Overcoming language barriers in healthcare: A protocol for investigating safe and effective communication when patients or clinicians use a second language

Background Miscommunication in the healthcare sector can be life-threatening. The rising number of migrant patients and foreign-trained staff means that communication errors between a healthcare practitioner and patient when one or both are speaking a second language are increasingly likely. However, there is limited research that addresses this issue systematically. This protocol outlines a hospital-based study examining interactions between healthcare practitioners and their patients who either share or do not share a first language. Of particular interest are the nature and efficacy of communication in language-discordant conversations, and the degree to which risk is communicated. Our aim is to understand language barriers and miscommunication that may occur in healthcare settings between patients and healthcare practitioners, especially where at least one of the speakers is using a second (weaker) language. Methods/Design Eighty individual interactions between patients and practitioners who speak either English or Chinese (Mandarin or Cantonese) as their first language will be video recorded in a range of in- and out-patient departments at three hospitals in the Metro South area of Brisbane, Australia. All participants will complete a language background questionnaire. Patients will also complete a short survey rating the effectiveness of the interaction. Recordings will be transcribed and submitted to both quantitative and qualitative analyses to determine elements of the language used that might be particularly problematic and the extent to which language concordance and discordance impacts on the quality of the patient-practitioner consultation. Discussion Understanding the role that language plays in creating barriers to healthcare is critical for healthcare systems that are experiencing an increasing range of culturally and linguistically diverse populations both amongst patients and practitioners. The data resulting from this study will inform policy and practical solutions for communication training, provide an agenda for future research, and extend theory in health communication.

Expression of high mobility group box 1 in inflamed dental pulp and its chemotactic effect on dental pulp cells

High mobility group box 1 protein (HMGB1) is a chromatin protein which can be released extracellularly, eliciting a pro-inflammatory response and promoting tissue repair process. This study aimed to examine the expression and distribution of HMGB1 and its receptor RAGE in inflamed dental pulp tissues, and to assess its effects on proliferation, migration and cytoskeleton of cultured human dental pulp cells (DPCs). Our data demonstrated that cytoplasmic expression of HMGB1 was observed in inflamed pulp tissues, while HMGB1 expression was confined in the nuclei in healthy dental pulp. The mRNA expression of HMGB1 and RAGE were significantly increased in inflamed pulps. In in vitro cultured DPCs, expression of HMGB1 in both protein and mRNA level was up-regulated after treated with lipopolysaccharide (LPS). Exogenous HMGB1 enhanced DPCs migration in a dose-dependent manner and induced the reorganization of f-actin in DPCs. Our results suggests that HMGB1 are not only involved in the process of dental pulp inflammation, but also play an important role in the recruitment of dental pulp stem cells, promoting pulp repair and regeneration.

Zombies on the road: A holistic design approach to balancing gamification and safe driving [poster]

This paper explores novel driving experiences that make use of gamification and augmented reality in the car. We discuss our design considerations, which are grounded in road safety psychology and video game design theory. We aim to address the tension between safe driving practices and player engagement. Specifically, we propose a holistic, iterative thinking process inspired by game design cognition and share our insights generated through the application of this process. We present preliminary game concepts that blend digital components with physical elements from the driving environment. We further highlight how this design process helped us to iteratively evolve these concepts towards being safer while maintaining fun. These insights and game design cognition itself will be useful to the AutomotiveUI community investigating similar novel driving experiences.

Fate and transport of nursery-box-applied tricyclazole and imidacloprid in paddy fields

The fate and transport of tricyclazole and imidacloprid in paddy plots after nursery-box application was monitored. Water and surface soil samples were collected over a period of 35 days. Rates of dissipation from paddy waters and soils were also measured. Dissipation of the two pesticides from paddy water can be described by first-order kinetics. In the soil, only the dissipation of imidacloprid fitted to the simple first-order kinetics, whereas tricyclazole concentrations fluctuated until the end of the monitoring period. Mean half-life (DT₅₀) values for tricyclazole were 11.8 and 305 days, respectively, in paddy water and surface soil. The corresponding values of imidacloprid were 2.0 and 12.5 days, respectively, in water and in surface soil. Less than 0.9% of tricyclazole and 0.1% of imidacloprid were lost through runoff during the monitoring period even under 6.3 cm of rainfall. The pesticide formulation seemed to affect the environmental fate of these pesticides when these results were compared to those of other studies.

