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CLASSIFICATION OF UNCERTAINTY/PROBABILITY ON GEOTECHNICAL RISK SOURCE, AND A SUGGESTION FOR EFFECTIVE PROCESS OF RISK MANAGEMENT
No full textGeotechnical risk management is an important activity that reduces serious cost loss to often occur in civil engineering projects, but has not progressed inserting to projects. This may be caused by non-understanding of the effect of risk management, because it is not sure that the risk sources and the uncertainty improved by risk management, also difference between normal geotechnical survey and risk management. In this study, based on a review of the literature and observation of business practice, we clarify the uncertainty improved by risk management, by classification of the geotechnical uncertainty(probability) on geotechnical risk source. And with arranging features of each management processes, we suggest that -geotechnical risk might increase caused by change circumstance of project, and it is necessary that inserting a process of management design at a view of geotechnical risk, for effective management
Changing the antibiotic prescribing of Australian general practice registrars’ for acute respiratory tract infections: a non-randomized controlled trial: a non-randomized controlled trial
Get PDFBackground:Inappropriate antibiotic prescription for self-limiting respiratory tract infections (RTIs) by general practitioner (GP) registrars (trainees) is less common than by established GPs but still exceeds evidence-based benchmarks. A 2014 face-to-face educational intervention for registrars and supervisors reduced registrars’ acute bronchitis antibiotic prescription by 16% (absolute reduction). We aimed to establish the efficacy of an updated registrar/supervisor RTI-management intervention (delivered at distance) on antibiotic prescribing.Methods:A non-randomized trial using a non-equivalent control-group nested within the ReCEnT cohort study. The intervention included online educational modules, registrar and supervisor webinars, and materials for registrar-supervisor in-practice educational sessions, and focussed on acute bronchitis as an exemplar RTI. The theoretical underpinning was the ‘capability, opportunity, and motivation’ (COM-B) framework. The intervention was delivered to registrars and supervisors of one large educational/training organization annually from mid-2021, with pre-intervention period from 2017, and with postintervention period ending 2023. Two other educational/training organizations served as controls. The primary outcome was antibiotics prescribed for acute bronchitis. Analyses used multivariable logistic regression with predictors of interest: time (before/after intervention), treatment group, and an interaction term for time-by-treatment group, adjusted for potential confounders. The interaction term P-value was used to infer statistical significance of the intervention effect.Results:Of 4612 acute bronchitis presentations, 70% were prescribed antibiotics. There was a 6.9% absolute reduction (adjusted) of prescribing in the intervention-group compared with the control-group. This was not statistically significant (Pinteraction = .22).Conclusions:Failure to find a significant effect on prescribing suggests difficulties with scalability of this (and similar educational) innovations
Heart Rate Variability of High-Risk Warrant Service in Tactical Police Personnel: A Case Series
No full textUnderstanding Barriers and Pathways for the Sustainable Implementation of Affordable Housing in Australia: The Case of the National Rental Affordability Scheme (NRAS)
No full textAustralia’s housing affordability crisis has deepened despite extensive policy intervention, with the private rental sector experiencing unprecedented pressure. This study proposes that affordable housing should guarantee low and moderate-income households their fundamental right to access secure and safe dwellings, enabling these households to meet essential needs and maintain quality of life without enduring housing stress. Despite significant public investment, a critical housing shortage persists across the nation with a need to build 640,000 homes annually. This crisis is exacerbated by ineffective public–private–community partnerships (PPCP) and the absence of a unified national housing policy. This study critically examines the NRAS to understand why market-based interventions have consistently fallen short of addressing housing affordability challenges. Through empirical analysis of 31 in-depth interviews with senior stakeholders across public, private and community sectors, this research identifies five systemic barriers: definitional inconsistencies in affordable housing policy; inflexible strategic frameworks; misaligned investment incentives; geographical inequities in resource allocation; and fragmented governance structures. The study introduces the Personal and Collective Will in Policy Implementation (PaCWiPI) framework as an innovative approach integrating Maslow’s Hierarchy of Needs with Henderson’s Poverty Line metrics. Our findings demonstrate that effective housing policy requires a fundamental shift from rigid, standardised approaches towards adaptive frameworks that are responsive to diverse market conditions. This research advances housing policy scholarship by providing empirical evidence of implementation barriers while offering practical recommendations for future initiatives, relevant to the current Housing Australia Future Fund and other regionally-related housing policies.</p
Reported foodservice environmental sustainability practices in Australian healthcare and aged care services pre and post the onset of COVID-19
No full textAIMS: Healthcare foodservices substantially impact global environmental changes. This study investigated environmentally sustainable practices in Australian health foodservices; and perceptions of the influence of COVID-19 on foodservice environmental sustainability.METHODS: An observational study was undertaken collecting data at two time points (2019 and 2022) via a pre-workshop survey with healthcare foodservice stakeholders. The survey used rating scales and free text options to explore sustainable practices, perceived barriers and enablers to sustainable practices, and a free-text response on the impact of COVID-19. Analysis included independent samples t-tests (continuous, normally distributed), Mann-Whitney U tests (continuous non-normally distributed data), and Pearson chi-squared tests (categorical data). A qualitative analysis of free text responses to a single question about the impact of COVID-19 was used to identify, analyse, and report positive and negative aspects of COVID-19 for sustainable foodservice practices.RESULTS: Demographic and employment characteristics were similar between timepoints n = 37 (2019) and n = 30 (2022), except for number who had attended sustainability training (n = 14, 38.8% vs n = 19, 63.3%; p = 0.038). There were fewer private hospital (n = 6, 16.2% vs n = 0), (0%) and more rural site representation in 2022 (n = 2, 5.4% vs n = 13, 43.3%; p <0.001). Sustainable foodservice practices were consistent across timepoints (overall mean (SD) sum score for sustainable practices 63.3 (20.7) vs 61.3 (20.4); p = 0.715), with recycling cardboard (n = 27, 90.0% vs n = 22, 84.6%), and the use of reusable cutlery (n = 26, 86.7% vs n = 22, 84.6%) the most prevalent practices at both timepoints. A 'lack of equipment' was the primary reported barrier while passionate staff ("champions") was the primary reported enabler. Participants reported that the COVID-19 pandemic led to an increase in single-use disposable items.CONCLUSIONS: This study describes negligible changes in reported environmental sustainability practices by Australian healthcare foodservice stakeholders from 2019 to 2022. The study provides useful information on sustainability beliefs and practices in healthcare foodservices.</p
How to … Overcome Challenges in Implementing Escape Rooms in Medical Education
No full textEscape rooms have emerged as a dynamic educational tool in medical education, offering immersive experiences that foster critical thinking, teamwork and practical skills. Despite their potential, the implementation of escape rooms faces significant challenges, including resource limitations, curricular integration and ensuring educational effectiveness. This paper presents practical tips to address these challenges, covering aspects such as securing resources, designing scalable and inclusive activities, leveraging technology and evaluating educational outcomes. These tips provide educators with a comprehensive guide to navigate the complexities of integrating escape rooms into medical curricula successfully. By adopting these strategies, educators can enhance the learning experience, making escape rooms a valuable component of medical education that prepares students for the complexities of healthcare practice.</p
Does the Addition of a Lateral Extra-Articular Procedure to a Primary Anterior Cruciate Ligament Reconstruction Result in Superior Functional and Clinical Outcomes. A Systematic Review and Meta-analysis of Randomized Controlled Trials
Get PDFBackground:Current research focused on clinical outcomes suggests that lateral extra-articular procedures (LEAPs) can reduce rotational instability and graft failure rates in primary anterior cruciate ligament reconstructions (ACLRs). Limited studies have investigated the functional outcomes after LEAPs, including patient-reported outcome measures, sports participation, and physical performance.Purpose:To conduct a systematic literature review and meta-analysis to determine whether the addition of a LEAP to an ACLR results in superior functional and clinical outcomes as compared with an isolated ACLR.Study Design:Systematic review and meta-analysis; