Ambulance use is associated with higher self-rated illness seriousness : user attitudes and perceptions

Objectives The objective was to study the role and effect of patients' perceptions on reasons for using ambulance services in Queensland, Australia. Methods A cross-sectional survey was conducted of patients (n = 911) presenting via ambulance or self-transport at eight public hospital emergency departments (EDs). The survey included perceived illness severity, attitudes toward ambulance, and reasons for using ambulance. A theoretical framework was developed to inform this study. Results Ambulance users had significantly higher self-rated perceived seriousness, urgency, and pain than self-transports. They were also more likely to agree that ambulance services are for everyone to use, regardless of the severity of their conditions. In compared to self-transports, likelihood of using an ambulance increased by 26% for every unit increase in perceived seriousness; and patients who had not used an ambulance in the 6 months prior to the survey were 66% less likely to arrive by ambulance. Patients who had presented via ambulance stated they considered the urgency (87%) or severity (84%) of their conditions as reasons for calling the ambulance. Other reasons included requiring special care (76%), getting higher priority at the ED (34%), not having a car (34%), and financial concerns (17%). Conclusions Understanding patients' perceptions is essential in explaining their actions and developing safe and effective health promotion programs. Individuals use ambulances for various reasons and justifications according to their beliefs, attitudes, and sociodemographic conditions. Policies to reduce and manage demand for such services need to address both general opinions and specific attitudes toward emergency health services to be effective.

Motorcycle Rider Safety Project Summary Report

Motorcycle trauma is a serious issue in Queensland and throughout Australia; the fatality rate per 100 million kilometres travelled for motorcycle riders in Australia is nearly 30 times the rate for drivers of other vehicles (Australian Transport Safety Bureau, 2002). In 2009, the then Queensland Transport (later the Department of Transport and Main Roads or TMR) appointed CARRS-Q to provide a three-year program of Road Safety Research Services for Motorcycle Rider Safety. Funding for this research originated from the Motor Accident Insurance Commission. This program of research was undertaken to produce knowledge to assist TMR to improve motorcycle safety by further strengthening the licensing and training system to make learner riders safer by developing a pre-learner package (Deliverable 1), and by evaluating the Q-Ride CAP program to ensure that it is maximally effective and contributes to the best possible training for new riders (Deliverable 2), and identifying potential new licensing components that will reduce the incidence of risky riding and improve higher-order cognitive skills in new riders (Deliverable 3).

Motorcycle Safety Research Project Interim Report 2 : Review of the Consistent Assessment Process (CAP)

Motorcycle trauma is a serious road safety issue in Queensland and throughout Australia. In 2009, Queensland Transport (later Transport and Main Roads or TMR) appointed CARRS-Q to provide a three-year program of Road Safety Research Services for Motorcycle Rider Safety. Funding for this research originated from the Motor Accident Insurance Commission. This program of research was undertaken to produce knowledge to assist TMR to improve motorcycle safety by further strengthening the licensing and training system to make learner riders safer by developing a pre-learner package (Deliverable 1), and by evaluating the Q-Ride CAP program to ensure that it is maximally effective and contributes to the best possible training for new riders (Deliverable 2), which is the focus of this report. Deliverable 3 of the program identified potential new licensing components that will reduce the incidence of risky riding and improve higher-order cognitive skills in new riders. This report provides a summary of Deliverables 2.1 through to 2.4.

Traffic harmony in China? Investigating driver perceptions of traffic law enforcement and social responsibility for harmonious road use.

Social harmony can manifest in many ways. In rapidly motorizing countries like China, a growing area of potential disharmony is road use. The increased ability to purchase a car for the first time and a subsequent increase in new drivers has seen several Chinese cities take unprecedented measures to manage congestion. There is a corresponding need to ensure effective traffic law enforcement in promoting a safe environment for all road users. This paper reports qualitative research conducted with Beijing car drivers to investigate perceptions of unsafe road use, penalties for traffic violations, and improvements for the current system. Overall, the findings suggest awareness among drivers of many of the key risk factors. A perceived lack of clarity in how penalties are determined was identified and drivers in-dicated a desire to know how revenue from traffic fines is used. Several suggestions for improving the current system included school/community education about road risks and traffic law. The rise of private car ownership in China may contribute to a more harmonious personal life, but at the same time, may contribute to a decrease in societal harmony. A major challenge for authorities in any country is to promote the idea of a collective responsibility for road safety (traffic harmony), especially to those who perceive that traffic rules do not apply to them. This is a potentially greater challenge for China as it strives to balance harmony on the road and harmony in the broader society.

