What can we learn from the crashes of learner riders?

In some parts of Australia, people wanting to learn to ride a motorcycle are required to complete an off-road training course before they are allowed to practice on the road. In the state of Queensland, they are only required to pass a short multiple-choice road rules knowledge test. This paper describes an analysis of police-reported crashes involving learner riders in Queensland that was undertaken as part of research investigating whether pre-learner training is needed and, if so, the issues that should be addressed in training.. The crashes of learner riders and other riders were compared to identify whether there are particular situations or locations in which learner motorcyclists are over-involved in crashes, which could then be targeted in the pre-learner package. The analyses were undertaken separately for riders aged under 25 (330 crashes) versus those aged 25 and over (237 crashes) to provide some insight into whether age or riding inexperience are the more important factors, and thus to indicate whether there are merits in having different licensing or training approaches for younger and older learner riders. Given that the average age of learner riders was 33 years, under 25 was chosen to provide a sufficiently large sample of younger riders. Learner riders appeared to be involved in more severe crashes and to be more often at fault than fully-licensed riders but this may reflect problems in reporting, rather than real differences. Compared to open licence holders, both younger and older learner riders had relatively more crashes in low speed zones and relatively fewer in high speed zones. Riders aged under 25 had elevated percentages of night-time crashes and fewer single unit (potentially involving rider error only) crashes regardless of the type of licence held. The contributing factors that were more prevalent in crashes of learner riders than holders of open licences were: inexperience (37.2% versus 0.5%), inattention (21.5% versus 15.6%), alcohol or drugs (12.0% versus 5.1%) and drink riding (9.9% versus 3.1%). The pattern of contributing factors was generally similar for younger and older learner riders, although younger learners were (not surprisingly) more likely to have inexperience coded as a contributing factor (49.7% versus 19.8%). Some of the differences in crashes between learner riders and fully-licensed riders appear to reflect relatively more riding in urban areas by learners, rather than increased risks relating to inexperience. The analysis of contributing factors in learner rider crashes suggests that hazard perception and risk management (in terms of speed and alcohol and drugs) should be included in a pre-learner program. Currently, most learner riders in Queensland complete pre-licence training and become licensed within one month of obtaining their learner permit. If the introduction of pre-learner training required that the learner permit was held for a minimum duration, then the immediate effect might be more learners riding (and crashing). Thus, it is important to consider how training and licensing initiatives work together in order to improve the safety of new riders (and how this can be evaluated).

Acknowledging, moving toward and transcending psychophysiological angst during a paradox of conflicting desires

In this paper I integrate the work of a number of philosophers to clarify some psychological issues that can arise in human existence when a conflict of intrapersonal or interpersonal desires arises. This paper utilises the work of Deleuze, Freud, Jung, Heidegger, Hegel and Nietzsche to provide a conceptual framework as to how mental disturbances can arise if unconscious desires cannot be satisfied due to the experience of a resistance from a conflicting or opposing desire. This paper argues that the phenomenal experience of a conflict of desires can be unconcealed in moments of un-readiness-to-hand and from the awareness of the psychophysiological experience of stress or angst. The work that is presented, results in the conclusion that it is fundamentally necessary to embrace Nietzsche’s idea of the ‘will to power’ to overcome these difficulties and to achieve personal individuation and authentic wellbeing. This advice is in contrast to an inauthentic choice of depending on the use of Freudian defence mechanisms to conceal a conflict of desires from consciousness. A detailed theoretical example of the process involved in the resolution of a conflict of desires through self-transcendence is specifically informed by the ideas of Nietzsche and Jung.

Emergency Health Services (EHS) : demand and service delivery models. monograph 3 : patients’ reasons and perceptions

