study adopts an ethnographic lens to observe how information is created and used during the patient journey and the social factors impacting on the adoption of the PCEHR at the micro-level in order to develop a conceptual model that will encourage the sharing of patient information within the cycle of care. Objective: This study aims to firstly, establish a basic understanding of healthcare professional attitudes toward a national platform for sharing patient summary information in the form of a PCEHR. Secondly, the studies aims to map the flow of patient related information as it traverses a patient’s personal cycle of care. Thus, an ethnographic approach was used to bring a “real world” lens to information flow in a series of case studies in the Australian healthcare system to discover themes and issues that are important from the patient’s perspective. Design: Qualitative study utilising ethnographic case studies. Setting: Case studies were conducted at primary and allied healthcare professionals located in Brisbane Queensland between October 2013 and July 2014. Results: In the first dimension, it was identified that healthcare professionals’ concerns about trust and medico-legal issues related to patient control and information quality, and the lack of clinical value available with the PCEHR emerged as significant barriers to use. The second dimension of the study which attempted to map patient information flow identified information quality issues, clinical workflow inefficiencies and interoperability misconceptions resulting in duplication of effort, unnecessary manual processes, data quality and integrity issues and an over reliance on the understanding and communication skills of the patient. Conclusion: Opportunities for process efficiencies, improved data quality and increased patient safety emerge with the adoption of an appropriate information sharing platform. More importantly, large scale eHealth initiatives must be aligned with the value proposition of individual stakeholders in order to achieve widespread adoption. Leveraging an Australian national eHealth infrastructure and the PCEHR we offer a practical example of a service driven digital ecosystem suitable for co-creating value in healthcare.

Improving health and safety communication of migrant construction workers

Although statistical data in some developed countries indicate that migrant workers are nearly 30% more likely to have work-related injuries than local workers, no equivalent official injury/ incident statistics on the health and safety (H&S) of migrant workers are currently tracked in Australia. With increasing numbers of migrant workers having joined Australia’s extractive industries infrastructure and commercial construction industry, this suggests the need for some investigation. A particular issue is that lack of H&S communication is one of the key factors leading to construction industry accidents/ incidents as it prevents workers from effectively receiving H&S safety training and acquiring H&S information. Migrant workers whose first languages are not English are particularly affected by this problem and ways are needed to improve their situation. The research aims to do this by evaluating the H&S communication problems of migrant workers and identify an effective H&S communication structure. An overview of the challenge being addressed by the research is firstly provided, followed by a description of the research framework, and a report of the initial findings, from which recommendations are provided for improving H&S performance in the construction industry.

Grand challenges for public health

What is the future for public health in the twenty-first century? Can we glean an idea about the future of public health from its past? As Winston Churchill once said: ‘[T]he further backward you look, the further forward you can see.’ What can we see in the history of public health that gives us an idea of where public health might be headed in the future? (Gruszin et al. 2012). In the twentieth century there was substantial progress in public health in Australia. These improvements were brought about through a number of factors. In part, improvements were due to increasing knowledge about the natural history of disease and its treatment. Added to this knowledge was a shifting focus from legislative measures to protect health, to the emergence of improved promotion and prevention strategies, and a general improvement in social and economic conditions for people living in countries such as Australia. Gruszin et al. (2012) consider the range of social and economic reforms of the twentieth century as the most important determinants of the public’s health at the start of the twenty-first century (Gruszin et al. 2012 p 201). The same could not, however, be said for second or third world countries, many of whom have the most fundamental of sanitary and health protection issues still to deal with. For example, in sub-Saharan Africa and in Russia the decline in life expectancy can be said to be related to a range of interconnected factors. In Russia, issues such as alcoholism, violence, suicide, accidents and cardiovascular disease could be contributing to the falling life expectancy (McMichael & Butler 2007). In sub-Saharan Africa, a range of factors, such as HIV/AIDS, poverty, malaria, tuberculosis, undernutrition, totally inadequate infrastructure, gender inequality, conflict and violence, political taboos and a complete lack of political will, have all contributed to a dramatic drop in life expectancy (McMichael & Butler 2007).

IMIA working group on health record banking - How complex systems can cooperate towards having individual's consolidated data

This workshop aims at discussing alternative approaches to resolving the problem of health information fragmentation, partially resulting from difficulties of health complex systems to semantically interact at the information level. In principle, we challenge the current paradigm of keeping medical records where they were created and discuss an alternative approach in which an individual's health data can be maintained by new entities whose sole responsibility is the sustainability of individual-centric health records. In particular, we will discuss the unique characteristics of the European health information landscape. This workshop is also a business meeting of the IMIA Working Group on Health Record Banking.