An Integrated Assessment Of The Suitability Of Domestic Solar Still As A Viable Safe Water Technology For India

Improving access to safe drinking water can result in multi-dimensional impacts on people's livelihood. This has been aptly reflected in the Millennium Development Goals (MDG) as one of the major objectives. Despite the availability of diverse and complex set of technologies for water purification, pragmatic and cost-effective use of the same is impeding the use of available sources of water. Hence, in country like India simple low-energy technologies such as solar still are likely to succeed. Solar stills would suffice the basic minimum drinking water requirements of man. Solar stills use sunlight, to kill or inactivate many, if not all, of the pathogens found in water. This paper provides an integrated assessment of the suitability of domestic solar still as a viable safe water technology for India. Also an attempt has been made to critically assess the operational feasibility and costs incurred for using this technology in rural India.

Tactical Pasture Management: Enhancing Profits from Poplar Box Country

The project assembled basic information to allow effective management and manipulation of native pastures in the southern Maranoa region of Queensland. This involved a range of plant studies, including a grazing trial, to quantify the costs of poor pasture composition. While the results focus on perennial grasses, we recognise the important dietary role played by broad-leaved herbs. The plant manipulation studies focussed on ways to change the proportions of plants in a grazed pasture, eg. by recruitment or accelerated morbidity of existing plants. As most perennial grasses have a wide range of potential flowering times outside of mid-winter, rainfall exerts the major influence on flowering and seedset; exceptions are black speargrass, rough speargrass and golden beardgrass that flower only for a restricted period each year. This simplifies potential control options through reducing seedset. Data from field growth studies of four pasture grasses have been used to refine the State's pasture production model GRASP. We also provide detailed data on the forage value of many native species at different growth stages. Wiregrass dominance in pastures on a sandy red earth reduced wool value by only 5-10% at Roma in 1994/95 when winters were very dry and grass seed problems were minimal.

Woody plant responses to various clearing strategies imposed on a poplar box (Eucalyptus populnea) community at Dingo in central Queensland

The efficacy of individual tree treatment (stem-injection), aerially applied root-absorbed herbicide and mechanical felling (with and without subsequent fire) in controlling woody plants was compared in a poplar box (Eucalyptus populnea) woodland community in central Queensland, Australia. All treatments reduced woody plant populations and basal area relative to the untreated control. Chemical control and 'mechanical felling plus fire' treatments were equally effective in reducing woody plant basal area 7 years after the treatments were imposed. However, mechanical felling alone was less effective. There was a clear tendency for the scattered tree (80% thinning) treatment to recover woody plant basal area towards pre-treatment levels faster than other clearing strategies, although this response was not significantly different from 20% clump retention and mechanical felling (without burning) treatments.

Research note: poplar box (Eucalyptus populnea) growth rates in thinned and intact woodlands in central Queensland

A 19-year data set, which highlights the rapid growth rate in basal area of trees in thinned plots compared with unthinned controls, is presented. These results support the contention that, following tree thinning, basal area of retained trees will increase more rapidly than that of trees on unthinned areas. Indications are that pre-thinning levels in tree basal area will again be reached before the cost of treatment can be recouped by increased pasture and livestock production.

Safe to crush? A pilot study into solid dosage form modification in aged care

Aims To observe medication solid dosage form modification in aged care facilities (ACFs), and assess staff levels of self-perceived knowledge of medication modification and the types of resources available to them. Method Observation of medication rounds in a convenience sample of Australian Capital Territory ACFs and assessment of staff knowledge of dosage form modification and available resources. Results From 160 observations across six medication rounds, 29 residents had a total of 75 medications modified by the nursing staff prior to administration, with 32% of these instances identified as inappropriate. The methods used for crushing and administration resulted in drug mixing, spillage and incomplete dosing. The staff reported adequate resources; however, a lack of knowledge on how to locate and use these resources was evident. Conclusions Improved staff training on how to use available resources is needed to reduce the observed high incidence of inappropriate medication crushing.