Executive Summary Emergency health is a critical component of Australia’s health system and emergency departments (EDs) are increasingly congested from growing demand and blocked access to inpatient beds. The Emergency Health Services Queensland (EHSQ) study aims to identify the factors driving increased demand for emergency health and to evaluate strategies which may safely reduce the future demand growth. This monograph addresses the perspectives of users of both ambulance services and EDs. The research reported here aimed to identify the perspectives of users of emergency health services, both ambulance services and public hospital Emergency Departments and to identify the factors that they took into consideration when exercising their choice of location for acute health care. A cross-sectional survey design was used involving a survey of patients or their carers presenting to the EDs of a stratified sample of eight hospitals. A specific purpose questionnaire was developed based on a novel theoretical model which had been derived from analysis of the literature (Monograph 1). Two survey versions were developed: one for adult patients (self-complete); and one for children (to be completed by parents/guardians). The questionnaires measured perceptions of social support, health status, illness severity, self-efficacy; beliefs and attitudes towards ED and ambulance services; reasons for using these services, and actions taken prior to the service request. The survey was conducted at a stratified sample of eight hospitals representing major cities (four), inner regional (two) and outer regional and remote (two). Due to practical limitations, data were collected for ambulance and ED users within hospital EDs, while patients were waiting for or under treatment. A sample size quota was determined for each ED based on their 2009/10 presentation volumes. The data collection was conducted by four members of the research team and a group of eight interviewers between March and May 2011 (corresponding to autumn season). Of the total of 1608 patients in all eight emergency departments the interviewers were able to approach 1361 (85%) patients and seek their consent to participate in the study. In total, 911 valid surveys were available for analysis (response rate= 67%). These studies demonstrate that patients elected to attend hospital EDs in a considered fashion after weighing up alternatives and there is no evidence of deliberate or ill-informed misuse. • Patients attending ED have high levels of social support and self-efficacy that speak to the considered and purposeful nature of the exercise of choice. • About one third of patients have new conditions while two thirds have chronic illnesses • More than half the attendees (53.1%) had consulted a healthcare professional prior to making the decision. • The decision to seek urgent care at an ED was mostly constructed around the patient’s perception of the urgency and severity of their illness, reinforced by a strong perception that the hospital ED was the correct location for them (better specialised staff, better care for my condition, other options not as suitable). • 33% of the respondent held private hospital insurance but nevertheless attended a public hospital ED. Similarly patients exercised considered and rational judgements in their choice to seek help from the ambulance service. • The decision to call for ambulance assistance was based on a strong perception about the severity of the illness (too severe to use other means of transport) and that other options were not considered appropriate. • The decision also appeared influenced by a perception that the ambulance provided appropriate access to the ED which was considered most appropriate for their particular condition (too severe to go elsewhere, all facilities in one spot, better specialised and better care). • In 43.8% of cases a health care professional advised use of the ambulance. • Only a small number of people perceived that ambulance should be freely available regardless of severity or appropriateness. These findings confirm a growing understanding that the choice of professional emergency health care services is not made lightly but rather made by reasonable people exercising a judgement which is influenced by public awareness of the risks of acute health and which is most often informed by health professionals. It is also made on the basis of a rational weighing up of alternatives and a deliberate and considered choice to seek assistance from a service which the patient perceived was most appropriate to their needs at that time. These findings add weight to dispensing with public perceptions that ED and ambulance congestion is a result of inappropriate choice by patients. The challenge for health services is to better understand the patient’s needs and to design and validate services that meet those needs. The failure of our health system to do so should not be grounds for blaming the patient, claiming inappropriate patient choices.

Demystifying paradoxical characteristics of narcissistic personality disorder

This letter is aimed for psychotherapy clinicians and researchers who should acknowledge the relationship linking Kohut's self-psychology and Glasser's Choice theory that can demystify relationship difficulties and mental health problems in narcissistic personality disorder (NPD).

Implementation of a better choice healthy food and drink supply strategy for staff and visitors in government owned health facilities in Queensland, Australia

Objective The present paper reports on a quality improvement activity examining implementation of A Better Choice Healthy Food and Drink Supply Strategy for Queensland Health Facilities (A Better Choice). A Better Choice is a policy to increase supply and promotion of healthy foods and drinks and decrease supply and promotion of energy-dense, nutrient-poor choices in all food supply areas including food outlets, staff dining rooms, vending machines, tea trolleys, coffee carts, leased premises, catering, fundraising, promotion and advertising. Design An online survey targeted 278 facility managers to collect self-reported quantitative and qualitative data. Telephone interviews were sought concurrently with the twenty-five A Better Choice district contact officers to gather qualitative information. Setting Public sector-owned and -operated health facilities in Queensland, Australia. Subjects One hundred and thirty-four facility managers and twenty-four district contact officers participated with response rates of 48·2 % and 96·0 %, respectively. Results Of facility managers, 78·4 % reported implementation of more than half of the A Better Choice requirements including 24·6 % who reported full strategy implementation. Reported implementation was highest in food outlets, staff dining rooms, tea trolleys, coffee carts, internal catering and drink vending machines. Reported implementation was more problematic in snack vending machines, external catering, leased premises and fundraising. Conclusions Despite methodological challenges, the study suggests that policy approaches to improve the food and drink supply can be implemented successfully in public-sector health facilities, although results can be limited in some areas. A Better Choice may provide a model for improving food supply in other health and workplace settings.

Countermeasures to driver sleepiness : is the message getting through?

The most effective countermeasures to driver sleepiness (caffeine and a nap, ideally in combination) are not the most popular choice for UK drivers. Groups susceptible to driver sleepiness (OSA patients and truck drivers) do not favour effective countermeasures to driver sleepiness. Prior experience of driver sleepiness does not promote an effective choice of countermeasure.

