Sequential monitoring of hospital adverse events when control charts fail : the example of fall injuries in hospitals

Objective To evaluate methods for monitoring monthly aggregated hospital adverse event data that display clustering, non-linear trends and possible autocorrelation. Design Retrospective audit. Setting The Northern Hospital, Melbourne, Australia. Participants 171,059 patients admitted between January 2001 and December 2006. Measurements The analysis is illustrated with 72 months of patient fall injury data using a modified Shewhart U control chart, and charts derived from a quasi-Poisson generalised linear model (GLM) and a generalised additive mixed model (GAMM) that included an approximate upper control limit. Results The data were overdispersed and displayed a downward trend and possible autocorrelation. The downward trend was followed by a predictable period after December 2003. The GLM-estimated incidence rate ratio was 0.98 (95% CI 0.98 to 0.99) per month. The GAMM-fitted count fell from 12.67 (95% CI 10.05 to 15.97) in January 2001 to 5.23 (95% CI 3.82 to 7.15) in December 2006 (p<0.001). The corresponding values for the GLM were 11.9 and 3.94. Residual plots suggested that the GLM underestimated the rate at the beginning and end of the series and overestimated it in the middle. The data suggested a more rapid rate fall before 2004 and a steady state thereafter, a pattern reflected in the GAMM chart. The approximate upper two-sigma equivalent control limit in the GLM and GAMM charts identified 2 months that showed possible special-cause variation. Conclusion Charts based on GAMM analysis are a suitable alternative to Shewhart U control charts with these data.

