Vision, functional and cognitive determinants of motor vehicle incidents in older drivers

Background: The proportion of older individuals in the driving population is predicted to increase in the next 50 years. This has important implications for driving safety as abilities which are important for safe driving, such as vision (which accounts for the majority of the sensory input required for driving), processing ability and cognition have been shown to decline with age. The current methods employed for screening older drivers upon re-licensure are also vision based. This study, which investigated social, behavioural and professional aspects involved with older drivers, aimed to determine: (i) if the current visual standards in place for testing upon re-licensure are effective in reducing the older driver fatality rate in Australia; (ii) if the recommended visual standards are actually implemented as part of the testing procedures by Australian optometrists; and (iii) if there are other non-standardised tests which may be better at predicting the on-road incident-risk (including near misses and minor incidents) in older drivers than those tests recommended in the standards. Methods: For the first phase of the study, state-based age- and gender-stratified numbers of older driver fatalities for 2000-2003 were obtained from the Australian Transportation Safety Bureau database. Poisson regression analyses of fatality rates were considered by renewal frequency and jurisdiction (as separate models), adjusting for possible confounding variables of age, gender and year. For the second phase, all practising optometrists in Australia were surveyed on the vision tests they conduct in consultations relating to driving and their knowledge of vision requirements for older drivers. Finally, for the third phase of the study to investigate determinants of on-road incident risk, a stratified random sample of 600 Brisbane residents aged 60 years and were selected and invited to participate using an introductory letter explaining the project requirements. In order to capture the number and type of road incidents which occurred for each participant over 12 months (including near misses and minor incidents), an important component of the prospective research study was the development and validation of a driving diary. The diary was a tool in which incidents that occurred could be logged at that time (or very close in time to which they occurred) and thus, in comparison with relying on participant memory over time, recall bias of incident occurrence was minimised. Association between all visual tests, cognition and scores obtained for non-standard functional tests with retrospective and prospective incident occurrence was investigated. Results: In the first phase,rivers aged 60-69 years had a 33% lower fatality risk (Rate Ratio [RR] = 0.75, 95% CI 0.32-1.77) in states with vision testing upon re-licensure compared with states with no vision testing upon re-licensure, however, because the CIs are wide, crossing 1.00, this result should be regarded with caution. However, overall fatality rates and fatality rates for those aged 70 years and older (RR=1.17, CI 0.64-2.13) did not differ between states with and without license renewal procedures, indicating no apparent benefit in vision testing legislation. For the second phase of the study, nearly all optometrists measured visual acuity (VA) as part of a vision assessment for re-licensing, however, 20% of optometrists did not perform any visual field (VF) testing and only 20% routinely performed automated VF on older drivers, despite the standards for licensing advocating automated VF as part of the vision standard. This demonstrates the need for more effective communication between the policy makers and those responsible for carrying out the standards. It may also indicate that the overall higher driver fatality rate in jurisdictions with vision testing requirements is resultant as the tests recommended by the standards are only partially being conducted by optometrists. Hence a standardised protocol for the screening of older drivers for re-licensure across the nation must be established. The opinions of Australian optometrists with regard to the responsibility of reporting older drivers who fail to meet the licensing standards highlighted the conflict between maintaining patient confidentiality or upholding public safety. Mandatory reporting requirements of those drivers who fail to reach the standards necessary for driving would minimise potential conflict between the patient and their practitioner, and help maintain patient trust and goodwill. The final phase of the PhD program investigated the efficacy of vision, functional and cognitive tests to discriminate between at-risk and safe older drivers. Nearly 80% of the participants experienced an incident of some form over the prospective 12 months, with the total incident rate being 4.65/10 000 km. Sixty-three percent reported having a near miss and 28% had a minor incident. The results from the prospective diary study indicate that the current vision screening tests (VA and VF) used for re-licensure do not accurately predict older drivers who are at increased odds of having an on-road incident. However, the variation in visual measurements of the cohort was narrow, also affecting the results seen with the visual functon questionnaires. Hence a larger cohort with greater variability should be considered for a future study. A slightly lower cognitive level (as measured with the Mini-Mental State Examination [MMSE]) did show an association with incident involvement as did slower reaction time (RT), however the Useful-Field-of-View (UFOV) provided the most compelling results of the study. Cut-off values of UFOV processing (>23.3ms), divided attention (>113ms), selective attention (>258ms) and overall score (moderate/ high/ very high risk) were effective in determining older drivers at increased odds of having any on-road incident and the occurrence of minor incidents. Discussion: The results have shown that for the 60-69 year age-group, there is a potential benefit in testing vision upon licence renewal. However, overall fatality rates and fatality rates for those aged 70 years and older indicated no benefit in vision testing legislation and suggests a need for inclusion of screening tests which better predict on-road incidents. Although VA is routinely performed by Australian optometrists on older drivers renewing their licence, VF is not. Therefore there is a need for a protocol to be developed and administered which would result in standardised methods conducted throughout the nation for the screening of older drivers upon re-licensure. Communication between the community, policy makers and those conducting the protocol should be maximised. By implementing a standardised screening protocol which incorporates a level of mandatory reporting by the practitioner, the ethical dilemma of breaching patient confidentiality would also be resolved. The tests which should be included in this screening protocol, however, cannot solely be ones which have been implemented in the past. In this investigation, RT, MMSE and UFOV were shown to be better determinants of on-road incidents in older drivers than VA and VF, however, as previously mentioned, there was a lack of variability in visual status within the cohort. Nevertheless, it is the recommendation from this investigation, that subject to appropriate sensitivity and specificity being demonstrated in the future using a cohort with wider variation in vision, functional performance and cognition, these tests of cognition and information processing should be added to the current protocol for the screening of older drivers which may be conducted at licensing centres across the nation.

