Safer construction : the development of a guide to best practice

In Australia, an average 49 building and construction workers have been killed at work each year since 1997-98. Building/construction workers are more than twice as likely to be killed at work, than the average worker in all Australian industries. The ‘Safer Construction’ project, funded by the CRC-Construction Innovation and led by a task force comprising representatives of construction clients, designers and constructors, developed a Guide to Best Practice for Safer Construction. The Guide, which was informed by research undertaken at RMIT University, Queensland University of Technology and Curtin University, establishes broad principles for the improvement of safety in the industry and provides a ‘roadmap’ for improvement based upon lifecycle stages of a building/construction project. Within each project stage, best practices for the management of safety are identified. Each best practice is defined in terms of the recommended action, its key benefits, desirable outcomes, performance measures and leadership. ‘Safer Construction’ practices are identified from the planning to commissioning stages of a project. The ‘Safer Construction’ project represents the first time that key stakeholder groups in the Australian building/construction industry have worked together to articulate best practice and establish an appropriate basis for allocating (and sharing) responsibility for project safety performance.

The new world of work and employment: fitness workers and what they want from the employment relationship

This paper reports on an empirically based study of the Queensland (Australia) health and fitness industry over 15 years (1993 -2008). This study traces the development of the new occupation of fitness instructor in a service industry which has evolved si nce the 1980s and is embedded in values of consumption and individualism. It is the new world of work. The data from the 1993 study was historically significant, capturing the conditions o f employment in an unregulated setting prior to the introduction of the first industrial a ward in that industry in 1994. Fitness workers bargained directly with employers over all a spects of the employment relationship without the constraints of industrial regulation or the presence of trade unions. The substantive outcomes of the employment relationship were a direct reflection of m anagerial prerogative and worker orientation and preference, and did not reflect the rewards and outcomes traditionally found in Australian workplaces. While the focus of the 1993 research was on exploring the employment relationship in a deregulated environment, an unusual phenomenon was identified: fitness workers happily trading-off what would be considere d standard working conditions for the opportunity to work (‘take the stage’). Since then, several streams of literature have evolved providing a new context for understanding this phenomenon in the fitness industry, including: the sociology of the body (Shilling 1993; Turner 1996); emotional (Hochschild 1984) and aesthetic labour (Warhurst et al 2000); the so cial relations of production and space (Lefebvre 1991; Moss 1995); body history (Helps 2007); the sociology of consumption (Saunders 1988; Baudrillard 1998; Ritzer 2004); and work identity (Du Gay 1996; Strangleman 2004). The 2008 survey instrument replicated the 1993 study but was additionally informed b y the new literature. Surveys were sent to 310 commercial fitness centres and 4,800 fitness workers across Queensland. Worker orientation appears unchanged, and industry working conditions still seem atypical despite regulation si nce 1994. We argue that for many fitness workers the goal is to gain access to the fitness centre economy. For this they are willing to trade-off standard conditions of employment, and exchange traditional employm ent rewards for m ore intrinsic psycho-social rewards gained the through e xp o sure of their physical capital (Bourdieu 1984) o r bo dily prowess to the adoration o f their gazing clients. Building on the tradition of emotional labour and aesthetic labour, this study introduces the concept of ocularcentric labour: a state in which labour’s quest for the psychosocial rewards gained from their own body image shapes the employment relationship. With ocularcentric labour the p sycho-social rewards have greater value for the worker than ‘hard’, core conditions of employment, and are a significant factor in bargaining and outcomes, often substituting fo r direct earnings. The wo rkforce profile (young, female, casual) and their expectations (psycho-social rewards of ado ration and celebrity) challenge traditional trade unions in terms of what they can deliver, given the fitness workers’ willingness to trade-off minimum conditions, hard-won by unions.

Transformational learning in the workplace

Although transformative learning theory remains one of the most influential theories in the field of adult education, studies on fostering transformative learning, particularly in groups and in the workplace, remain sparse. This article summarises some evidence of transformational learning that influenced changes to practice, processes, and the organisational culture in a case study. It is based on a cohort of 12 worker-learners enrolled in a Graduate Certificate in Education (Executive Leadership) course offered by an Australian university (Queensland University of Technology). Data for this article were drawn from interviews with 10 participants, a focus group with 6 of them, their assessment presentations, and reflective notes of the course facilitators. Also included here are the effects on transformational learning of Taylor’s five elements of work-based learning design, Fuller and Unwins’ features of expansive learning, and Billett’s workplace pedagogies.