Using the Donabedian framework to examine the quality and safety of nursing service innovation

Aims and objectives To evaluate the safety and quality of nurse practitioner service using the audit framework of Structure,Process and Outcome. Background Health service and workforce reform are on the agenda of governments and other service providers seeking to contain healthcare costs whilst providing safe and effective health care to communities. The nurse practitioner service is one health workforce innovation that has been adopted globally to improve timely access to clinical care, but there is scant literature reporting evaluation of the quality of this service innovation. Design. A mixed-methods design within the Donabedian evaluation framework was used. Methods The Donabedian framework was used to evaluate the Structure, Process and Outcome of nurse practitioner service. A range of data collection approaches was used, including stakeholder survey (n=36), in-depth interviews (11 patients and 13 nurse practitioners) and health records data on service processes. Results The study identified that adequate and detailed preparation of Structure and Process is essential for the successful implementation of a service innovation. The multidisciplinary team was accepting of the addition of nurse practitioner service, and nurse practitioner clinical care was shown to be effective, satisfactory and safe from the perspective of the clinician stakeholders and patients. Conclusions This study demonstrated that the Donabedian framework of Structure, Process and Outcome evaluation is a valuable and validated approach to examine the safety and quality of a service innovation. Furthermore, in this study, specific Structure elements were shown to influence the quality of service processes further validating the framework and the interdependence of the Structure, Process and Outcome components. Relevance to clinical practice Understanding the structure and process requirements for establishing nursing service innovation lays the foundation for safe, effective and patient-centred clinical care.

Organisational culture in airworthiness management programs : developing a measurement model

All civil and private aircraft are required to comply with the airworthiness standards set by their national airworthiness authority and throughout their operational life must be in a condition of safe operation. Aviation accident data shows that over twenty percent of all fatal accidents in aviation are due to airworthiness issues, specifically aircraft mechanical failures. Ultimately it is the responsibility of each registered operator to ensure that their aircraft remain in a condition of safe operation, and this is done through both effective management of airworthiness activities and the effective program governance of safety outcomes. Typically, the projects within these airworthiness management programs are focused on acquiring, modifying and maintaining the aircraft as a capability supporting the business. Program governance provides the structure through which the goals and objectives of airworthiness programs are set along with the means of attaining them. Whilst the principal causes of failures in many programs can be traced to inadequate program governance, many of the failures in large scale projects can have their root causes in the organisational culture and more specifically in the organisational processes related to decision-making. This paper examines the primary theme of project and program based enterprises, and introduces a model for measuring organisational culture in airworthiness management programs using measures drawn from 211 respondents in Australian airline programs. The paper describes the theoretical perspectives applied to modifying an original model to specifically focus it on measuring the organisational culture of programs for managing airworthiness; identifying the most important factors needed to explain the relationship between the measures collected, and providing a description of the nature of these factors. The paper concludes by identifying a model that best describes the organisational culture data collected from seven airworthiness management programs.

Large eddy simulation of smoke flow in a real road tunnel fire using FDS

Numerical study is carried out using large eddy simulation to study the heat and toxic gases released from fires in real road tunnels. Due to disasters about tunnel fires in previous decade, it attracts increasing attention of researchers to create safe and reliable ventilation designs. In this research, a real tunnel with 10 MW fire (which approximately equals to the heat output speed of a burning bus) at the middle of tunnel is simulated using FDS (Fire Dynamic Simulator) for different ventilation velocities. Carbone monoxide concentration and temperature vertical profiles are shown for various locations to explore the flow field. It is found that, with the increase of the longitudinal ventilation velocity, the vertical profile gradients of CO concentration and smoke temperature were shown to be both reduced. However, a relatively large longitudinal ventilation velocity leads to a high similarity between the vertical profile of CO volume concentration and that of temperature rise.

