Addressing the road trauma burden in China: Exploring attitudes, behaviours, risk perceptions and cultural uniqueness

As China continues to motorise rapidly, solutions are needed to reduce the burden of road trauma that is spread inequitably across the community. Little is currently known about how new drivers are trained to deal with on-road challenges, and little is also known about the perceptions, behaviours and attitudes of road users in China. This paper reports on a pilot study conducted in a driver retraining facility in one Chinese city where people who have had their licence suspended for accrual of 12 demerit points in a one year period must attend compulsory retraining in order to regain their licence. A sample of 239 suspended drivers responded to an anonymous questionnaire that sought information about preferred driving speeds and perceptions of safe driving speeds across two speed zones. Responses indicated that speeds higher than the posted limits were commonly reported, and that there was incongruence between preferred and safe speeds, such that a greater proportion of drivers reported preferred speeds that were substantially faster than what were reported as safe speeds. Participants with more driving experience reported significantly fewer crashes than newly licensed drivers (less than 2 years licensed) but no differences were found in offences when compared across groups with different levels of driving experience. Perceptions of risky behaviours were assessed by asking participants to describe what they considered to be the most dangerous on-road behaviours. Speeding and drink driving were the most commonly reported by far, followed by issues such as fatigue, ignoring traffic rules, not obeying traffic rules, phone use while driving, and non-use of seatbelts, which attracted an extremely low response which seems consistent with previously reported low belt wearing rates, unfavourable attitudes towards seatbelt use, and low levels of enforcement. Finally, observations about culturally specific considerations are made from previous research conducted by the authors and others. Specifically, issues of saving face and the importance and pervasiveness of social networks and social influence are discussed with particular regard to how any future countermeasures need to be informed by a thorough understanding of Chinese customs and culture.

Understanding the mental health of refugees: Trauma, stress, and the cultural context

Long considered important for professionals working with minority and under-represented populations, cross-cultural competency has become a requisite for all health care providers. As society in the US increasingly diversifies, there is a crucial need to prepare health care professionals to effectively treat this changing population. The Massachusetts General Hospital Textbook on Diversity and Cultural Sensitivity in Mental Health addresses the importance and relevance of cultural sensitivity in US mental health. Prominent researchers and clinicians examine the cultural and cross-cultural mental health issues of Native American, Latino, Asian, African American, Middle Eastern, Refugee and LGBQT communities. The discussion includes understanding the complexities in making mental health diagnoses and the various meanings it has for the socio-cultural group described, as well as biopsychosocial treatment options and challenges. In understanding the specific populations, the analysis delves into overarching concepts that may apply to specific populations and to those at the intersection of multiple cultures. An invaluable resource for mental health professionals, including clinicians, researchers, educators, leaders and advocates in the United States, The Massachusetts General Hospital Textbook on Diversity and Cultural Sensitivity in Mental Health provides the necessary understanding and insights for research and clinical practice in specific cultural and multicultural groups.

Organisational belongingness mediates the relationship between sources of stress and post-trauma outcomes in fire-fighters

Previous research with emergency service workers has examined the relationship between operational and organisational stress and negative indicators of mental health, and generally found that organisational stress is more strongly related to pathology than operational stress. The current study aimed to create and test a model predicting both posttraumatic stress disorder (PTSD) symptoms and posttraumatic growth (PTG) simultaneously in a sample of fire-fighters (N = 250). The results found that the model demonstrated good fit for the data. In contrast to previous research operational stress was directly related to PTSD symptoms, while organisational stress was not. Organisational stress was indirectly related to PTG, through the mediating role of organisational belongingness. This research identified organisational belongingness as a good target for psychosocial interventions aimed at promoting positive adaptation following the experience of trauma in emergency services.

Triaging older major trauma patients in the emergency department: An observational study

