Is the two hour recommended maximum driving time appropriate for both healthy older and treated obstructive sleep apnoea drivers?

Objectives The UK Department for Transport recommends taking a break from driving every 2 h. This study investigated: (i) if a 2 h drive time on a monotonous road is appropriate for OSA patients treated with CPAP, compared with healthy age matched controls, (ii) the impact of a night’s sleep restriction (with CPAP) and (iii) what happens if these patients miss one nights’ CPAP treatment. Methods About 19 healthy men aged 52–74 y (m = 66.2 y) and 19 OSA participants aged 50–75 y (m = 64.4 y) drove an interactive car simulator under monotonous motorway conditions for 2 h on two afternoons, in a counterbalanced design; (1) following a normal night’s sleep (8 h). (2) following a restricted night’s sleep (5 h), with normal CPAP use (3) following a night without CPAP treatment. (n = 11) Lane drifting incidents, indicative of falling asleep, were recorded for up to 2 h depending on competence to continue driving. Results Normal sleep: Controls drove for an average of 95.9 min (s.d. 37 min) and treated OSA drivers for 89.6 min (s.d. 29 min) without incident. 63.2% of controls and 42.1% of OSA drivers successfully completed the drive without an incident. Sleep restriction: 47.4% of controls and 26.3% OSA drivers finished without incident. Overall: controls drove for an average of 89.5 min (s.d. 39 min) and treated OSA drivers 65 min (s.d. 42 min) without incident. The effect of condition was significant [F(1.36) = 9.237, P < 0.05, eta2 = 0.204]. Stopping CPAP: 18.2% of drivers successfully completed the drive. Overall, participants drove for an average of 50.1 min (s.d. 38 min) without incident. The effect of condition was significant [F(2) = 8.8, P < 0.05, eta2 = 0.468]. Conclusion 52.6% of all drivers were able to complete a 2 hour drive under monotonous conditions after a full night’s sleep. Sleep restriction significantly affected both control and OSA drivers. We find evidence that treated OSA drivers are more impaired by sleep restriction than healthy control, as they were less able to sustain safely the 2 h drive without incidents. OSA drivers should be aware that non-compliance with CPAP can significantly impair driving performance. It may be appropriate to recommend older drivers take a break from driving every 90 min especially when undertaking a monotonous drive, as was the case here.

Can Business Continuity Management Create Reliability in Airports? (Issues from Theory into Practice)

The advances made within the aviation industry over the past several decades have significantly improved the availability, affordability and convenience of air travel and have been greatly beneficial in both social and economic terms. Air transport has developed into an irreplaceable service being relied on by millions of people each day and as such airports have become critical elements of national infrastructure to facilitate the movement of people and goods. As components of critical infrastructure (CI), airports are integral parts of a national economy supporting regional as well as national trade, commercial activity and employment. Therefore, any disruption or crisis which impacts the continuity of operations at airports can have significant negative consequences for the airport as a business, for the local economy and other nodes of transport infrastructure as well as for society. Due to the highly dynamic and volatile environment in which airports operate in, the aviation industry has faced many different challenges over the years ranging from terrorist attacks such as September 11, to health crises such as the SARS epidemic to system breakdowns such as the recent computer system outage at Virgin Blue Airlines in Australia. All these events have highlighted the vulnerability of airport systems to a range of disturbances as well as the gravity and widespread impact of any kind of discontinuity in airport functions. Such incidents thus emphasise the need for increasing resilience and reliability of airports and ensuring business continuity in the event of a crisis...

Violence in and around entertainment districts : a longitudinal analysis of the impact of late-night lockout legislation

Violence in entertainment districts is a major problem across urban landscapes throughout the world. Research shows that licensed premises are the third most common location for homicides and serious assaults, accounting for one in ten fatal and nonfatal assaults. One class of interventions that aims to reduce violence in entertainment districts involves the use of civil remedies: a group of strategies that use civil or regulatory measures as legal “levers” to reduce problem behavior. One specific civil remedy used to reduce problematic behavior in entertainment districts involves manipulation of licensed premise trading hours. This article uses generalized linear models to analyze the impact of lockout legislation on recorded violent offences in two entertainment districts in the Australian state of Queensland. Our research shows that 3 a.m. lockout legislation led to a direct and significant reduction in the number of violent incidents inside licensed premises. Indeed, the lockouts cut the level of violent crime inside licensed premises by half. Despite these impressive results for the control of violence inside licensed premises, we found no evidence that the lockout had any impact on violence on streets and footpaths outside licensed premises that were the site for more than 80 percent of entertainment district violence. Overall, however, our analysis suggests that lockouts are an important mechanism that helps to control the level of violence inside licensed premises but that finely grained contextual responses to alcohol-related problems are needed rather than one-size-fits-all solutions.

