Improving the management of behaviour that challenges associated with dementia in care homes:protocol for pharmacy-health psychology intervention feasibility study

INTRODUCTION: The inappropriate use of antipsychotics in people with dementia for behaviour that challenges is associated with an estimated 1800 deaths annually. However, solely focusing on antipsychotics may transfer prescribing to other equally dangerous psychotropics. Little is known about the role of pharmacists in the management of psychotropics used to treat behaviours that challenge. This research aims to determine whether it is feasible to implement and measure the effectiveness of a combined pharmacy-health psychology intervention incorporating a medication review and staff training package to limit the prescription of psychotropics to manage behaviour that challenges in care home residents with dementia. METHODS/ANALYSIS: 6 care homes within the West Midlands will be recruited. People with dementia receiving medication for behaviour that challenges, or their personal consultee, will be approached regarding participation. Medication used to treat behaviour that challenges will be reviewed by the pharmacist, in collaboration with the general practitioner (GP), person with dementia and carer. The behavioural intervention consists of a training package for care home staff and GPs promoting person-centred care and treating behaviours that challenge as an expression of unmet need. The primary outcome measure is the Neuropsychiatric Inventory-Nursing Home version (NPI-NH). Other outcomes include quality of life (EQ-5D and DEMQoL), cognition (sMMSE), health economic (CSRI) and prescribed medication including whether recommendations were implemented. Outcome data will be collected at 6 weeks, and 3 and 6 months. Pretraining and post-training interviews will explore stakeholders' expectations and experiences of the intervention. Data will be used to estimate the sample size for a definitive study. ETHICS/DISSEMINATION: The project has received a favourable opinion from the East Midlands REC (15/EM/3014). If potential participants lack capacity, a personal consultee will be consulted regarding participation in line with the Mental Capacity Act. Results will be published in peer-reviewed journals and presented at conferences.

The role of stimulating employees creativity and idea generation in encouraging innovation behaviour in Irish firms

This paper analyses the impact of stimulating staff creativity and idea generation on the likelihood of innovation. Using data for over 3,000 firms, obtained from the Irish Community Innovation Survey 2008-10, we examine the impact of six creativity generating stimuli on product, process, organisational, and marketing innovation. Our results indicate that the stimuli impact the four forms of innovation in different ways. For instance brainstorming and multidisciplinary teams are found to stimulate all forms of innovation, rotation of employees is found to stimulate organisational innovation, while financial and non-financial incentives are found to have no effect on any form of innovation. We also find that the co-introduction of two or more stimuli increases the likelihood of innovation more than implementing stimuli in isolation. These results have important implications for management decisions in that they suggest that firms should target their creative efforts towards specific innovation outcomes.

From Customer-Oriented Strategy to Organizational Financial Performance: The Role of Human Resource Management and Customer-Linking Capability

Drawing on the organizational capabilities literature, the authors developed and tested a model of how supportive human resource management (HRM) improved firms’ financial performance perceived by marketing managers through fostering the implementation of a customer-oriented strategy. Customer-linking capability, which is the capability in managing close customer relationships, indicated the implementation of the customer-oriented strategy. Data collected from two emerging economies – China and Hungary –established that supportive HRM partially mediated the relationship between customer-oriented strategy and customer-linking capability. Customer-linking capability further explained how supportive HRM contributed to perceived financial performance. This study explicates the implication of customer-oriented strategy for HRM and reveals the
importance of HRM in strategy implementation. It also sheds some light on the ‘black box’ between HRM and performance. While making important contributions to the field of strategy, HRM and marketing, this study also offers useful practical implications.