Background The objective of this study was to compare the triage category assigned to older trauma patients with younger trauma patients upon arrival to the emergency department. The focus was to examine whether older major trauma patients were less likely to be assigned an emergency triage category on arrival to the emergency department after controlling for relevant demographics, injury characteristics and injury severity. Methods This was an observational study using data from the Queensland Trauma Registry. All trauma patients aged 15 years and older who presented to contributing hospitals between 1 January 2005 and 31 December 2009 with an Injury Severity Score (ISS)>15 were included. Logistic regression analysis examined the odds of assignment to emergency (Australasian Triage Scale (ATS) 1 or 2) versus urgent (ATS 3–5) treatment for patients across various age categories after adjustment for relevant demographics, injury characteristics and injury severity. Results The study used data on 6923 patients with a median (IQR) age of 43 (26–62) years and a mortality of 11.4% (95% CI 10.7% to 12.2%). Compared with individuals aged 15–34, the adjusted odds of being assigned an ATS category 1 or 2 were 30% lower (OR=0.68, 95% CI 0.57 to 0.81) for individuals aged 55–75 years and were 50% lower (OR=0.46, 95% CI 0.37 to 0.56) for individuals aged 75 years or older. Conclusions Among patients with an ISS>15, older major trauma patients were less likely to be assigned an emergency triage category compared with younger patients. This suggests that the elderly may be undertriaged and provides a potential area of study for reducing mortality and morbidity in older

Public Open Spaces in Kathmandu Valley: A Review of Contemporary Problems and Historic Precedents

The current growth of Kathmandu Valley has been malignant in many ways which suggests a decline of public realm in the city. As the current efforts for planning and design of public open space exhibit numerous problems related to both physical and social aspects of city building, this book examines the shortcomings with contemporary urban development from urban planning and design point of view and attempts to suggest methods to overcome such shortcomings based on the study of historic urban squares. This book identifies the inherent urban design qualities of the historic urban squares in order to learn from them and also attempts to put forward the principles and guidelines for contemporary public space design based on such findings.

Fictionalising Trauma : The Aesthetics of Marguerite Duras's India Cycle

Marguerite Duras (1914−1996) was one of the most original French writers and film directors, whose cycles are renowned for a transgeneric repetition variation of human suffering in the modern condition. Her fictionalisation of Asian colonialism, the India Cycle (1964−1976), consists of three novels, Le ravissement de Lol V. Stein (1964), Le Vice-consul (1966) and L'amour (1971), a theatre play, India Song (1973), and three films, La Femme du Gange (1973), India Song (1974) and Son nom de Venise dans Calcutta desért (1976). Duras’s cultural position as a colon in inter-war ‘Indochina’ was the backdrop for this “théâtre-text-film”, while its creation was provoked by the atrocities of World War II and post-war decolonisation. Fictionalising Trauma analyses the aesthetics of the India Cycle as Duras’s critical working-through of historical trauma. From an emotion-focused cognitive viewpoint, the study sheds light on trauma’s narrativisation using the renewed concept of traumatic memory developed by current social neuroscience. Duras is shown to integrate embodied memory and narrative memory into an emotionally progressing fiction. Thus the rhetoric of the India Cycle epitomises a creative symbolisation of the unsayable, which revises the concept of trauma from a semiotic failure into an imaginative metaphorical process. The India Cycle portrays the stagnated situation of a white society in Europe and British India during the thirties. The narratives of three European protagonists and one fictional Cambodian mendicant are organised as analogues mirroring the effects of rejection and loss on both sides of the colonial system. Using trauma as a conceptual prism, the study rearticulates this composition as three roles: those of witnessing writers, rejected survivors and colonial perpetrators. Three problems are analysed in turn by reading the non-verbal markers of the text: the white man as a witness, the subversive trope of the madwoman and the deadlock of the colonists’ destructive passion. The study reveals emotion and fantasy to be crucial elements in critical trauma fiction. Two devices intertwine throughout the cycle: affective images of trauma expressing the horror of life and death, and self-reflexive metafiction distancing the face-value of the melodramatic stories. This strategy dismantles racist and sexist discourses underpinning European life, thus demanding a renewal of cultural memory by an empathic listening to the ‘other’. And as solipsism and madness lead the lives of the white protagonists to tragic ends, the ‘real’ beggar in Calcutta lives in ecological harmony with Nature. This emphasises the failure of colonialism, as the Durasian phantasm ambiguously strives for a deconstruction of the exotic mythical fiction of French ‘Indochina’.

Micro-CT based characterisation of changes to the vascular network following closed soft tissue trauma and cryotherapy

This project has investigated how the architecture of the blood vessels supplying nutrients to skeletal muscles is affected by muscle contusion injuries, and how it changes during healing with or without initial treatment of the injury by icing. In order to do this, we used contrast agents to visualise blood vessels in 3D with micro-computed tomography imaging. This research significantly contributes to the fields of orthopaedics, traumatology and sports medicine, as it improves our understanding of muscle contusion injuries. Furthermore, the methods developed in this thesis may help to improve the diagnosis and monitoring of these injuries.