Bringing the real world into university learning

Introduction: As part of ongoing quality assurance, all university programs must be regularly reviewed to ensure curriculum is current, meets university and national standards, and for medical science, criteria for AIMS Accreditation. With recent developments at the national and international level also signaling change, a course design team (CDT) was assembled and tasked with developing and implementing a new four year Bachelor of Medical Laboratory Science (BMLS) course at QUT. Method: A whole-of-course approach was adopted, incorporating inverted curriculum and Capstone experience. First, course vision and desired graduate profile are defined as course learning outcomes (CLO), i.e. skills, knowledge, behaviours and attributes graduates must demonstrate. CLO are then back-mapped into introductory, developmental and expected phases from fourth to first year on a course plan and assessment map. Unit learning outcomes (ULO) are then defined, and finally, each unit (subject) designed, directly aligned with assessment. Results: The resulting BMLS course represents a deliberate program of study across four years, which from day one, focuses on the professional aspects of MLS, clinical pathology disciplines, and incrementally developing and assessing the skills, knowledge, behaviours and attributes required to undertake the Work Integrated Learning Internship (WILI) and Capstone experience in final year, and subsequently, graduate from the program. Conclusions: At the start of the year, the BMLS commenced with higher than anticipated enrolments. To date, survey data and feedback is positive, with particular emphasis on the directed nature of the course. The method of course design also ensures university/national standards, and criteria for AIMS Accreditation have been met.

An online community designed to support future makers in educational reform

Australian education is undergoing national reform at many levels. The school sector, where preservice teachers will be employed, are adjusting to the demands of the National Curriculum and improving teacher quality through the National Professional Standards for Teachers. In addition, the university sector, where pre-service teachers are prepared, is undergoing its own education reform through the introduction of a demand-driven system and ensuring quality for tertiary education interns through the Higher Education Standards Framework. In moving to prepare preservice teachers for the school system; universities are grappling with the double-barreled approach to teacher quality; quality within the university course and quality within the student teachers being prepared. Through a collaborative partnership including university lecturers, Department of Education central administration staff, school principals, school coordinators, practicum supervisors, mentor teachers and pre-service teachers; the stakeholders have formed an online community of learners engaging in reflective practice who are committed to improving teacher quality. This online community not only links the key stakeholders within the project, it facilitates the nexus between theory and practice often missing in our pre-service teacher placements. This paper reports preliminary data about an initiative to ensure final year pre-service teachers are aspiring to meet the graduate professional standards through the use of an innovative online community.

Translating and testing the Alberta Context Tool for use among nurses in Swedish elder care

Background. There is emerging evidence that context is important for successful transfer of research knowledge into health care practice. The Alberta Context Tool (ACT) is a Canadian developed research-based instrument that assesses 10 modifiable concepts of organizational context considered important for health care professionals’ use of evidence. Swedish and Canadian health care have similarities in terms of organisational and professional aspects, suggesting that the ACT could be used for measuring context in Sweden. This paper reports on the translation of the ACT to Swedish and a testing of preliminary aspects of its validity, acceptability and reliability in Swedish elder care. Methods. The ACT was translated into Swedish and back-translated into English before being pilot tested in ten elder care facilities for response processes validity, acceptability and reliability (Cronbach’s alpha). Subsequently, further modification was performed. Results. In the pilot test, the nurses found the questions easy to respond to (52%) and relevant (65%), yet the questions’ clarity were mainly considered ‘neither clear nor unclear’ (52%). Missing data varied between 0 (0%) and 19 (12%) per item, the most common being 1 missing case per item (15 items). Internal consistency (Cronbach’s Alpha > .70) was reached for 5 out of 8 contextual concepts. Translation and back translation identified 21 linguistic- and semantic related issues and 3 context related deviations, resolved by developers and translators. Conclusion. Modifying an instrument is a detailed process, requiring time and consideration of the linguistic and semantic aspects of the instrument, and understanding of the context where the instrument was developed and where it is to be applied. A team, including the instrument’s developers, translators, and researchers is necessary to ensure a valid translation. This study suggests preliminary validity, reliability and acceptability evidence for the ACT when used with nurses in Swedish elder care.