Exploring the effects of a universal classroom management training programme on teacher and child behaviour: a group randomised controlled trial and cost analysis

Teachers frequently struggle to cope with conduct problems in the classroom. The aim of this study was to assess the effectiveness of the Incredible Years Teacher Classroom Management Training Programme for improving teacher competencies and child adjustment. The study involved a group randomised controlled trial which included 22 teachers and 217 children (102 boys and 115 girls). The average age of children included in the study was 5.3 years (standard deviation = 0.89). Teachers were randomly allocated to an intervention group (n = 11 teachers; 110 children) or a waiting-list control group (n = 11; 107 children). The sample also included 63 ‘high-risk’ children (33 intervention; 30 control), who scored above the cut-off (>12) on the Strengths and Difficulties Questionnaire for abnormal socioemotional and behavioural difficulties. Teacher and child behaviours were assessed at baseline and 6 months later using psychometric and observational measures. Programme delivery costs were also analysed. Results showed positive changes in teachers’ self-reported use of positive classroom management strategies (effect size = 0.56), as well as negative classroom management strategies (effect size = −0.43). Teacher reports also highlight improvements in the classroom behaviour of the high-risk group of children, while the estimated cost of delivering the Incredible Years Teacher Classroom Management Training Programme was modest. However, analyses of teacher and child observations were largely non-significant. A need for further research exploring the effectiveness and cost-effectiveness of the Incredible Years Teacher Classroom Management Training Programme is indicated.

Shining a Light on the Dark Side: How the Global Financial Crisis Exposed the Dark Side of Leadership

The global financial crisis has had innumerate outcomes around the globe. Whilst most of these are generally perceived to be negative, there are outcomes which could be considered positive for society. One such outcome is the spotlight that the financial crisis has shone on corruption within organisations and in particular, the role that destructive leaders play in the promotion of negative behaviours within organisations. This interest in identifying so-called ‘dark-side’ traits in leaders is a positive step both academically and practically. Academically, there is a limited research examining individuals with ‘dark-traits’ within organisations (Mahmut, Homewood & Stevenson, 2008). Practically, most leader derailment can be attributed to ‘dark-side’ traits and leaders with such traits are implicated in a host of issues for organisations including poor staff morale and satisfaction, bullying, poor levels of productivity, high staff turnover, unethical behaviour and even white collar crime (e.g. Boddy,2010; 2011; Lesha & Lesha, 2012; O’Boyle, Forsyth, Banks & McDaniel, 2012; Sanecka, 2013). This paper focuses on one of the ‘dark-side’ traits; psychopathy. Psychopathy is a personality disorder characterised by guiltlessness, incapacity to experience love, impulsivity, shallow emotions, superficial charm and an inability to learn from experience (Cleckley, 1941, 1982). Research has found that individuals with high levels of psychopathy can be found working within organisations and experiencing some degree of career success (e.g. Babiak, Neumann & Hare, 2010; Board & Fritzon, 2005; Boddy, 2010; Lilienfeld, Latzman, Watts, Smith & Dutton, 2014). These individuals are theoretically thought to be attracted to careers which offer power, status and monetary rewards. In particular, the finance industry has been suggested as an ideal work place for the organisational psychopath. Some authors go as far as attribute organisational psychopaths a key role in the financial crisis (Boddy, 2011). However, little research has been conducted to explore whether levels of psychopathy in employees differ across industries and what careers might be most attractive to individuals with high levels of psychopathy. This paper presents the results of a large scale survey of 265 alumni of universities in the Central England region of the UK. The survey was conducted to assess the link between levels of three factors of psychopathy (Egotism, Callousness and Antisocialism) with occupation as defined by Holland’s RIASEC model. Participants completed Brinkley, Diamond, Magaletta & Heigel’s (2008) revision of Levenson’s Self-Report Psychopathy Scale and responded to questions regarding their current occupation. Logistic regression analyses were conducted to assess whether levels of Egotism, Callousness and Antisocialism were predictive of occupation. The results showed that when compared to individuals who occupy job roles within the Social sector of Holland’s model, individuals with higher levels of psychopathy were more likely to be employed within Realistic, Investigative, Enterprising and Conventional roles. When comparing Social and Realistic roles, more Egotistical individuals were likely to be employed within Realistic roles. When comparing those employed in Social roles to Investigative, Enterprising and Conventional roles, individuals with higher levels of Antisocialism were more likely to be employed within the latter three occupations than within Social roles. This suggests that individuals with psychopathy do gravitate towards certain career paths. Social roles where job incumbents are required to be caring and interact with others to a large extent appear to be unattractive to individuals with high levels of psychopathy. Social roles are also associated with lower monetary rewards and are generally less prestigious (Henley, 2001). These individuals instead seek out occupations where there are higher levels of risk, power and reward. Roles in the Realistic category include those which include high levels of risk e.g. fighter pilot, fireman etc., (Cohen, Meir, Segal & Amar, 2003). Investigative careers hold the highest level of prestige and ranking. Enterprising roles include management positions where power is wielded over subordinates and sales roles, where customers can be manipulated (ACT, 2009). Conventional roles include those within the finance industry, which include some of the most financially lucrative positive available (Babiak & Hare, 2006). The above suggests that individuals with higher levels of psychopathy may be seeking to satisfy their self-centred natures by selecting careers which provide them with high levels of reward in one way or another. Alternatively, these individuals may select roles where their traits can be accepted. The importance of Antisocialism in predicting occupation may be testament to the importance of finding a career which ‘fits’ such traits. Antisocialism is generally associated with negative outcomes in the workplace (Ettner, MacLean & French, 2010). Therefore, finding environments tolerant of antisocial tendencies may be a priority for individuals with high levels of these traits. The results suggest that Enterprising, Investigative and Conventional work environments may be tolerant of Antisocialism in employees and Realistic environments tolerant of Egotism. Academically, the results show that there is value in studying ‘dark-side’ characteristics in organisations. Individuals with higher levels of psychopathic traits, do not appear to randomly enter employment. Instead, they appear to gravitate to careers which meet their needs and/or tolerate their traits. It is important to further explore what industries and positions are particularly attractive to individuals with higher levels of psychopathy and what makes them attractive to these individuals. Such knowledge is important for practitioners to be able to advise organisations as to the likely level of risk they face of employing organisational psychopaths and to enable organisations which are particularly attractive to highly psychopathic employees to design selection systems which detect undesirable traits in candidates. Furthermore, organisations can examine their culture to assess whether traits such as antisocialism are tolerated (or even rewarded) and what the implications of this are.