Visualization of predictive distributions for discrete spatial-temporal log Cox processes approximated with MCMC

An important aspect of decision support systems involves applying sophisticated and flexible statistical models to real datasets and communicating these results to decision makers in interpretable ways. An important class of problem is the modelling of incidence such as fire, disease etc. Models of incidence known as point processes or Cox processes are particularly challenging as they are ‘doubly stochastic’ i.e. obtaining the probability mass function of incidents requires two integrals to be evaluated. Existing approaches to the problem either use simple models that obtain predictions using plug-in point estimates and do not distinguish between Cox processes and density estimation but do use sophisticated 3D visualization for interpretation. Alternatively other work employs sophisticated non-parametric Bayesian Cox process models, but do not use visualization to render interpretable complex spatial temporal forecasts. The contribution here is to fill this gap by inferring predictive distributions of Gaussian-log Cox processes and rendering them using state of the art 3D visualization techniques. This requires performing inference on an approximation of the model on a discretized grid of large scale and adapting an existing spatial-diurnal kernel to the log Gaussian Cox process context.

Sedation breaks : are they good for the critically ill patient? A review.

Background:  Tradition has led us to believe that a heavily sedated patient is a comfortable, settled, compliant patient for whom sedation will improve outcome. The current move witnessed in clinical practice today of limiting sedation has led health care in recent years to question the benefit and necessity of routine, continuous sedation for all patients requiring mechanical ventilation. However, as a result there has been a rise in the amount of agitation being reported as being experienced by patients with the daily withdrawal of sedation. Aims:  The purpose of this paper is to review current arguments for and against perserving with agitation versus re-sedating, when it presents during the daily sedation breaks. Findings:  Of the literature reviewed, the question to re-sedate the mechanically ventilated agitated patient during sedation breaks remains an issue of contention. Although there is evidence focusing on the psychological effects of long-term sedation and sedation breaks specifically, the complex nature of critical illness in some cases means that individualized care is of paramount importance and in-depth assessment is crucial when deciding to re-sedate in the face of undetermined agitation. Agitation has been closely linked with several incidents that can be detrimental to patient safety, such as removal of lines and unplanned self-extubation. Conclusion:  The recommendations of this review are that nurses should re-commence sedation if the patient becomes agitated following a sedation break. Aims:  The purpose of this paper is to review current arguments for and against perserving with agitation versus re-sedating, when it presents during the daily sedation breaks. Findings:  Of the literature reviewed, the question to re-sedate the mechanically ventilated agitated patient during sedation breaks remains an issue of contention. Although there is evidence focusing on the psychological effects of long-term sedation and sedation breaks specifically, the complex nature of critical illness in some cases means that individualized care is of paramount importance and in-depth assessment is crucial when deciding to re-sedate in the face of undetermined agitation. Agitation has been closely linked with several incidents that can be detrimental to patient safety, such as removal of lines and unplanned self-extubation. Conclusion:  The recommendations of this review are that nurses should re-commence sedation if the patient becomes agitated following a sedation break.

Psychological predictors of injury among elite athletes

Objectives: To establish injury rates among a population of elite athletes, to provide normative data for psychological variables hypothesised to be predictive of sport injuries, and to establish relations between measures of mood, perceived life stress, and injury characteristics as a precursor to introducing a psychological intervention to ameliorate the injury problem. Methods: As part of annual screening procedures, athletes at the Queensland Academy of Sport report medical and psychological status. Data from 845 screenings (433 female and 412 male athletes) were reviewed. Population specific tables of normative data were established for the Brunel mood scale and the perceived stress scale. Results: About 67% of athletes were injured each year, and about 18% were injured at the time of screening. Fifty percent of variance in stress scores could be predicted from mood scores, especially for vigour, depression, and tension. Mood and stress scores collectively had significant utility in predicting injury characteristics. Injury status (current, healed, no injury) was correctly classified with 39% accuracy, and back pain with 48% accuracy. Among a subset of 233 uninjured athletes (116 female and 117 male), five mood dimensions (anger, confusion, fatigue, tension, depression) were significantly related to orthopaedic incidents over the preceding 12 months, with each mood dimension explaining 6–7% of the variance. No sex differences in these relations were found. Conclusions: The findings support suggestions that psychological measures have utility in predicting athletic injury, although the relatively modest explained variance highlights the need to also include underlying physiological indicators of allostatic load, such as stress hormones, in predictive models.

An interpretative phenomenological analysis of stress and well-being in Emergency Medical Dispatchers

This study explored the stress and wellbeing of Emergency Medical Dispatchers (EMD) who remotely provide crisis intervention to medical emergencies through telehealth support. Semi-structured interviews with 16 EMDs were conducted and Interpretative Phenomenological Analysis was used to identify themes in the data. These results indicated that despite their physical distance from the crisis scene, EMDs can experience vicarious trauma through acute and cumulative exposure to traumatic incidents and their perceived lack of control which can expound feelings of helplessness. Three superordinate themes of operational stress and trauma, organisational stress, and posttraumatic growth were identified. Practical implications are suggested to enable emergency services organisations to counteract this job related stress and promote more positive mental health outcomes.