Nineteenth century narratives reveal historic catch rates for Australian snapper (Pagrus auratus)

Snapper (Pagrus auratus) is widely distributed throughout subtropical and temperate southern oceans and forms a significant recreational and commercial fishery in Queensland, Australia. Using data from government reports, media sources, popular publications and a government fisheries survey carried out in 1910, we compiled information on individual snapper fishing trips that took place prior to the commencement of fisherywide organized data collection, from 1871 to 1939. In addition to extracting all available quantitative data, we translated qualitative information into bounded estimates and used multiple imputation to handle missing values, forming 287 records for which catch rate (snapper fisher−1 h−1) could be derived. Uncertainty was handled through a parametric maximum likelihood framework (a transformed trivariate Gaussian), which facilitated statistical comparisons between data sources. No statistically significant differences in catch rates were found among media sources and the government fisheries survey. Catch rates remained stable throughout the time series, averaging 3.75 snapper fisher−1 h−1 (95% confidence interval, 3.42–4.09) as the fishery expanded into new grounds. In comparison, a contemporary (1993–2002) south-east Queensland charter fishery produced an average catch rate of 0.4 snapper fisher−1 h−1 (95% confidence interval, 0.31–0.58). These data illustrate the productivity of a fishery during its earliest years of development and represent the earliest catch rate data globally for this species. By adopting a formalized approach to address issues common to many historical records – missing data, a lack of quantitative information and reporting bias – our analysis demonstrates the potential for historical narratives to contribute to contemporary fisheries management.

Ballistic Trauma in Finland : An Epidemiologic and Clinical Study of Firearm and Explosion Injuries

The occurrence and nature of civilian firearm- and explosion-injuries in Finland, and the nature of severe gunshot injuries of the extremities were described in seven original articles. The main data sources used were the National Hospital Discharge Register, the Cause-of-Death Register, and the Archive of Death Certificates at Statistics Finland. The present study was population based. Epidemiologic methods were used in six and clinical analyses in five papers. In these clinical studies, every original hospital record and death certificate was critically analyzed. The trend of hospitalized firearm injuries has slightly declined in Finland from the late 1980s to the early 2000s. The occurrence decreased from 5.1 per 100 000 person-years in 1990 to 2.6 in 2003. The decline was found in the unintentional firearm injuries. A high incidence of unintentional injuries by firearms was characteristic of the country, while violence and homicides by firearms represented a minor problem. The incidence of fatal non-suicidal firearm injuries has been stable, 1.8 cases per 100 000 person-years. Suicides using firearms were eight times more common during the period studied. This is contrary to corresponding reports from many other countries. However, the use of alcohol and illegal drugs or substances was detected in as many as one-third of the injuries studied. The median length of hospitalization was three days and it was significantly associated (p<0.001) with the type of injury. The mean length of hospital stay has decreased from the 1980s to the early 2000s. In this study, there was a special interest in gunshot injuries of the extremities. From a clinical point of view, the nature of severe extremital gunshot wounds, as well as the primary operative approach in their management, varied. The patients with severe injuries of this kind were managed at university and central hospital emergency departments, by general surgeons in smaller hospitals and by cardiothoracic or vascular surgeons in larger hospitals. Injuries were rarities and as such challenges for surgeons on call. Some noteworthy aspects of the management were noticed and these should be focused on in the future. On the other hand, the small population density and the relatively large geographic area of Finland do not favor high volume, centralized trauma management systems. However, experimental war surgery has been increasingly taught in the country from the 1990s, and excellent results could be expected during the present decade. Epidemiologically, explosion injuries can be considered a minor problem in Finland at present, but their significance should not be underestimated. Fatal explosion injuries showed up sporadically. An increase occurred from 2002 to 2004 for no obvius reason. However, in view of the historical facts, a possibility for another rare major explosion involving several people might become likely within the next decade. The national control system of firearms is mainly based on the new legislations from 1998 and 2002. However, as shown in this study, there is no reason to assume that the national hospitalization policies, or the political climate, or the legislation might have changed over the study period and influenced the declining development, at least not directly. Indeed, the reason for the decline to appear in the incidence of unintentional injuries only remains unclear. It may derive from many practical steps, e.g. locked firearm cases, or from the stability of the community itself. For effective reduction of firearm-related injuries, preventive measures, such as education and counseling, should be targeted at recreational firearm users. To sum up, this study showed that the often reported increasing trend in firearm as well as explosion-related injuries has not manifested in Finland. Consequently, it can be recognized that, overall, the Finnish legislation together with the various strategies have succeeded in preventing firearm- and explosion-related injuries in the country.