Reviewing the hedge funds literature II:hedge funds' returns and risk management characteristics

This paper summarizes the literature on hedge funds (HFs) developed over the last two decades, particularly that which relates to risk management characteristics (a companion piece investigates the managerial characteristics of HFs). It discusses the successes and the shortfalls to date in developing more sophisticated risk management frameworks and tools to measure and monitor HF risks, and the empirical evidence on the role of the HFs and their investment behaviour and risk management practices on the stability of the financial system. It also classifies the HF literature considering the most recent contributions and, particularly, the regulatory developments after the 2007 financial crisis.

Music purchase behaviour : the effect of emotional loyalty on intention to purchase.

This paper explores the influence of emotional loyalty on music purchase behaviour. Specifically, it examines whether emotional attachment to an artist's music influences loyalty to that artist, and how emotional loyalty influences a consumer's decision to purchase music. Data collection involved fifteen semi-structured interviews with young (18-30) subjects recruited through non-probability convenience sampling. Findings show that consumers who are emotionally loyal to an artistes) are more inclined to purchase the music rather than download free of charge.

Investigating motivation, attitudinal loyalty and attendance behaviour with fans of Australian football

The present study examined how individual difference factors contribute to attitudes and behaviour of spectators attending an Australian Football League game. The results revealed that four factors: Team Interest, Vicarious Achievement, Excitement and Player Interest were successful in predicting level of loyalty, while five factors: Vicarious Achievement, Player Interest, Entertainment Value, Drama and Socialization predicted game day attendance. This study illustrates the applicability of the Sport Interest Inventory developed in North America to understand motivational factors of Australian sports fans.