On-road driver sleepiness : what are Australian drivers experiences and awareness of sleepiness while driving?

Objectives: Driver sleepiness contributes substantially to road crash incidents. Simulator and on-road studies clearly reveal an impairing effect from sleepiness for driving ability. However, drivers might not appreciate the dangerousness of driving while sleepy and this could translate to their on-road driving behaviours. This study sought to determine drivers’ on-road experiences of sleepiness, their sleep habits, and personal awareness of the signs of sleepiness. Methods: Participants were a random selection of 92 drivers travelling on a major highway in the state of Queensland, Australia, who were stopped by Police as part of routine drink driving operations. Participants completed a brief questionnaire that included: demographic details, awareness and on-road experiences of sleepy driving, and sleep habits. A modified version of the Karolinska Sleepiness Scale (KSS) was used to assess subjective sleepiness during the last 15 minutes of driving. Results: Participants rating of subjective sleepiness was quite low with 90% reporting at or below 3 on the KSS. Participants were reasonably aware of the signs of sleepiness; with a number of these correlated with on-road experiences. The participants sleep debt correlated with their alertness (r = -.30) and the hours spent driving (r = .38). Conclusions: These results suggest that drivers had moderate or substantial experience of driving when sleepy and many were aware of the signs of sleepiness. As many of the participants reported driving long distances after suboptimal sleep durations, it is possible that their risk perception of the dangerousness of sleepy driving maybe erroneous.

Secondary user relations in emerging mobile computing environments

Mobile technologies are enabling access to information in diverse environ.ments, and are exposing a wider group of individuals to said technology. Therefore, this paper proposes that a wider view of user relations than is usually considered in information systems research is required. Specifically, we examine the potential effects of emerging mobile technologies on end-­‐user relations with a focus on the ‘secondary user’, those who are not intended to interact directly with the technology but are intended consumers of the technology’s output. For illustration, we draw on a study of a U.K. regional Fire and Rescue Service and deconstruct mobile technology use at Fire Service incidents. Our findings provide insights, which suggest that, because of the nature of mobile technologies and their context of use, secondary user relations in such emerging mobile environments are important and need further exploration.

Profiling contextual factors which influence safety in heavy vehicle industries

A significant proportion of worker fatalities within Australia result from truck-related incidents. Truck drivers face a number of health and safety concerns. Safety culture, viewed here as the beliefs, attitudes and values shared by an organisation’s workers, which interact with their surrounding context to influence behaviour, may provide a valuable lens for exploring safety-related behaviours in heavy vehicle operations. To date no major research has examined safety culture within heavy vehicle industries. As safety culture provides a means to interpret experiences and generate behaviour, safety culture research should be conducted with an awareness of the context surrounding safety. The current research sought to examine previous health and safety research regarding heavy vehicle operations to profile contextual factors which influence health and safety. A review of 104 peer-reviewed papers was conducted. Findings of these papers were then thematically analysed. A number of behaviours and scenarios linked with crashes and non-crash injuries were identified, along with a selection of health outcomes. Contextual factors which were found to influence these outcomes were explored. These factors were found to originate from government departments, transport organisations, customers and the road and work environment. The identified factors may provide points of interaction, whereby culture may influence health and safety outcomes.

Near-miss event detection at railway level crossings

Recent modelling of socio-economic costs by the Australian railway industry in 2010 has estimated the cost of level crossing accidents to exceed AU$116 million annually. To better understand the causal factors of these accidents, a video analytics application is being developed to automatically detect near-miss incidents using forward facing videos from trains. As near-miss events occur more frequently than collisions, by detecting these occurrences there will be more safety data available for analysis. The application that is being developed will improve the objectivity of near-miss reporting by providing quantitative data about the position of vehicles at level crossings through the automatic analysis of video footage. In this paper we present a novel method for detecting near-miss occurrences at railway level crossings from video data of trains. Our system detects and localizes vehicles at railway level crossings. It also detects the position of railways to calculate the distance of the detected vehicles to the railway centerline. The system logs the information about the position of the vehicles and railway centerline into a database for further analysis by the safety data recording and analysis system, to determine whether or not the event is a near-miss. We present preliminary results of our system on a dataset of videos taken from a train that passed through 14 railway level crossings. We demonstrate the robustness of our system by showing the results of our system on day and night videos.