Best management practices for sustainable and safe playing surface of Australian Football League sports fields

In 2002, AFL Queensland and the Brisbane Lions Football Club approached the Department of Primary Industries and Fisheries (Queensland) for advice on improving their Premier League sports fields. They were concerned about player safety and dissatisfaction with playing surfaces, particularly uneven turf cover and variable under-foot conditions. They wanted to get the best from new investments in ground maintenance equipment and irrigation infrastructure. Their sports fields were representative of community-standard, multi-use venues throughout Australia; generally ‘natural’ soil fields, with low maintenance budgets, managed by volunteers. Improvements such as reconstruction, drainage, or regular re-turfing are generally not affordable. Our project aimed to: (a) Review current world practice and performance benchmarks; (b) Demonstrate best-practice management for community-standard fields; (c) Adapt relevant methods for surface performance testing; (d) Assess current soils, and investigate useful amendments; (e) Improve irrigation system performance; and (e) Build industry capacity and encourage patterns for ongoing learning. Most global sports field research focuses on elite, sand-based fields. We adjusted elite standards for surface performance (hardness, traction, soil moisture, evenness, sward cover/height) and maintenance programs, to suit community-standard fields with lesser input resources. In regularly auditing ground conditions across 12 AFLQ fields in SE QLD, we discovered surface hardness (measured by Clegg Hammer) was the No. 1 factor affecting player safety and surface performance. Other important indices were turf coverage and surface compaction (measured by penetrometer). AFLQ now runs regularly audits affiliated fields, and closes grounds with hardness readings greater than 190 Gmax. Aerating every two months was the primary mechanical practice improving surface condition and reducing hardness levels to < 110 Gmax on the renovated project fields. With irrigation installation, these fields now record surface conditions comparable to elite fields. These improvements encouraged many other sporting organisations to seek advice / assistance from the project team. AFLQ have since substantially invested in an expanded ground improvement program, to cater for this substantially increased demand. In auditing irrigation systems across project fields, we identified low maintenance (with < 65% of sprinklers operating optimally) as a major problem. Retrofitting better nozzles and adjusting sprinklers improved irrigation distribution uniformity to 75-80%. Research showed that reducing irrigation frequency to weekly, and preparedness to withhold irrigation longer after rain, reduced irrigation requirement by 30-50%, compared to industry benchmarks of 5-6 ML/ha/annum. Project team consultation with regulatory authorities enhanced irrigation efficiency under imposed regional water restrictions. Laboratory studies showed incorporated biosolids / composts, or topdressed crumb rubber, improved compaction resistance of soils. Field evaluations confirmed compost incorporation significantly reduced surface hardness of high wear areas in dry conditions, whilst crumb rubber assisted turf persistence into early winter. Neither amendment was a panacea for poor agronomic practices. Under the auspices of the project Trade Mark Sureplay®, we published > 80 articles, and held > 100 extension activities involving > 2,000 participants. Sureplay® has developed a multi-level curator training structure and resource materials, subject to commercial implementation. The partnerships with industry bodies (particularly AFLQ), frequent extension activities, and engagement with government/regulatory sectors have been very successful, and are encouraged for any future work. Specific aspects of sports field management for further research include: (a) Understanding of factors affecting turf wear resistance and recovery, to improve turf persistence under wear; (b) Simple tests for pinpointing areas of fields with high hardness risk; and (c) Evaluation of new irrigation infrastructure, ‘water-saving’ devices, and irrigation protocols, in improving water use and turf cover outcomes.

Objective `Safe' Grazing Capacities for South-West Queensland Australia: Model Application and Evaluation

This paper describes the employment of two experienced graziers as consultants to apply and evaluate a model for calculating 'safe' long-term grazing capacities of individual properties. The model was based on ecological principles and entailed estimates of average annual forage grown (kglha) on the different land systems on each property and the calculation of the number of livestock (dry sheep equivalents, DSE) required to 'safely' utilise this forage. The grazier consultants applied and evaluated the 'safe' grazing capacity model on 20 properties of their choosing. For evaluation, model results were compared with; (a) the Department of Lands rated carrying capacities for those properties and (b) the grazing capacity assessed independently by the owners of those properties. For the 20 properties, the average 'safe' grazing capacity calculated by the model (21.0 DSE/kmZ) was 8% lighter than the average of the owner assessed capacities (22.7 DSE/kmZ), which in tum was 37% lighter than the average of the pre-1989 Department of Lands rated carrying capacity (31.0 DSE/kmZ). The grazing land management and administrative implications of these results and the role graziers played as consultants are discussed.