The importance of gestation process dynamics

Principal Topic In this paper we seek to highlight the important intermediate role that the gestation process plays in entrepreneurship by examining its key antecedents and its consequences for new venture emergence. In doing so we take a behavioural perspective and argue that it is not only what a nascent venture is, but what it does (Katz & Gartner, 1988; Shane & Delmar, 2004; Reynolds, 2007) and when it does it during start-up (Reynolds & Miller, 1992; Lichtenstein, Carter, Dooley & Gartner, 2007) that is important. To extend an analogy from biological development, what we suggest is that the way a new venture is nurtured is just as fundamental as its nature. Much prior research has focused on the nature of new ventures and attempted to attribute variations in outcomes directly to the impact resource endowments and investments have. While there is little doubt that venture resource attributes such as human capital, and specifically prior entrepreneurial experience (Alsos & Kolvereid, 1998), access to social (Davidsson & Honig, 2003) and financial capital have an influence. Resource attributes themselves are distal from successful start-up endeavours and remain inanimate if not for the actions of the nascent venture. The key contribution we make is to shift focus from whether or not actions are taken, but when these actions happen and how that is situated in the overall gestation process. Thus, we suggest that it is gestation process dynamics, or when gestation actions occur, that is more proximal to venture outcomes and we focus on this. Recently scholars have highlighted the complexity that exists in the start-up or gestation process, be it temporal or contextual (Liao, Welsch & Tan, 2005; Lichtenstein et al. 2007). There is great variation in how long a start-up process might take (Reynolds & Miller, 1992), some processes require less action than others (Carter, Gartner & Reynolds, 1996), and the overall intensity of the start-up effort is also deemed important (Reynolds, 2007). And, despite some evidence that particular activities are more influential than others (Delmar & Shane, 2003), the order in which events may happen is, until now, largely indeterminate as regard its influence on success (Liao & Welsch, 2008). We suggest that it is this complexity of the intervening gestation process that attenuates the effect of resource endowment and has resulted in mixed findings in previous research. Thus, in order to reduce complexity we shall take a holistic view of the gestation process and argue that it is its’ dynamic properties that determine nascent venture attempt outcomes. Importantly, we acknowledge that particular gestation processes of themselves would not guarantee successful start-up, but it is more correctly the fit between the process dynamics and the ventures attributes (Davidsson, 2005) that is influential. So we aim to examine process dynamics by comparing sub-groups of venture types by resource attributes. Thus, as an initial step toward unpacking the complexity of the gestation process, this paper aims to establish the importance of its role as an intermediary between attributes of the nascent venture and the emergence of that venture. Here, we make a contribution by empirically examining gestation process dynamics and their fit with venture attributes. We do this by firstly, examining that nature of the influence that venture attributes such as human and social capital have on the dynamics of the gestation process, and secondly by investigating the effect that gestation process dynamics have on venture creation outcomes. Methodology and Propositions In order to explore the importance that gestation processes dynamics have in nascent entrepreneurship we conduct an empirical study of ventures start-ups. Data is drawn from a screened random sample of 625 Australian nascent business ventures prior to them achieving consistent outcomes in the market. This data was collected during 2007/8 and 2008/9 as part of the Comprehensive Australian Study of Entrepreneurial Emergence (CAUSEE) project (Davidsson et al., 2008). CAUSEE is a longitudinal panel study conducted over four years, sourcing information from annually administered telephone surveys. Importantly for our study, this methodology allows for the capture and tracking of active nascent venture creation as it happens, thus reducing hindsight and selection biases. In addition, improved tests of causality may be made given that outcome measures are temporally removed from preceding events. The data analysed in this paper represents the first two of these four years, and for the first time has access to follow-up outcome measures for these venture attempts: where 260 were successful, 126 were abandoned, and 191 are still in progress. With regards to venture attributes as gestation process antecedents, we examine specific human capital measured as successful prior experience in entrepreneurship, and direct social capital of the venture as ‘team start-ups’. In assessing gestation process dynamics we follow Lichtenstein et al. (2007) to suggest that the rate, concentration and timing of gestation activities may be used to summarise the complexity dynamics of that process. In addition, we extend this set of measures to include the interaction of discovery and exploitation by way of changes made to the venture idea. Those ventures with successful prior experience or those who conduct symbiotic parallel start-up attempts may be able to, or be forced to, leave their gestation action until later and still derive a successful outcome. In addition access to direct social capital may provide the support upon which the venture may draw in order to persevere in the face of adversity, turning a seemingly futile start-up attempt into a success. On the other hand prior experience may engender the foresight to terminate a venture attempt early should it be seen to be going nowhere. The temporal nature of these conjectures highlight the importance that process dynamics play and will be examined in this research Statistical models are developed to examine gestation process dynamics. We use multivariate general linear modelling to analyse how human and social capital factors influence gestation process dynamics. In turn, we use event history models and stratified Cox regression to assess the influence that gestation process dynamics have on venture outcomes. Results and Implications What entrepreneurs do is of interest to both scholars and practitioners’ alike. Thus the results of this research are important since they focus on nascent behaviour and its outcomes. While venture attributes themselves may be influential this is of little actionable assistance to practitioners. For example it is unhelpful to say to the prospective first time entrepreneur “you’ll be more successful if you have lots of prior experience in firm start-ups”. This research attempts to close this relevance gap by addressing what gestation behaviours might be appropriate, when actions best be focused, and most importantly in what circumstances. Further, we make a contribution to the entrepreneurship literature, examining the role that gestation process dynamics play in outcomes, by specifically attributing these to the nature of the venture itself. This extension is to the best of our knowledge new to the research field.