Investigating information systems analysts' possession of tacit organisational knowledge

Outsourcing of Information Technology (IT) services which are central to business strategy may be risky. Managers have made the outsourcing decision both to concentrate financially on the core competencies and to rid themselves of a troublesome and cost inefficient department. More recent research has, however, cast doubt on the promises of huge savings. In this paper, we consider the likelihood that outsourcing may lead to the loss of organisational knowledge - that organisations outsourcing their total Information Systems operations may also have lost irreplaceable tacit, cross-functional knowledge which subsisted within the minds of the professional systems analysts. The findings of our research revealed that expert systems analysts possess a unique organisational understanding and draw on this knowledge to operate efficiently in their environment. We present a model that will allow future researchers to build on our findings and examine whether outsourcing can lead to a loss of organisational memory.

Actor-Network Theory (ANT) based visualisation of socio-technical facets of RFID technology translation: an Australian hospital scenario

In the early 2000s, Information Systems researchers in Australia had begun to emphasise socio-technical approaches in innovation adoption of technologies. The ‘essentialist' approaches to adoption (for example, Innovation Diffusion or TAM), suggest an essence is largely responsible for rate of adoption (Tatnall, 2011) or a new technology introduced may spark innovation. The socio-technical factors in implementing an innovation are largely flouted by researchers and hospitals. Innovation Translation is an approach that purports that any innovation needs to be customised and translated in to context before it can be adopted. Equally, Actor-Network Theory (ANT) is an approach that embraces the differences in technical and human factors and socio-professional aspects in a non-deterministic manner. The research reported in this paper is an attempt to combined the two approaches in an effective manner, to visualise the socio-technical factors in RFID technology adoption in an Australian hospital. This research investigation demonstrates RFID technology translation in an Australian hospital using a case approach (Yin, 2009). Data was collected using a process of focus groups and interviews, analysed with document analysis and concept mapping techniques. The data was then reconstructed in a ‘movie script' format, with Acts and Scenes funnelled to ANT informed abstraction at the end of each Act. The information visualisation at the end of each Act using ANT informed Lens reveal the re-negotiation and improvement of network relationships between the people (factors) involved including nurses, patient care orderlies, management staff and non-human participants such as equipment and technology. The paper augments the current gaps in literature regarding socio-technical approaches in technology adoption within Australian healthcare context, which is transitioning from non-integrated nearly technophobic hospitals in the last decade to a tech-savvy integrated era. More importantly, the ANT visualisation addresses one of the criticisms of ANT i.e. its insufficiency to explain relationship formations between participants and over changes of events in relationship networks (Greenhalgh & Stones, 2010).

Aspectos de uma polícia profissional e a Polícia Federal Brasileira: o caso dos escrivães, papiloscopistas e agente – EPA – de polícia federal lotados em Foz do Iguaçu-PR

Esta pesquisa teve por objetivo identificar os aspectos de uma polícia profissional presentes na literatura especializada sobre o assunto e compará-los com a Polícia Federal Brasileira, utilizando-se de pesquisa bibliográfica, documental e de campo. Para isso, pesquisou-se os conceitos de profissionalização policial na literatura e verificou-se que sua definição é controversa e complexa e que as reformas ocorridas nas policias ocidentais, principalmente nos EUA e Inglaterra, no final do século XIX até metade do século XX, criaram um modelo burocrático de polícia, com uma estrutura militarizada e com ênfase na aplicação da lei. Esse modelo influenciou o modelo profissional das polícias brasileiras, e em destaque, a Polícia Federal brasileira. Identificou-se dez principais aspectos de uma polícia profissional. Estes foram divididos em 18 itens, e realizou-se uma pesquisa documental para verificar como esses aspectos estavam presentes na Polícia Federal brasileira e levantou-se algumas hipóteses/suposições sobre os problemas encontrados. Após, realizou-se pesquisa quantitativa, através de um questionário estruturado, com 25 perguntas, para a população de policiais federais dos cargos de Agente, Escrivão e Papiloscopistas de Polícia Federal lotados na Delegacia de Polícia Federal em Foz do Iguaçu-PR, sobre os aspectos verificados na pesquisa documental Com a pesquisa, verificou-se que, na opinião dos respondentes, os itens com maiores problemas eram os relacionados à carreira policial (promoção de classes, funções do cargo e avaliação de desempenho), controle interno (estrutura de corregedorias e aplicação de penalidade), remuneração, cursos de progressão de classes na carreira e a relação democrática entre os servidores policiais. Em relação aos itens mais bem avaliados, destacam-se os relacionados à formação profissional do policial, a deontologia policial e o relacionamento democrático do policial federal com o cidadão.