Objective `Safe' Grazing Capacities for South-West Queensland Australia: Development of a Model for Individual Properties

Few tools are available to assist graziers, land administrators and financiers in making objective grazing capacity decisions on Australian rangelands, despite existing knowledge regarding stocking rate theory and the impact of stocking rates on land condition. To address this issue a model for objectively estimating 'safe' grazing capacities on individual grazing properties in south-west Queensland was developed. The method is based on 'safe' levels of utilisation (15%-20%) by domestic livestock of average annual forage grown for each land system on a property. Average annual forage grown (kglha) was calculated as the product of the rainfall use efficiency (kglhdmm) and average annual rainfall (mm) for a land system. This estimate included the impact of tree and shrub cover on forage production. The 'safe' levels of forage utilisation for south- west Queensland pastures were derived from the combined experience of (1) re-analysis of the results of grazing trials, (2) reaching a consensus on local knowledge and (3) examination of existing grazing practice on 'benchmark' grazing properties. We recognise the problems in defining, determining and using grazing capacity values, but consider that the model offers decision makers a tool that can be used to assess the grazing capacity of individual properties.

Enhancing pasture stability and profitability for producers in Poplar Box and Silver-leaved Ironbark woodlands.

Over 7 years, this project collected data about the pasture, tree and soil surface dynamics of two major Aristida/Bothriochloa pasture types within the eucalypt woodlands of central Queensland. Six different grazing management scenarios were compared ecologically and economically, along with the effects of spring burns and tree killing. Heavy stocking (3-4 ha per adult equivalent) produced the greatest short-term financial return from healthy pastures but was not a sustainable practice and long-term cash returns were no better than those from moderate stocking. The environmental benefits of moderate grazing over heavy grazing were very clear. Light stocking produced better environmental outcomes compared to moderate stocking but was clearly inferior with respect to economic returns. Killing silver-leaved ironbark trees near Rubyvale produced no measurable improvement in pasture growth or quality for at least 6 years whereas at Injune the same treatment of poplar box trees resulted in an immediate and large enhancement in pasture production and carrying capacity. The gritty red duplex soil at Rubyvale was much more erodible than the grey solodic at Injune although the latter becomes very erodible if the stable surface soil is breached. Good seasonal rainfall produced faster changes in pasture composition than extremes of grazing management. The perennial grasses were easier to recruit than to eliminate by grazing management changes.

Book Review: "Safe Design and Construction of Machinery – Regulation, Practice and Performance [First edition]"

With Safe Design and Construction of Machinery, the author presents the results of empirical studies into this significant aspect of safety science in a very readable, well-structured format. The book contains 436 references, 17 tables, one figure and a comprehensive index. Liz Bluff addresses a complex and important, but often neglected domain in OHS – the safety of machinery – in a holistic and profound, yet evidence based analysis; with many applied cases from her studies, which make the book accessible and a pleasant lecture. Although research that led to this remarkable publication might have been primarily focused on the regulators, this book can be highly recommended to all OHS academics and practitioners. It provides an important contribution to the body of knowledge in OHS, and establishes one of the few Australian in-depth insights into the significance of machinery producers, rather than machinery users in the wider framework of risk management. The author bases this fresh perspective on the well-established European Machinery Safety guidelines, and grounds her mixed-methods research predominantly in qualitative analysis of motivation and knowledge, which eventually leads to specific safety outcomes. It should be noted that both European and Australian legal aspects are investigated and considered, as both equally apply to many machinery exporters. A detailed description of the research design and methods can be found in an appendix. Overall, the unique combination of quantitative safety performance data and qualitative analysis of safety behaviours form a valuable addition to the understanding of machinery safety. The author must be congratulated on making these complex relationships transparent to the reader through her meticulous inquiry.