Regulating roles of the use of the balanced scorecard in shaping corporate identities

The literature on corporate identity management suggests that managing corporate identity is a strategically complex task embracing the shaping of a range of dimensions of organisational life. The performance measurement literature and its applications likewise now also emphasise organisational ability to incorporate various dimensions considering both financial and non-financial performance measures when assessing success. The inclusion of these soft non-financial measures challenges organisations to quantify intangible aspects of performance such as corporate identity, transforming unmeasurables into measurables. This paper explores the regulatory roles of the use of the balanced scorecard in shaping key dimensions of corporate identities in a public sector shared service provider in Australia. This case study employs qualitative interviews of senior managers and employees, secondary data and participant observation. The findings suggest that the use of the balanced scorecard has potential to support identity construction, as an organisational symbol, a communication tool of vision, and as strategy, through creating conversations that self-regulate behaviour. The development of an integrated performance measurement system, the balanced scorecard, becomes an expression of a desired corporate identity, and the performance measures and continuous process provide the resource for interpreting actual corporate identities. Through this process of understanding and mobilising the interaction, it may be possible to create a less obtrusive and more subtle way to control “what an organisation is”. This case study also suggests that the theoretical and practical fusion of the disciplinary knowledge around corporate identities and performance measurement systems could make a contribution to understanding and shaping corporate identities.