Qualidade de vida e saúde física e mental de médicos: uma autoavaliação por egressos da Faculdade de Medicina de Botucatu - UNESP

OBJETIVO: O presente artigo teve como objetivo analisar resultados de autoavaliações em termos de qualidade de vida (QV), saúde física (SF) e saúde mental (SM) realizadas por ex-alunos do curso de medicina de uma universidade pública brasileira, associando-se tais indicadores a dados demográficos e diversas dimensões da atuação profissional. MÉTODOS: estudo de corte transversal que teve como população-alvo todos os egressos da Faculdade de Medicina de Botucatu (UNESP) no período de 1968 a 2005, utilizando-se um questionário autoaplicável, respondido por correio ou internet. RESULTADOS: Dos 2.864 questionários enviados, 1.224 (45%) foram respondidos. Tanto a QV como SF e SM foram avaliadas como boa ou muito boa por 67,8%, 78,8% e 84,5% dos participantes, respectivamente. Nos modelos finais de regressão logística, associaram-se a avaliação favorável de QV: ter boa SF e SM, frequentar congressos regulamente, ter tempo suficiente de lazer e estar satisfeito com a profissão. SF boa ou muito boa associou-se independentemente com QV e SM positivas, faixa de renda mais alta, prática regular de atividades físicas e nunca ter fumado. SM favorável permaneceu associada com satisfação profissional, tempo para lazer, e boa avaliação da QV e da SF. CONCLUSÕES: Entre os médicos egressos da UNESP, SF e SM foram aspectos indissociáveis e também relacionados à QV. Bons hábitos, como praticar atividades físicas, ter tempo para lazer e não fumar foram associados à melhor avaliação da saúde em geral e devem ser incentivados. A satisfação profissional teve um peso importante no bem-estar emocional relatado pelos participantes.

Library professionals' education in the Mercosur countries

This paper deals with library professionals education in Mercosur - the Common Market of South America - established on 29 March, 1991 to expand the national markets of Argentina, Brazil, Paraguay and Uruguay, and promote free circulation of goods, services and production agents in that region. The paper presents, through a descriptive study, the undergraduate and graduate courses in Library Science, how many and what schools there are, and what programs are developed. It ends by identifying the directions in which they are moving and the challenges they are now facing.

Entropy variation in isothermal fluid flow considering real gas effects

The present paper concerns on the estimative of the pressure loss and entropy variation in an isothermal fluid flow, considering real gas effects. The 1D formulation is based on the isothermal compressibility module and on the thermal expansion coefficient in order to be applicable for both gas and liquid as pure substances. It is emphasized on the simple methodology description, which establishes a relationship between the formulation adopted for ideal gas and another considering real gas effects. A computational procedure has been developed, which can be used to determine the flow properties in duct with a variable area, where real gas behavior is significant. In order to obtain quantitative results, three virial coefficients for Helium equation of state are employed to determine the percentage difference in pressure and entropy obtained from different formulations. Results are presented graphically in the form of real gas correction factors, which can be applied to perfect gas calculations.

Patellofemoral pain syndrome: Electromyography in a frequency domain analysis

The Patellofemoral Pain Syndrome (PFPS), has a multifactorial etiology and affects approximately 7 to 15% of the population, mostly women, youth, adults and active persons. PFPS causes anterior or retropatelar pain that is exacerbated during functional motor gestures, such as up and down stairs or spending long periods of time sitting, squatting or kneeling. As the diagnostic evaluation of this syndrome is still indirect, different mechanisms and methodologies try to make a classification that distinguishes patients with PFPS in relation to asymptomatic. Thereby, the purpose of this investigation was to determine the characteristics of the electromyographic (EMG) signal in the frequency domain of the vastus medialis oblique (VMO) and vastus lateralis (VL) in patients with PFPS, during the ascent of stairs. 33 young women (22 control group and 11 PFPS group), were evaluated by EMG during ascent of stairs. The VMO mean power frequency (MPF) and the VL frequency 95% (F95) were lower in symptomatic individuals. This may be related to the difference in muscle recruitment strategy exerted by each muscle in the PFPS group compared to the control group.