Priority threat management of invasive plant species in the Lake Eyre Basin

This project is led by scientists in conservation decision appraisal and brings together a group of experts working across the Lake Eyre Basin (LEB). The LEB covers a sixth of Australia, with an array of globally significant natural values that are threatened by invasive plants, among other things. Managers at various levels are investing in attempts to control, contain and eradicate these invasive plant species, under severe time and resources limitations. To date there has been no basin-wide assessment of which weed management strategies and locations provide the best investments for maximising outcomes for biodiversity per unit cost. Further, there has been no assessment of the extent of ecosystem intactness that may be lost without effective invasive plant species management strategies. Given that there are insufficient resources to manage all invasive plant species everywhere, this information has the potential to improve current investment decisions. Here, we provide a prioritisation of invasive plant management strategies in the LEB. Prioritisation was based on cost-effectiveness for biodiversity benefits. We identify the key invasive plant species to target to protect ecosystem intactness across the bioregions of the LEB, the level of investment required and the likely reduction in invasive species dominance gained per dollar spent on each strategy. Our focus is on strategies that are technically and socially feasible and reduce the likelihood that high impact invasive plant species will dominate native ecosystems, and therefore change their form and function. The outputs of this work are designed to help guide decision-making and further planning and investment in weed management for the Basin. Experts in weed management, policy-making, community engagement, biodiversity and natural values of the Basin, attended a workshop and agreed upon 12 strategies to manage invasive plants. The strategies focused primarily on 10 weeds which were considered to have a high potential for broad, significant impacts on natural ecosystems in the next 50 years and for which feasible management strategies could be defined. Each strategy consisted of one or more supporting actions, many of which were spatially linked to IBRA (Interim Biogeographical Regionalisation of Australia) bioregions. The first strategy was an over-arching recommendation for improved mapping, information sharing, education and extension efforts in order to facilitate the more specific weed management strategies. The 10 more specific weed management strategies targeted the control and/or eradication of the following high-impact exotic plants: mesquite, parkinsonia, rubber vine, bellyache bush, cacti, mother of millions, chinee apple, athel pine and prickly acacia, as well as a separate strategy for eradicating all invasive plants from one key threatened ecological community, the GAB (Great Artesian Basin dependant) mound springs. Experts estimated the expected biodiversity benefit of each strategy as the reduction in area that an invasive plant species is likely to dominate in over a 50-year period, where dominance was defined as more than 30% coverage at a site. Costs were estimated in present day terms over 50 years largely during follow up discussions post workshop. Cost-effectiveness was then calculated for each strategy in each bioregion by dividing the average expected benefit by the average annual costs. Overall, the total cost of managing 12 invasive plant strategies over the next 50 years was estimated at $1.7 billion. It was estimated that implementation of these strategies would result in a reduction of invasive plant dominance by 17 million ha (a potential 32% reduction), roughly 14% of the LEB. If only targeting Weeds of National Significance (WONS), the total cost was estimated to be $113 million over the next 50 years. Over the next 50 years, $2.3 million was estimated to eradicate all invasive plant species from the Great Artesian Basin Mound Springs threatened ecological community. Prevention and awareness programs were another key strategy targeted across the Basin and estimated at $17.5 million in total over 50 years. The cost of controlling, eradicating and containing buffel grass were the most expensive, over $1.5 billion over 50 years; this strategy was estimated to result in a reduction in buffel grass dominance of a million ha in areas where this species is identified as an environmental problem. Buffel grass has been deliberately planted across the Basin for pasture production and is by far the most widely distributed exotic species. Its management is contentious, having economic value to many graziers while posing serious threats to biodiversity and sites of high cultural and conservation interest. The strategy for containing and locally eradicating buffel grass was a challenge to cost based on expert knowledge, possibly because of the dual nature of this species as a valued pastoral grass and environmental weed. Based on our conversations with experts, it appears that control and eradication programs for this species, in conservation areas, are growing rapidly and that information on the most cost-effective strategies for this species will continue to develop over time. The top five most cost-effective strategies for the entire LEB were for the management of: 1) parkinsonia, 2) chinee apple, 3) mesquite, 4) rubber vine and 5) bellyache bush. Chinee apple and mother of millions are not WONS and have comparatively small populations within the semi-arid bioregions of Queensland. Experts felt that there was an opportunity to eradicate these species before they had the chance to develop into high-impact species within the LEB. Prickly acacia was estimated to have one of the highest benefits, but the costs of this strategy were high, therefore it was ranked 7th overall. The buffel grass strategy was ranked the lowest (10th) in terms of cost effectiveness. The top five most cost-effective strategies within and across the bioregions were the management of: 1) parkinsonia in the Channel Country, 2) parkinsonia in the Desert Uplands, 3) mesquite in the Mitchell Grass Downs, 4) parkinsonia in the Mitchell Grass Downs, and 5) mother of millions in the Desert Uplands. Although actions for several invasive plant species like parkinsonia and prickly acacia were concentrated in the Queensland part of the LEB, the actions involved investing in containment zones to prevent the spread of these species into other states. In the NT and SA bioregions of the LEB, the management of athel pine, parkinsonia and cacti were the main strategies. While outside the scientific research goals of study, this work highlighted a number of important incidental findings that led us to make the following recommendations for future research and implementation of weed management in the Basin: • Ongoing stakeholder engagement, extension and participation is required to ensure this prioritisation effort has a positive impact in affecting on-ground decision making and planning. • Short term funding for weed management was identified as a major reason for failure of current efforts, hence future funding needs to be secure and ongoing. • Improved mapping and information sharing is essential to implement effective weed management. • Due to uncertainties in the outcomes and impacts of management options, strategies should be implemented as part of an adaptive management program. The information provided in this report can be used to guide investment for controlling high-impact invasive plant species for the benefits of biodiversity conservation. We do not present a final prioritisation of invasive plant strategies for the LEB, and we have not addressed the cultural, socio-economic or spatial components necessary for an implementation plan. Cost-effectiveness depends on the objectives used; in our case we used the intactness of ecosystems as a surrogate for expected biodiversity benefits, measured by the extent that each invasive plant species is likely to dominate in a bioregion. When other relevant factors for implementation are considered the priorities may change and some actions may not be appropriate in some locations. We present the costs, ecological benefits and cost-effectiveness of preventing, containing, reducing and eradicating the dominance of high impact invasive plants through realistic management actions over the next 50 years. In doing so, we are able to estimate the size of the weed management problem in the LEB and provide expert-based estimates of the likely outcomes and benefits of implementing weed management strategies. The priorities resulting from this work provide a prospectus for guiding further investment in management and in improving information availability.

A policy model for access control using building information models

Building information models have created a paradigm shift in how buildings are built and managed by providing a dynamic repository for building data that is useful in many new operational scenarios. This change has also created an opportunity to use building information models as an integral part of security operations and especially as a tool to facilitate fine-grained access control to building spaces in smart buildings and critical infrastructure environments. In this paper, we identify the requirements for a security policy model for such an access control system and discuss why the existing policy models are not suitable for this application. We propose a new policy language extension to XACML, with BIM specific data types and functions based on the IFC specification, which we call BIM-XACML.