WorkChoices, ImageChoices and the marketing of new industrial relations legislation

This article takes a critical discourse approach to one aspect of the Australian WorkChoices industrial relations legislation: the government’s major advertisement published in national newspapers in late 2005 and released simultaneously as a 16-page booklet. This strategic move was the initial stage of one of the largest ‘information’ campaigns ever mounted by an Australian government, costing more than $AUD137 million. This article analyse the semiotic (visual and graphic) elements of the advertisement to uncover what these elements contribute to the message, particularly through their construction of both an image of the legislation and a portrayal of the Australian worker. We argue for the need to fuse approaches from critical discourse studies and social semiotics to deepen understanding of industrial relations phenomena such as the ‘hard sell’ to win the hearts and minds of citizens regarding unpopular new legislation.

Major depressive disorder and nutritional medicine : a review of monotherapies and adjuvant treatments

A literature review was conducted to examine the evidence for nutritional interventions in depression. It revealed a number of significant conclusions. Interestingly, more positive clinical trials were found to support adjuvant, rather than monotherapeutic, use of nutrients to treat depression. Much evidence exists in the area of adjuvant application of folic acid, S-adenosyl-methionine, omega-3, and L-tryptophan with antidepressants. Current evidence does not support omega-3 as an effective monotherapy to treat depression. However, this may be due, at least in part, to olive oil being used as the control intervention, some studies using docosahexaenoic acid alone or a higher docosahexaenoic acid to eicosapentaenoic acid ratio, and significant heterogeneity regarding depressive populations. Nevertheless, adjunctive prescription of omega-3 with antidepressants, or in people with dietary deficiency, may be beneficial. Inositol lacks evidence as an effective antidepressant and cannot be currently recommended. Evidence on the use of L-trytophan for depression is inconclusive and additional studies utilizing a more robust methodology are required.

Unionization : a necessary strategy to arrest professional decline?

This article examines contemporary social work and why it is under serious threat, ideologically and economically, in a rapidly changing world that no longer highly values its social mandate, methods, and outcomes. Within this hostile environment we investigate the low salaries and high student debt that beginning social workers experience, which might otherwise drive them into unions. Instead, the profession resists unionization, preferring to remain focused on its ideals rather than the disquieting marketplace realities. We then examine the general elements of a hybrid union model that can assist social workers to organize and thus arrest their long-standing professional and fiscal decline.

The present via the past : an archaelogical approach to analysing the design and use of a contemporary urban village

This research applies an archaeological lens to an inner-city master planned development in order to investigate the tension between the design of space and the use of space. The chosen case study for this thesis is Kelvin Grove Urban Village (KGUV), located in inner city Brisbane, Australia. The site of this urban village has strong links to the past. KGUV draws on both the history of the place in particular along with more general mythologies of village life in its design and subsequent marketing approaches. The design and marketing approach depends upon notions of an imagined past where life in a place shaped like a traditional village was better and more socially sustainable than modern urban spaces. The appropriation of this urban village concept has been criticised as a shallow marketing ploy. The translation and applicability of the urban village model across time and space is therefore contentious. KGUV was considered both in terms of its design and marketing and in terms of a reading of the actual use of this master planned place. Central to this analysis is the figure of the boundary and related themes of social heterogeneity, inclusion and exclusion. The refraction of history in the site is also an important theme. An interpretive archaeological approach was used overall as a novel method to derive this analysis.

The use of narrative text for injury surveillance research : a systematic review

Objective: To summarise the extent to which narrative text fields in administrative health data are used to gather information about the event resulting in presentation to a health care provider for treatment of an injury, and to highlight best practise approaches to conducting narrative text interrogation for injury surveillance purposes.----- Design: Systematic review----- Data sources: Electronic databases searched included CINAHL, Google Scholar, Medline, Proquest, PubMed and PubMed Central.. Snowballing strategies were employed by searching the bibliographies of retrieved references to identify relevant associated articles.----- Selection criteria: Papers were selected if the study used a health-related database and if the study objectives were to a) use text field to identify injury cases or use text fields to extract additional information on injury circumstances not available from coded data or b) use text fields to assess accuracy of coded data fields for injury-related cases or c) describe methods/approaches for extracting injury information from text fields.----- Methods: The papers identified through the search were independently screened by two authors for inclusion, resulting in 41 papers selected for review. Due to heterogeneity between studies metaanalysis was not performed.----- Results: The majority of papers reviewed focused on describing injury epidemiology trends using coded data and text fields to supplement coded data (28 papers), with these studies demonstrating the value of text data for providing more specific information beyond what had been coded to enable case selection or provide circumstantial information. Caveats were expressed in terms of the consistency and completeness of recording of text information resulting in underestimates when using these data. Four coding validation papers were reviewed with these studies showing the utility of text data for validating and checking the accuracy of coded data. Seven studies (9 papers) described methods for interrogating injury text fields for systematic extraction of information, with a combination of manual and semi-automated methods used to refine and develop algorithms for extraction and classification of coded data from text. Quality assurance approaches to assessing the robustness of the methods for extracting text data was only discussed in 8 of the epidemiology papers, and 1 of the coding validation papers. All of the text interrogation methodology papers described systematic approaches to ensuring the quality of the approach.----- Conclusions: Manual review and coding approaches, text search methods, and statistical tools have been utilised to extract data from narrative text and translate it into useable, detailed injury event information. These techniques can and have been applied to administrative datasets to identify specific injury types and add value to previously coded injury datasets. Only a few studies thoroughly described the methods which were used for text mining and less than half of the studies which were reviewed used/described quality assurance methods for ensuring the robustness of the approach. New techniques utilising semi-automated computerised approaches and Bayesian/clustering statistical methods offer the potential to further develop and standardise the analysis of narrative text for injury surveillance.