Characteristics of low-speed vehicle run-over events in children : an 11-year review

Objectives: The purpose of this study was to investigate the characteristics associated with fatal and non-fatal low-speed vehicle run-over (LSVRO) events in relation to person, incident and injury characteristics, in order to identify appropriate points for intervention and injury prevention. Methods: Data on all known LSVRO events in Queensland, Australia, over 11 calendar years (1999–2009) were extracted from five different databases representing the continuum of care ( prehospital to fatality) and manually linked. Descriptive and multivariate analyses were used to analyse the sample characteristics in relation to demographics, health service usage, outcomes, incident characteristics, and injury characteristics. Results: Of the 1641 LSVRO incidents, 98.4% (n=1615) were non-fatal, and 1.6% were fatal (n=26). Over half the children required admission to hospital (56%, n=921); mean length of stay was 3.4 days. Younger children aged 0–4 years were more frequently injured, and experienced more serious injuries with worse outcomes. Patterns of injury (injury type and severity), injury characteristics (eg, time of injury, vehicle type, driver of vehicle, incident location), and demographic characteristics (such as socioeconomic status, indigenous status, remoteness), varied according to age group. Almost half (45.6%; n=737) the events occurred outside major cities, and approximately 10% of events involved indigenous children. Parents were most commonly the vehicle drivers in fatal incidents. While larger vehicles such as four-wheel drives (4WD) were most frequently involved in LSVRO events resulting in fatalities, cars were most frequently involved in non-fatal events. Conclusions: This is the first study, to the authors’ knowledge, to analyse the characteristics of fatal and non-fatal LSVRO events in children aged 0–15 years on a state-wide basis. Characteristics of LSVRO events varied with age, thus age-specific interventions are required. Children living outside major cities, and indigenous children, were over-represented in these data. Further research is required to identify the burden of injury in these groups.

Making informed decisions on selecting promising Work Zone Safety Treatments

Lack of detailed and accurate safety records on incidents in Australian work zones prevents a thorough understanding of the relevant risks and hazards. Consequently it is difficult to select appropriate treatments for improving the safety of roadworkers and motorists alike. This paper presents a method for making informed decisions about safety treatments by 1) identifying safety issues and hazards in work zones, 2) understanding the attitudes and perceptions of both roadworkers and motorists, 3) reviewing the effectiveness of work zone safety treatments according to existing research, and 4) incorporating local expert opinion on the feasibility and usefulness of the safety treatments. Using data collected through semi-structured interviews with roadwork personnel and online surveys of Queensland drivers, critical safety issues were identified. The effectiveness of treatments for addressing the issues was understood through rigorous literature review and consultations with local road authorities. Promising work zone safety treatments include enforcement, portable rumble strips, perceptual measures to imply reduced lane width, automated or remotely-operated traffic lights, end of queue measures, and more visible and meaningful signage.

The waves in business transformation management: a conceptualization of how IT-enabled Business Transformations Unfold

We examine IT-enabled Business Transformations (ITBT) based on three case studies of successful, multi-year ERP implementation programs. Given the inconsistencies in segmenting the different key periods in ITBTs in both literature and our cases, we sought to consolidate the common events or critical incidents in such initiatives. We label those key periods as waves, and the emergence of triggers and reactions thereunto in the management of business transformations. We show that business transformations unfold in four distinct waves: Wave 1 Concept Development, Wave 2 Blueprint Design, Wave 3 Solution Delivery and Wave 4 Post-Transformation. These waves are characterized by the occurrence of strategic- and program-level triggers to which organizations respond by invoking different management services. Our interpretive research provides a new conceptualization of ITBTs based on a service-oriented view of such initiatives. This view draws attention to managerial capabilities as a service to transformations, and how and when these capabilities are required to respond to triggering incidents. We outline propositions and recommendations for business transformation management.

Occupational Health and Safety, Courts and Crime: the legal construction of occupational health and safety offences in Victoria

This book reports on an empirically-based study of the manner in which the Magistrates' Courts in Victoria, construct occupational health and safety (OHS) issues when hearing prosecutions for offences under the Victorian OHS legislation. Prosecution has always been a controversial element in the enforcement armoury of OHS regulators, but at the same time it has long been argued that the low level of fines imposed by courts has had an important chilling effect on the OHS inspectorate's enforcement approaches, and on the impact of OHS legislation. Using a range of empirical research methods, including three samples of OHS prosecutions carried out in the Victorian Magistrates' Courts, Professor Johnstone shows how courts, inspectors, prosecutors and defence counsel are involved in filtering or reshaping OHS issues during the prosecution process, both pre-trial and in court. He argues that OHS offences are constructed by focusing on "events", in most cases incidents resulting in injury or death. This "event-focus" ensures that the attention of the parties is drawn to the details of the incident, and away from the broader context of the event. During the court-based sentencing process defence counsel is able to adopt a range of techniques which isolate the incident from its micro and macro contexts, thereby individualising and decontextualising the incident.