Graph theory based representation of building information models for access control applications

Building information models are increasingly being utilised for facility management of large facilities such as critical infrastructures. In such environments, it is valuable to utilise the vast amount of data contained within the building information models to improve access control administration. The use of building information models in access control scenarios can provide 3D visualisation of buildings as well as many other advantages such as automation of essential tasks including path finding, consistency detection, and accessibility verification. However, there is no mathematical model for building information models that can be used to describe and compute these functions. In this paper, we show how graph theory can be utilised as a representation language of building information models and the proposed security related functions. This graph-theoretic representation allows for mathematically representing building information models and performing computations using these functions.

Critical factors for waste management in office building retrofit projects in Australia

Office building retrofit is a sector being highlighted in Australia because of the mature office building market characterised by a large proportion of ageing properties. The increasing number of office building retrofit projects strengthens the need for waste management. Retrofit projects possess unique characteristics in comparison to traditional demolition and new builds such as partial operation of buildings, constrained site spaces and limited access to as-build information. Waste management activities in retrofit projects can be influenced by issues that are different from traditional construction and demolition projects. However, previous research on building retrofit projects has not provided an understanding of the critical issues affecting waste management. This research identifies the critical factors which influence the management of waste in office building retrofit projects through a literature study and a questionnaire survey to industry practitioners. Statistical analysis on a range of potential waste issues reveals the critical factors, as agreed upon by survey respondents in consideration of their different professional responsibilities and work natures. The factors are grouped into five dimensions, comprising industry culture, organisational support and incentive, existing building information, design, and project delivery process. The discussions of the dimensions indicate that the waste management factors of office building retrofit projects are further intensified compared to those for general demolition and construction because retrofit projects involve existing buildings which are partially operating with constrained work space and limited building information. Recommendations for improving waste management in office building retrofit projects are generalised such as waste planning, auditing and assessment in the planning and designing stage, collaboration and coordination of various stakeholders and different specialists, optimised building surveying and BIM technologies for waste analysis, and new design strategies for waste prevention.

Interventions to control nosocomial infections : study designs and statistical issues

There is a wide range of potential study designs for intervention studies to decrease nosocomial infections in hospitals. The analysis is complex due to competing events, clustering, multiple timescales and time-dependent period and intervention variables. This review considers the popular pre-post quasi-experimental design and compares it with randomized designs. Randomization can be done in several ways: randomization of the cluster [intensive care unit (ICU) or hospital] in a parallel design; randomization of the sequence in a cross-over design; and randomization of the time of intervention in a stepped-wedge design. We introduce each design in the context of nosocomial infections and discuss the designs with respect to the following key points: bias, control for nonintervention factors, and generalizability. Statistical issues are discussed. A pre-post-intervention design is often the only choice that will be informative for a retrospective analysis of an outbreak setting. It can be seen as a pilot study with further, more rigorous designs needed to establish causality. To yield internally valid results, randomization is needed. Generally, the first choice in terms of the internal validity should be a parallel cluster randomized trial. However, generalizability might be stronger in a stepped-wedge design because a wider range of ICU clinicians may be convinced to participate, especially if there are pilot studies with promising results. For analysis, the use of extended competing risk models is recommended.

Smart coordinated distribution system control to enable high level penetration of rooftop PVs

This thesis addresses voltage violation problem, the most critical issue associated with high level penetration of photovoltaic (PV) in electricity distribution network. A coordinated control algorithm using the reactive power from PV inverter and integrated battery energy storage has been developed and investigated in different network scenarios in the thesis. Probable variations associated with solar generation, end-user participation and network parameters are also considered. Furthermore, a unified data model and well-defined communication protocol to ensure the smooth coordination between all the components during the operation of the algorithm is described. Finally this thesis incorporated the uncertainties of solar generation using probabilistic load flow analysis.

Wide area control of SVCs for first swing stabilisation and damping in longitudinal systems

A non-linear Kalman filter based control strategy for SVCs located in major load groups is presented. This focusses on the limitation and damping of inter-area modes. It does this through treating local modes as noise and uses a tunable nonlinear control algorithm to improve both first swing stability and system damping. Simulation on a four machine system shows that the Kalman filer can successfully lock on to a desired inter-area mode and obtain a 31% improvement in critical clearing time as well as improved damping.