A question of agency : applying Sen’s theory of human capability to the concept of secondary school student career ‘choice’

In this paper, we seek to operationalize Amartya Sen's concept of human capability to guide a scholarly investigation of student career choice capability. We begin by outlining factors affecting youth labour markets in Australia; a prosperous country that is affected by a ‘two-speed’ national economy. We then examine recent government initiatives that have been designed to combat youth unemployment and cyclical disadvantage by enhancing the aspirations and career knowledge of secondary school students. We argue that these policy measures are based on four assumptions: first, that career choice capability is a problem of individual agency; second, that the dissemination of career information can empower students to act as ‘consumers’ in an unequal job market; third, that agency is simply a question of will; and finally, that school education and career advice – as a means to freedom in the space of career development – is of equal quality, distribution and value to an increasingly diverse range of upper secondary school students. The paper concludes by outlining a conceptual framework capable of informing an empirical research project that aims to test these assumptions by measuring and comparing differences between groups in the range of freedom to achieve and, therefore, to choose.

Who struggles most in making a career choice and why?Findings from a cross-sectional survey of highschool students

This paper reports findings from an empirical study examining the influence of student background and educational experiences on the development of career choice capability. Secondary school students attending years 9-12 (N = 706) in New South Wales (NSW), Australia, were invited to participate in an online survey that sought to examine factors influencing their career choices. The survey included questions relating to student demographics, parental occupation, attitudes to school and to learning, student aspirations, and students’ knowledge of the further education or skills required to achieve their desired goal. We found no significant differences in the proportions of students who were “uncertain” of their future career aspirations with respect to their socio-educational background. There were, however, significantly more students struggling with career decision making from an English-speaking background in comparison to households where children spoke a language other than English. Those students were proportionally present in government and non-government schools and had some behavioural and attitudinal characteristics in common.

Built to last or meant to end : intertemporal choice in strategic alliance portfolios

A salient but rarely explicitly studied characteristic of interfirm relationships is that they can intentionally be formed for finite periods of time. What determines firms' intertemporal choices between different alliance time horizons? Shadow of the future theorists suggest that when an alliance has an explicitly set short-term time frame, there is an increased risk that partners may behave opportunistically. This does not readily explain the high incidence of time-bound alliances being formed. Reconciling insights from the shadow of the future perspective with nascent research on the flexibility of temporary organizations, and shifting the focus from the level of individual transactions to that of strategic alliance portfolios, we argue that firms may be willing to accept a higher risk of opportunism when there are offsetting gains in strategic flexibility in managing their strategic alliance portfolio. Consequently, we hypothesize that environmental factors that increase the need for strategic flexibility—namely, dynamism and complexity in the environment—are likely to increase the relative share of time-bound alliances in strategic alliance portfolios. Our analysis of longitudinal data on the intertemporal alliance choices of a large sample of small and medium-sized enterprises provides support for this argument. Our findings fill an important gap in theory about time horizons in interfirm relationships and temporary organizations and show the importance of separating planned terminations from duration-based performance measures.

'Music eScape': mHealth application

Research Background Young people’s avid use of mobile technologies in daily life has led to an increase in the design and research on mHealth (mobile health) interventions targeting young people. ‘Music eScape’ is a mobile based mood regulation app that uses an innovative approach to promoting young people’s wellbeing using music. Research Question The design, research, development and evaluation of ‘Music eScape’ addressed a number of research questions from across the fields of Psychology and Interactive and Visual Design. The specific design research question addressed was: How can interaction and visual design be utilized to promote and enable young people to effectively regulate their mood using music and how can the new design further promote their experience of empowerment, control and agency over actively directing their mood journey? Research Contribution Innovation and New Knowledge Through its unique visual interface design and interactivity, the application presents a novel approach to promoting young people’s wellbeing using music and a specific function that allows users to ‘draw’ their mood journey in order to generate a playlist. The mobile app is the first to contain a function that enables users to plan their mood journey and exercise a sense of agency, intentional choice and control over the mood shift and by extension, their wellbeing. The feature ‘drawing’ interface was designed by Oksana Zelenko using participatory design research and Russell’s circumplex model of affect (1980) to inform the key visual design concept and underpinning interaction design. Research Significance The significance of the design research component within the larger interdisciplinary practices that have informed ‘Music eScape’ (e.g. field of psychology, reported through journal articles and other related outcomes), is the unique visual and interactive presentation of participant data and music therapy research within the app interface and interaction design which improves and increases young people’s engagement with the health messages it contains. The industry quality standard is further demonstrated by the launch on Apple iTunes. This demonstrates the application meets the high professional requirements for national release and meets international standards. The app also creates a new benchmark for the quality of health apps on the market as it marks the industry release of a trialled evidence-based mHealth intervention co-designed with young people.