Rural and remote road safety study : final report

• Introduction: Concern and action for rural road safety is relatively new in Australia in comparison to the field of traffic safety as a whole. In 2003, a program of research was begun by the Centre for Accident Research and Road Safety - Queensland (CARRS-Q) and the Rural Health Research Unit (RHRU) at James Cook University to investigate factors contributing to serious rural road crashes in the North Queensland region. This project was funded by the Premier’s Department, Main Roads Department, Queensland Transport, QFleet, Queensland Rail, Queensland Ambulance Service, Department of Natural Resources and Queensland Police Service. Additional funding was provided by NRMA Insurance for a PhD scholarship. In-kind support was provided through the four hospitals used for data collection, namely Cairns Base Hospital, The Townsville Hospital, Mount Isa Hospital and Atherton Hospital.----- The primary aim of the project was to: Identify human factors related to the occurrence of serious traffic incidents in rural and remote areas of Australia, and to the trauma suffered by persons as a result of these incidents, using a sample drawn from a rural and remote area in North Queensland.----- The data and analyses presented in this report are the core findings from two broad studies: a general examination of fatalities and casualties from rural and remote crashes for the period 1 March 2004 until 30 June 2007, and a further linked case-comparison study of hospitalised patients compared with a sample of non-crash-involved drivers.----- • Method: The study was undertaken in rural North Queensland, as defined by the Australian Bureau of Statistics (ABS) statistical divisions of North Queensland, Far North Queensland and North-West Queensland. Urban areas surrounding Townsville, Thuringowa and Cairns were not included. The study methodology was centred on serious crashes, as defined by a resulting hospitalisation for 24 hours or more and/or a fatality. Crashes meeting this criteria within the North Queensland region between 1 March 2004 and 30 June 2007 were identified through hospital records and interviewed where possible. Additional data was sourced from coroner’s reports, the Queensland Transport road crash database, the Queensland Ambulance Service and the study hospitals in the region.----- This report is divided into chapters corresponding to analyses conducted on the collected crash and casualty data.----- Chapter 3 presents an overview of all crashes and casualties identified during the study period. Details are presented in regard to the demographics and road user types of casualties; the locations, times, types, and circumstances of crashes; along with the contributing circumstances of crashes.----- Chapter 4 presents the results of summary statistics for all casualties for which an interview was able to be conducted. Statistics are presented separately for drivers and riders, passengers, pedestrians and cyclists. Details are also presented separately for drivers and riders crashing in off-road and on-road settings. Results from questionnaire data are presented in relation to demographics; the experience of the crash in narrative form; vehicle characteristics and maintenance; trip characteristics (e.g. purpose and length of journey; periods of fatigue and monotony; distractions from driving task); driving history; alcohol and drug use; medical history; driving attitudes, intentions and behaviour; attitudes to enforcement; and experience of road safety advertising.----- Chapter 5 compares the above-listed questionnaire results between on-road crash-involved casualties and interviews conducted in the region with non-crash-involved persons. Direct comparisons as well as age and sex adjusted comparisons are presented.----- Chapter 6 presents information on those casualties who were admitted to one of the study hospitals during the study period. Brief information is given regarding the demographic characteristics of these casualties. Emergency services’ data is used to highlight the characteristics of patient retrieval and transport to and between hospitals. The major injuries resulting from the crashes are presented for each region of the body and analysed by vehicle type, occupant type, seatbelt status, helmet status, alcohol involvement and nature of crash. Estimates are provided of the costs associated with in-hospital treatment and retrieval.----- Chapter 7 describes the characteristics of the fatal casualties and the nature and circumstances of the crashes. Demographics, road user types, licence status, crash type and contributing factors for crashes are presented. Coronial data is provided in regard to contributing circumstances (including alcohol, drugs and medical conditions), cause of death, resulting injuries, and restraint and helmet use.----- Chapter 8 presents the results of a comparison between casualties’ crash descriptions and police-attributed crash circumstances. The relative frequency of contributing circumstances are compared both broadly within the categories of behavioural, environmental, vehicle related, medical and other groupings and specifically for circumstances within these groups.----- Chapter 9 reports on the associated research projects which have been undertaken on specific topics related to rural road safety.----- Finally, Chapter 10 reports on the conclusions and recommendations made from the program of research.---- • Major Recommendations : From the findings of these analyses, a number of major recommendations were made: + Male drivers and riders - Male drivers and riders should continue to be the focus of interventions, given their very high representation among rural and remote road crash fatalities and serious injuries.----- - The group of males aged between 30 and 50 years comprised the largest number of casualties and must also be targeted for change if there is to be a meaningful improvement in rural and remote road safety.