Afterschool MediaClub: Critical literacy in a high diversity, high poverty urban setting

In this chapter we present analyses of data produced with young people in an afterschool digital literacy program for 9 – 12 year olds. The young people were students at a high diversity, high poverty outer suburban elementary school in Queensland, Australia. The club was part of the URLearning research project (2010-14). In the classroom-based component of the project we worked with teachers to develop intellectually substantive and critical digital literacy practice. MediaClub was in some ways complementary to the classroom component; it was designed to skill up interested kids as digital media experts not only for their families and communities, but also for the classroom. Given the critical literacy traditions established in Australian schools, we approached MediaClub with certain critical expectations. In this chapter we look at what ensued, highlighting unanticipated critical outcomes at a time of heightened struggle over English curriculum. Critical literacy has been part of official English curriculum in Queensland since the early 1990s. The approach has been primarily text analytic, concerned with giving students access to genres of power and tools for understanding the ideological work of language through text. Many ideas for translating this normative critical project into classroom practice have been developed for use from the earliest elementary grades onwards. However, curricular space for critical literacy is under pressure. Amongst other things, this reflects both the development of Australia’s first national curriculum and the construction of a regimen of national literacy testing. At MediaClub we found a certain resistance to learning activities which were “too much like school”. However, in a context of increased control of teachers’ and students’ work in the classroom, MediaClub evolved as a learning space that can be understood in critical terms. Our experience in this regard might be of interest to teachers and researchers in high diversity high poverty settings that are strongly controlled through increasingly prescriptive – even scripted – pedagogies.

Real-time and interactive attacks on DNP3 critical infrastructure using Scapy

The Distributed Network Protocol v3.0 (DNP3) is one of the most widely used protocols, to control national infrastructure. Widely used interactive packet manipulation tools, such as Scapy, have not yet been augmented to parse and create DNP3 frames (Biondi 2014). In this paper we extend Scapy to include DNP3, thus allowing us to perform attacks on DNP3 in real-time. Our contribution builds on East et al. (2009), who proposed a range of possible attacks on DNP3. We implement several of these attacks to validate our DNP3 extension to Scapy, then executed the attacks on real world equipment. We present our results, showing that many of these theoretical attacks would be unsuccessful in an Ethernet-based network.

Regional aviation and economic growth : cointegration and causality analysis in Australia

Air transport is a critical link to regional, rural and remote communities in Australia. Air services provide important economic and social benefits but very little research has been done on assessing the value of regional aviation. This research provides the first empirical evidence that there is short and long run causality between regional aviation and economic growth. The authors analysed 88 regional airports in Australia over a period of 1985–86 to 2010–11 to determine the catalytic impacts of regional air transport on regional economic growth. The analysis was conducted using annual data related to total airport passenger movements – for the level of airport activity, and real aggregate taxable income – to represent economic growth. A significant bi-directional relationship was established: airports have an impact on regional economic growth and the economy directly impacts regional air transport. The economic significance of regional air transport confirms the importance of the airport as infrastructure for regional councils and the need for them to maintain and develop local airports. Funding should be targeted at airports directly to support regional development.

Maintaining or changing a drinking behavior? GOKA's short-term outcomes

During the critical neurobiological and social developmental period of adolescence, binge drinking of alcohol increases the risk of mental health problems, school exclusion, convictions, fatal and non-fatal accidents. The present research utilizes a simple cluster randomized control trial design to evaluate a social marketing program, Game On: Know Alcohol (GOKA), employing innovative online edutainment games to target binge drinking. Pre and post data were collected for seven program (942 students, mean age: 14.6 years) and five control schools (578 students, mean age: 14.4 years). Significant improvements in alcohol knowledge and affective attitude toward binge drinking was observed for adolescents who participated in GOKA compared to the control group, with maintenance of desirable subjective norms, instrumental attitudes and intentions. Given considerable external competition from messages promoting the benefits of alcohol use, a one-off program that modifies incorrect knowledge and alters perceptions of binge drinking as a fun, recreational activity represents an important step. This research contributes to current understanding of social marketing’s capacity to change drivers and maintain inhibitors of binge drinking intentions of adolescents and provides an important basis for future research in the domain.