Intrapleural analgesis following endoscopic scoliosis correction

Endoscopic scoliosis correction plays an important part in the surgical options available for treating adolescent idiopathic scoliosis. However, there is a paucity of literature examining optimum methods of analgesia following this type of surgery. The role of intrapleural analgesia is examined and described. In this study, local anaesthetic administration via an intrapleural catheter was found to be a safe and effective method of analgesia following endoscopic scoliosis correction. Post-operative pain following anterior scoliosis correction can be reduced to ‘mild’ levels by combined analgesia regimes. Surgeons may wish to expand its use into open or minimally invasive anterior scoliosis correction or anterior releases.

A viable and sustainable key management approach for a national e-health environment

To protect the health information security, cryptography plays an important role to establish confidentiality, authentication, integrity and non-repudiation. Keys used for encryption/decryption and digital signing must be managed in a safe, secure, effective and efficient fashion. The certificate-based Public Key Infrastructure (PKI) scheme may seem to be a common way to support information security; however, so far, there is still a lack of successful large-scale certificate-based PKI deployment in the world. In addressing the limitations of the certificate-based PKI scheme, this paper proposes a non-certificate-based key management scheme for a national e-health implementation. The proposed scheme eliminates certificate management and complex certificate validation procedures while still maintaining security. It is also believed that this study will create a new dimension to the provision of security for the protection of health information in a national e-health environment.

The magic of numbers and the amazing disappearing act : the politics of counting youth homelessness

No-one wants to see young people who are no longer able to stay at home with their parents living in situations that are neither stable nor safe. Most Australians also appreciate that youth homelessness is typically a result of factors beyond the control of young people like poverty, lack of affordable housing, parental divorce or separation, family conflict and violence, sexual abuse, or mental health problems.1 Since the Burdekin Report of 1989 first put the issue on the national agenda, youth homelessness has been a point of some political sensitivity as the numbers of young homeless stayed stubbornly high through the 1990s and into the 2000s.

Using ‘think aloud’ as a strategy for improving clinical reasoning in high fidelity case-based simulation for undergraduate nursing students.

Theme Paper for Curriculum innovation and enhancement theme AIM: This paper reports on a research project that trialled an educational strategy implemented in an undergraduate nursing curriculum. The project aimed to explore the effectiveness of ‘think aloud’ as a strategy for improving clinical reasoning for students in simulated clinical settings. BACKGROUND: Nurses are required to apply and utilise critical thinking skills to enable clinical reasoning and problem solving in the clinical setting (Lasater, 2007). Nursing students are expected to develop and display clinical reasoning skills in practice, but may struggle articulating reasons behind decisions about patient care. The ‘think aloud’ approach is an innovative learning/teaching method which can create an environment suitable for developing clinical reasoning skills in students (Banning, 2008, Lee and Ryan-Wenger, 1997). This project used the ‘think aloud’ strategy within a simulation context to provide a safe learning environment in which third year students were assisted to uncover cognitive approaches to assist in making effective patient care decisions, and improve their confidence, clinical reasoning and active critical reflection about their practice. MEHODS: In semester 2 2011 at QUT, third year nursing students undertook high fidelity simulation (some for the first time), commencing in September of 2011. There were two cohorts for strategy implementation (group 1= used think aloud as a strategy within the simulation, group 2= no specific strategy outside of nursing assessment frameworks used by all students) in relation to problem solving patient needs. The think aloud strategy was described to students in their pre-simulation briefing and allowed time for clarification of this strategy. All other aspects of the simulations remained the same, (resources, suggested nursing assessment frameworks, simulation session duration, size of simulation teams, preparatory materials). Ethics approval has been obtained for this project. RESULTS: Results of a qualitative analysis (in progress- will be completed by March 2012) of student and facilitator reports on students’ ability to meet the learning objectives of solving patient problems using clinical reasoning and experience with the ‘think aloud’ method will be presented. A comparison of clinical reasoning learning outcomes between the two groups will determine the effect on clinical reasoning for students responding to patient problems. CONCLUSIONS: In an environment of increasingly constrained clinical placement opportunities, exploration of alternate strategies to improve critical thinking skills and develop clinical reasoning and problem solving for nursing students is imperative in preparing nurses to respond to changing patient needs.