Stone baby: An exploration of affect and trauma in visual art

Stone Baby: An Exploration of Affect and Trauma in Visual Art was held at the Block, QUT Creative Industries Precinct on August 27-28, 2014. At the conclusion of my Masters project, this exhibition was a showcase of the outcomes of my material and digital explorations in the form of installation, sculpture and film. My primary motivation can be described as a relational and ethical attempt to find a balance between the erotic and the aggressive. This is experienced in the self as feelings of attraction and repulsion in response to the new and unknown "other". Consequently creative practice is necessarily a complex affair that is experienced as a completely immersive and self-contained psychological space. It is within this space that both physical sensation and raw emotion are able to tangibly and conceptually interact with psychoanalytic theory, and concrete materials video and sound.

The prevalence and correlates of childhood trauma in patients with early psychosis

Objective: To describe the prevalence and demographic, clinical and functional correlates of childhood trauma in patients attending early psychosis clinics. Method: Participants were recruited from outpatients attending four early psychosis services. Exposure to childhood trauma was assessed using the Childhood Trauma Questionnaire (CTQ). Psychopathology was measured using the Positive and Negative Syndrome Scale and the Depression, Anxiety and Stress Scale. Social and vocational functioning and substance use were also assessed. Results: Over three-quarters of the 100 patients reported exposure to any childhood trauma. Emotional, physical and sexual abuse were reported by 54%, 23% and 28% of patients, respectively, while 49% and 42% of patients reported emotional and physical neglect, respectively. Female participants were significantly more likely to be exposed to emotional and sexual abuse. Exposure to childhood trauma was correlated with positive psychotic symptoms and higher levels of depressive, anxiety and stress symptoms; however, it had no impact on social or vocational functioning or recent substance use. Conclusion: Exposure to childhood trauma was common in patients with early psychosis, and associated with increased symptomatology. Existing recommendations that standard clinical assessment of patients with early psychosis should include inquiry into exposure to childhood trauma are supported.

Cultural Trauma and Life Stories

The purpose of this work is to use the concepts of human time and cultural trauma in a biographical study of the turning points in the recent history of Estonia. This research is primarily based on 148 in-depth biographical interviews conducted in Estonia and Sweden in 1995-2005, supplemented by excerpts from 5 collections and 10 individually published autobiographies. The main body of the thesis consists of six published and of two forthcoming separate refereed articles, summarised in the theoretical introduction, and Appendix of the full texts of three particular life stories. The topic of the first article is the generational composition and the collective action frames of anti-Soviet social mobilisation in Estonia in 1940-1990. The second article details the differentiation of the rites of passage and the calendar traditions as a strategy to adapt to the rapidly changed political realities, comparatively in Soviet Estonia and among the boat-refugees in Sweden. The third article investigates the life stories of the double-minded strategic generation of the Estonian-inclined Communists, who attempted to work within the Soviet system while professing to uphold the ideals of pre-war Estonia. The fourth article is concentrated on the problems of double mental standards as a coping strategy in a contradictory social reality. The fifth article implements the theory of cultural trauma for the social practice of singing nationalism in Estonia. The sixth article bridges the ideas of Russian theoreticians concerning cultural dialogue and the Western paradigm of cultural trauma, with examples from Estonian Russian life stories. The seventh article takes a biographical look at the logic of the unraveling of cultural trauma through four Soviet decades. The eighth article explores the re-shaping of citizen activities as a strategy of coping with the loss of the independent nation state, comparatively in Soviet Estonia and among Swedish Estonians. Cultural trauma is interpreted as the re-ordering of the society s value-normative constellation due to sharp, violent, usually political events. The first one under consideration was caused by the occupations of the Republic of Estonia by the Soviet army in 1940-45. After half a century of suppression the memories of these events resurfaced as different stories describing the long-term, often inter-generational strategies of coping with the value collapse. The second cultural trauma is revealed together with the collapse of the Soviet power and ideology in Estonia in 1991. According to empirical data, the following three trauma discourses have been reconstructed: - the forced adaptation to Soviet order of the homeland Estonians; - the difficulty of preserving Estonian identity in exile (Sweden); - the identity crisis of the Russian population of Estonia. Comparative analyses of these discourses have shown that opposing experiences and worldviews cause conflicting interpretations of the past. Different social and ethnic groups consider coping with cultural trauma as a matter of self-defence and create appropriate usable pasts to identify with. Keywords: human time, cultural trauma, frame analysis, discourse, life stories