----- + Motorcyclists - Single vehicle motorcycle crashes constitute over 80% of serious, on-road rural motorcycle crashes and need particular attention in development of policy and infrastructure.----- - The motorcycle safety consultation process currently being undertaken by Queensland Transport (via the "Motorbike Safety in Queensland - Consultation Paper") is strongly endorsed. As part of this process, particular attention needs to be given to initiatives designed to reduce rural and single vehicle motorcycle crashes.----- - The safety of off-road riders is a serious problem that falls outside the direct responsibility of either Transport or Health departments. Responsibility for this issue needs to be attributed to develop appropriate policy, regulations and countermeasures.----- + Road safety for Indigenous people - Continued resourcing and expansion of The Queensland Aboriginal Peoples and Torres Strait Islander Peoples Driver Licensing Program to meet the needs of remote and Indigenous communities with significantly lower licence ownership levels.----- - Increased attention needs to focus on the contribution of geographic disadvantage (remoteness) factors to remote and Indigenous road trauma.----- + Road environment - Speed is the ‘final common pathway’ in determining the severity of rural and remote crashes and rural speed limits should be reduced to 90km/hr for sealed off-highway roads and 80km/hr for all unsealed roads as recommended in the Austroads review and in line with the current Tasmanian government trial.----- - The Department of Main Roads should monitor rural crash clusters and where appropriate work with local authorities to conduct relevant audits and take mitigating action. - The international experts at the workshop reviewed the data and identified the need to focus particular attention on road design management for dangerous curves. They also indicated the need to maximise the use of audio-tactile linemarking (audible lines) and rumble strips to alert drivers to dangerous conditions and behaviours.----- + Trauma costs - In accordance with Queensland Health priorities, recognition should be given to the substantial financial costs associated with acute management of trauma resulting from serious rural and remote crashes.----- - Efforts should be made to develop a comprehensive, regionally specific costing formula for road trauma that incorporates the pre-hospital, hospital and post-hospital phases of care. This would inform health resource allocation and facilitate the evaluation of interventions.----- - The commitment of funds to the development of preventive strategies to reduce rural and remote crashes should take into account the potential cost savings associated with trauma.----- - A dedicated study of the rehabilitation needs and associated personal and healthcare costs arising from rural and remote road crashes should be undertaken.----- + Emergency services - While the study has demonstrated considerable efficiency in the response and retrieval systems of rural and remote North Queensland, relevant Intelligent Transport Systems technologies (such as vehicle alarm systems) to improve crash notification should be both developed and evaluated.----- + Enforcement - Alcohol and speed enforcement programs should target the period between 2 and 6pm because of the high numbers of crashes in the afternoon period throughout the rural region.----- + Drink driving - Courtesy buses should be advocated and schemes such as the Skipper project promoted as local drink driving countermeasures in line with the very high levels of community support for these measures identified in the hospital study.------ - Programs should be developed to target the high levels of alcohol consumption identified in rural and remote areas and related involvement in crashes.----- - Referrals to drink driving rehabilitation programs should be mandated for recidivist offenders.----- + Data requirements - Rural and remote road crashes should receive the same quality of attention as urban crashes. As such, it is strongly recommended that increased resources be committed to enable dedicated Forensic Crash Units to investigate rural and remote fatal and serious injury crashes.----- - Transport department records of rural and remote crashes should record the crash location using the national ARIA area classifications used by health departments as a means to better identifying rural crashes.----- - Rural and remote crashes tend to be unnoticed except in relatively infrequent rural reviews. They should receive the same level of attention and this could be achieved if fatalities and fatal crashes were coded by the ARIA classification system and included in regular crash reporting.----- - Health, Transport and Police agencies should collect a common, minimal set of data relating to road crashes and injuries, including presentations to small rural and remote health facilities.----- + Media and community education programmes - Interventions seeking to highlight the human contribution to crashes should be prioritised. Driver distraction, alcohol and inappropriate speed for the road conditions are key examples of such behaviours.----- - Promotion of basic safety behaviours such as the use of seatbelts and helmets should be given a renewed focus.----- - Knowledge, attitude and behavioural factors that have been identified for the hospital Brief Intervention Trial should be considered in developing safety campaigns for rural and remote people. For example challenging the myth of the dangerous ‘other’ or ‘non-local’ driver.----- - Special educational initiatives on the issues involved in rural and remote driving should be undertaken. For example the material used by Main Roads, the Australian Defence Force and local initiatives.