Sustainability in post disaster road infrastructure recovery projects in Queensland, Australia

between mid 2010 and early 2011, Queensland road related infrastructures were devastated by flood and cyclone related natural disasters. Responding to these recent events and in preparing for more regular and intense climate-change induced events in future, the Queensland Government is now reviewing how post-disaster road infrastructure recovery projects are planned and delivered. In particular, there is awareness that rebuilding such infrastructure need sustainable strategies across economic, environmental and social dimensions. A comprehensive sustainability assessment framework for pre and post disaster situations can minimize negative impact on our communities, economy and environment. This research is underway to develop a comprehensive sustainability element frame work for post disaster management in road infrastructures in Queensland, Australia. Analyzing the implications of disruption to transport network and associated services is an important part of preparing local and regional responses to the impacts of natural disasters. This research can contribute to strategic planning, management leading to safe, efficient and integrated transport system that supports sustainable economic, social and environmental outcomes in Queensland. Within this context, this paper provides an overview of the qualitative mixed-method research approach involving literature reviews and case studies to explore and evaluate a number of sustainability elements with a view to develop operational strategies for disaster recovery road projects.

Use of brain computer interface to drive : preliminary results

This paper reports on the implementation of a non-invasive electroencephalography-based brain-computer interface to control functions of a car in a driving simulator. The system is comprised of a Cleveland Medical Devices BioRadio 150 physiological signal recorder, a MATLAB-based BCI and an OKTAL SCANeR advanced driving experience simulator. The system utilizes steady-state visual-evoked potentials for the BCI paradigm, elicited by frequency-modulated high-power LEDs and recorded with the electrode placement of Oz-Fz with Fz as ground. A three-class online brain-computer interface was developed and interfaced with an advanced driving simulator to control functions of the car, including acceleration and steering. The findings are mainly exploratory but provide an indication of the feasibility and challenges of brain-controlled on-road cars for the future, in addition to a safe, simulated BCI driving environment to use as a foundation for research into overcoming these challenges.

Archivist as activist : lessons from three queer community archives in California

California is home to multiple queer community archives created by community members outside of government, academic, and public archives. These archives are maintained by the communities and are important spaces not only for the preservation of records, but also as safe spaces to study, gather, and learn about the communities’ histories. This article describes the histories of three such queer community archives (Gay, Lesbian, Bisexual, Transgender Historical Society Lavender Library, Archives, and Cultural Exchange of Sacramento, Inc.; and ONE National Gay & Lesbian Archives) in order to discuss the role of activism in the community archives and implications for re-examining the role of activism to incorporate communities into the heart of archival professional work. By understanding the impetus for creating and maintaining queer community archives, archivists can use this knowledge to foster more reflective practices to be more inclusive in their archival practices through outreach, collaboration, and descriptive practices. This article extends our knowledge of community archives and provides evidence for the need to include communities in archival professional practice.

Flammability and Sensitivity of Materials in Oxygen-Enriched Atmospheres : 13th Volume

"Seventeen peer-reviewed papers cover the latest research on the ignition and combustion of metals and non-metals, oxygen compatibility of components and systems, analysis of ignition and combustion, failure analysis and safety. It includes aerospace, military, scuba diving, and industrial oxygen applications. Topics cover: • Development of safe oxygen systems • Ignition mechanisms within oxygen systems and how to avoid them • Specific hazards that exist with the oxygen mixture breathed by divers in the scuba industry • Issues related to oxygen system level safety • Issues related to oxygen safety in breathing systems • Detailed investigations and discussions related to the burn curves that have been generated for metals that are burning in a standard test fixture This new publication is a valuable resource for professionals in the air separation industries, oxygen manufacturers, manufacturers of materials intended for oxygen service, and users of oxygen and oxygen-enriched atmospheres, including aerospace, medical, industrial gases, chemical processing, steel and metals refining, as well as to military, commercial or recreational diving."--- publisher website