The banking supervision agenda in Latin America

Includes bibliography

Dilemmas in Framing Research Studies in Engineering Education

There has been considerable debate about the need for more empirical, evidence based studies of the impact of various interventions and practices in engineering education. A number of resources including workshops to guide engineering faculty in the conduct of such studies have emerged over recent years. This paper presents a critique of the evolution of engineering education research and its underlying assumptions in the context of the systemic reform currently underway in engineering education. This critique leads to an analysis of the ways in which our current understanding of engineering, engineering education and research in engineering education is shaped by the traditions and cultural characteristics of the profession and grounded, albeit implicitly, in a particular suite of epistemological assumptions. It is argued that the whole enterprise of engineering education needs to be radically reconceptualized. A pluralistic approach to framing scholarship in engineering education is then proposed based on the principles of demonstrable practicality, critical interdisciplinarity and holistic reflexivity. This new framework has implications for engaging and developing faculty in the context of new teaching and learning paradigms, for the evaluation of the scholarship of teaching and for the research-teaching nexus.

Developing the public health function of locum pharmacists under the auspices of the new pharmacy contract

Focal Point - There are reduced opportunities for locum pharmacists to access training and education that meets their needs and enables them to play a full role under the new pharmacy contract - Eighty-six per cent of locums consider themselves to be more health professional than business person, compared to just 48% of pharmacy owners - Forty per cent of locums believe that a lack of access to training is a major barrier to the development of their public health function - While locum pharmacists are arguably more likely to embrace 'professionalising', patient-care-based roles, they are also the group least likely to be able to access the necessary training to fulfill such roles Introduction It has been suggested that locum pharmacists do not want the business-based responsibilities (e.g. staff management, meeting targets, etc) that come with pharmacy management.1 Research also suggests that locums derive great satisfaction from the health-professional aspects of the pharmacists’ role (e.g. patient contact, the provision of advice, etc).1 However, upon the introduction of the new pharmacy contract (April 2005), concerns were expressed that it was becoming increasingly difficult for locum pharmacists to access training and education that would meet their needs and enable them to play a full role under the new framework.2,3 Method After piloting, in August 2006 a self-completion postal questionnaire was sent to a random sample of practising community pharmacists, stratified for country and sex, within Great Britain (n = 1998), with a follow-up to non-responders 4 weeks later. Data were analysed using SPSS (v12.0). A final response rate of 51% (n = 1023/1998) was achieved. Respondents were asked ‘indicate how you view yourself as a pharmacist’ – in terms of their relative focus on the health-professional and business aspects of their role. Respondents were also asked ‘do you consider a lack of training opportunities to be a barrier to the development of the public health role of community pharmacists?’. Results Locums were significantly more likely than owners or employees to consider each factor a major barrier. Discussion Four in 10 locums consider a lack of training opportunities to constitute a major barrier to the development of their public health function. Pharmacy may not be able to provide the services required of it by the policy agenda if pharmacists are unable to be involved in extended role activities through a lack of training opportunities. Therefore, the paradox that needs to be addressed is that while locum pharmacists are arguably more likely to embrace ‘professionalising’, patient-care-based roles, they are also the group least likely to be able to access training to fulfil such roles. The training needs of this large subset of the pharmacist population need to be assessed and met if the whole community pharmacy workforce is going to maximise its contribution to public health under the new contractual framework. References 1 Shann P, Hassell K. An exploration of the diversity and complexity of the pharmacy locum workforce. London: Royal Pharmaceutical Society of Great Britain; 2004. 2 Almond M. Locums – key players in workforce – cast adrift as contract launched. Pharm J 2005;274:420. 3 Bishop DH. A lack of appreciation of what really happens. Pharm J 2005;274:451.

Projeto ético-político do serviço social e organização política da categoria: dilemas e tensões contemporâneas

The present study was to apprehend the controversies that underlie the political organization of the category nowadays. The research established time frame as the decade from 2003 to 2013, more precisely the situation that opens with Lula's election to the Presidency and its repercussions for the Brazilian left, social movements and for the category. Through documentary research, we studied the professional aspects that are organized politically in different fields , notably the Federal Council of Social Service (CFESS) and the National Federation of Social Workers (FENAS). Seeking to understand their relationship with the Ethical - Political Project of the profession, public documents were analyzed expressing the political positions of these entities, placing the controversies and political differences between them and understanding the political organization as a means to building professionals and corporate projects many.