A survey: Error control methods used in bio-cryptography

Integration of biometrics is considered as an attractive solution for the issues associated with password based human authentication as well as for secure storage and release of cryptographic keys which is one of the critical issues associated with modern cryptography. However, the widespread popularity of bio-cryptographic solutions are somewhat restricted by the fuzziness associated with biometric measurements. Therefore, error control mechanisms must be adopted to make sure that fuzziness of biometric inputs can be sufficiently countered. In this paper, we have outlined such existing techniques used in bio-cryptography while explaining how they are deployed in different types of solutions. Finally, we have elaborated on the important facts to be considered when choosing appropriate error correction mechanisms for a particular biometric based solution.

Using a theory of planned behaviour framework to explore hand hygiene beliefs at the ‘5 critical moments’ among Australian hospital-based nurses

Background Improving hand hygiene among health care workers (HCWs) is the single most effective intervention to reduce health care associated infections in hospitals. Understanding the cognitive determinants of hand hygiene decisions for HCWs with the greatest patient contact (nurses) is essential to improve compliance. The aim of this study was to explore hospital-based nurses’ beliefs associated with performing hand hygiene guided by the World Health Organization’s (WHO) 5 critical moments. Using the belief-base framework of the Theory of Planned Behaviour, we examined attitudinal, normative, and control beliefs underpinning nurses’ decisions to perform hand hygiene according to the recently implemented national guidelines. Methods Thematic content analysis of qualitative data from focus group discussions with hospital-based registered nurses from 5 wards across 3 hospitals in Queensland, Australia. Results Important advantages (protection of patient and self), disadvantages (time, hand damage), referents (supportive: patients, colleagues; unsupportive: some doctors), barriers (being too busy, emergency situations), and facilitators (accessibility of sinks/products, training, reminders) were identified. There was some equivocation regarding the relative importance of hand washing following contact with patient surroundings. Conclusions The belief base of the theory of planned behaviour provided a useful framework to explore systematically the underlying beliefs of nurses’ hand hygiene decisions according to the 5 critical moments, allowing comparisons with previous belief studies. A commitment to improve nurses’ hand hygiene practice across the 5 moments should focus on individual strategies to combat distraction from other duties, peer-based initiatives to foster a sense of shared responsibility, and management-driven solutions to tackle staffing and resource issues. Hand hygiene following touching a patient’s surroundings continues to be reported as the most neglected opportunity for compliance.

The influence of critical infrastructure interdependencies on post-disaster reconstruction: Elements of infrastructure interdependency that impede the post-disaster recovery effort

The importance of developing effective disaster management strategies has significantly grown as the world continues to be confronted with unprecedented disastrous events. Factors such as climate instability, recent urbanization along with rapid population growth in many cities around the world have unwittingly exacerbated the risks of potential disasters, leaving a large number of people and infrastructure exposed to new forms of threats from natural disasters such as flooding, cyclones, and earthquakes. With disasters on the rise, effective recovery planning of the built environment is becoming imperative as it is not only closely related to the well-being and essential functioning of society, but it also requires significant financial commitment. In the built environment context, post-disaster reconstruction focuses essentially on the repair and reconstruction of physical infrastructures. The reconstruction and rehabilitation efforts are generally performed in the form of collaborative partnerships that involve multiple organisations, enabling the restoration of interdependencies that exist between infrastructure systems such as energy, water (including wastewater), transport, and telecommunication systems. These interdependencies are major determinants of vulnerabilities and risks encountered by critical infrastructures and therefore have significant implications for post-disaster recovery. When disrupted by natural disasters, such interdependencies have the potential to promote the propagation of failures between critical infrastructures at various levels, and thus can have dire consequences on reconstruction activities. This paper outlines the results of a pilot study on how elements of infrastructure interdependencies have the potential to impede the post-disaster recovery effort. Using a set of unstructured interview questionnaires, plausible arguments provided by seven respondents revealed that during post-disaster recovery, critical infrastructures are mutually dependent on each other’s uninterrupted availability, both physically and through a host of information and communication technologies. Major disruption to their physical and cyber interdependencies could lead to cascading failures, which could delay the recovery effort. Thus, the existing interrelationship between critical infrastructures requires that the entire interconnected network be considered when managing reconstruction activities during the post-disaster recovery period.