The utility and challenges of using ICD codes in child maltreatment research : a review of existing literature

Objective: The objectives of this article are to explore the extent to which the International Statistical Classification of Diseases and Related Health Problems (ICD) has been used in child abuse research, to describe how the ICD system has been applied and to assess factors affecting the reliability of ICD coded data in child abuse research.----- Methods: PubMed, CINAHL, PsychInfo and Google Scholar were searched for peer reviewed articles written since 1989 that used ICD as the classification system to identify cases and research child abuse using health databases. Snowballing strategies were also employed by searching the bibliographies of retrieved references to identify relevant associated articles. The papers identified through the search were independently screened by two authors for inclusion, resulting in 47 studies selected for the review. Due to heterogeneity of studies metaanalysis was not performed.----- Results: This paper highlights both utility and limitations of ICD coded data. ICD codes have been widely used to conduct research into child maltreatment in health data systems. The codes appear to be used primarily to determine child maltreatment patterns within identified diagnoses or to identify child maltreatment cases for research.----- Conclusions: A significant impediment to the use of ICD codes in child maltreatment research is the under-ascertainment of child maltreatment by using coded data alone. This is most clearly identified and, to some degree, quantified, in research where data linkage is used. Practice Implications: The importance of improved child maltreatment identification will assist in identifying risk factors and creating programs that can prevent and treat child maltreatment and assist in meeting reporting obligations under the CRC.

Moving towards a knowledge city : Brisbane's experience in knowledge-based urban development

In the global knowledge economy, knowledge-intensive industries and knowledge workers are extensively seen as the primary factors to improve the welfare and competitiveness of cities. To attract and retain such industries and workers, cities produce knowledge-based urban development strategies, where such strategising is also an important development mechanism for cities and their economies. This paper investigates Brisbane’s knowledge-based urban development strategies that support generation, attraction, and retention of investment and talent. The paper provides a clear understanding on the policy frameworks, and relevant applications of Brisbane’s knowledge-based urban development experience in becoming a prosperous knowledge city.

Cost effectiveness of antimicrobial catheters in the intensive care unit : Addressing uncertainty in the decision

Introduction: Some types of antimicrobial-coated central venous catheters (A-CVC) have been shown to be cost-effective in preventing catheter-related bloodstream infection (CR-BSI). However, not all types have been evaluated, and there are concerns over the quality and usefulness of these earlier studies. There is uncertainty amongst clinicians over which, if any, antimicrobial-coated central venous catheters to use. We re-evaluated the cost-effectiveness of all commercially available antimicrobialcoated central venous catheters for prevention of catheter-related bloodstream infection in adult intensive care unit (ICU) patients. Methods: We used a Markov decision model to compare the cost-effectiveness of antimicrobial-coated central venous catheters relative to uncoated catheters. Four catheter types were evaluated; minocycline and rifampicin (MR)-coated catheters; silver, platinum and carbon (SPC)-impregnated catheters; and two chlorhexidine and silver sulfadiazine-coated catheters, one coated on the external surface (CH/SSD (ext)) and the other coated on both surfaces (CH/SSD (int/ext)). The incremental cost per qualityadjusted life-year gained and the expected net monetary benefits were estimated for each. Uncertainty arising from data estimates, data quality and heterogeneity was explored in sensitivity analyses. Results: The baseline analysis, with no consideration of uncertainty, indicated all four types of antimicrobial-coated central venous catheters were cost-saving relative to uncoated catheters. Minocycline and rifampicin-coated catheters prevented 15 infections per 1,000 catheters and generated the greatest health benefits, 1.6 quality-adjusted life-years, and cost-savings, AUD $130,289. After considering uncertainty in the current evidence, the minocycline and rifampicin-coated catheters returned the highest incremental monetary net benefits of $948 per catheter; but there was a 62% probability of error in this conclusion. Although the minocycline and rifampicin-coated catheters had the highest monetary net benefits across multiple scenarios, the decision was always associated with high uncertainty. Conclusions: Current evidence suggests that the cost-effectiveness of using antimicrobial-coated central venous catheters within the ICU is highly uncertain. Policies to prevent catheter-related bloodstream infection amongst ICU patients should consider the cost-effectiveness of competing interventions in the light of this uncertainty. Decision makers would do well to consider the current gaps in knowledge and the complexity of producing good quality evidence in this area.

The impact of health information technology on the quality of medical and health care : a systematic review

Objective: To systematically review the published evidence of the impact of health information technology (HIT) on the quality of medical and health care specifically clinicians’ adherence to evidence-based guidelines and the corresponding impact this had on patient clinical outcomes. In order to be as inclusive as possible the research examined literature discussing the use of health information technologies and systems in both medical care such as clinical and surgical, and other health care such as allied health and preventive services.----- Design: Systematic review----- Data Sources: Relevant literature was systematically searched on English language studies indexed in MEDLINE and CINAHL(1998 to 2008), Cochrane Library, PubMed, Database of Abstracts of Review of Effectiveness (DARE), Google scholar and other relevant electronic databases. A search for eligible studies (matching the inclusion criteria) was also performed by searching relevant conference proceedings available through internet and electronic databases, as well as using reference lists identified from cited papers.----- Selection criteria: Studies were included in the review if they examined the impact of Electronic Health Record (EHR), Computerised Provider Order-Entry (CPOE), or Decision Support System (DS); and if the primary outcomes of the studies were focused on the level of compliance with evidence-based guidelines among clinicians. Measures could be either changes in clinical processes resulting from a change of the providers’ behaviour or specific patient outcomes that demonstrated the effectiveness of a particular treatment given by providers. ----- Methods: Studies were reviewed and summarised in tabular and text form. Due to heterogeneity between studies, meta-analysis was not performed.----- Results: Out of 17 studies that assessed the impact of health information technology on health care practitioners’ performance, 14 studies revealed a positive improvement in relation to their compliance with evidence-based guidelines. The primary domain of improvement was evident from preventive care and drug ordering studies. Results from the studies that included an assessment for patient outcomes however, were insufficient to detect either clinically or statistically important improvements as only a small proportion of these studies found benefits. For instance, only 3 studies had shown positive improvement, while 5 studies revealed either no change or adverse outcomes.----- Conclusion: Although the number of included studies was relatively small for reaching a conclusive statement about the effectiveness of health information technologies and systems on clinical care, the results demonstrated consistency with other systematic reviews previously undertaken. Widescale use of HIT has been shown to increase clinician’s adherence to guidelines in this review. Therefore, it presents ongoing opportunities to maximise the uptake of research evidence into practice for health care organisations, policy makers and stakeholders.

Management of comorbidity

Comorbidity of substance use disorders and mental disorders is very common, and there is substantial heterogeneity within subgroups in terms of both their characteristics and the nature of causal relationships between the disorders. Assessment and management strategies need to deal with both the size of the problem across the community and its severe impact in some subgroups, including those with psychosis. At this stage, the research base from which we can derive recommendations is very narrow, but it does offer a foundation for preliminary conclusions. This chapter reviews the current evidence and makes some suggestions for assessment and for both psychological and pharmacological management.

Linkage and heritability analysis of migraine symptom groupings: A comparison of three different clustering methods on twin data

Migraine is a painful disorder for which the etiology remains obscure. Diagnosis is largely based on International Headache Society criteria. However, no feature occurs in all patients who meet these criteria, and no single symptom is required for diagnosis. Consequently, this definition may not accurately reflect the phenotypic heterogeneity or genetic basis of the disorder. Such phenotypic uncertainty is typical for complex genetic disorders and has encouraged interest in multivariate statistical methods for classifying disease phenotypes. We applied three popular statistical phenotyping methods—latent class analysis, grade of membership and grade of membership “fuzzy” clustering (Fanny)—to migraine symptom data, and compared heritability and genome-wide linkage results obtained using each approach. Our results demonstrate that different methodologies produce different clustering structures and non-negligible differences in subsequent analyses. We therefore urge caution in the use of any single approach and suggest that multiple phenotyping methods be used.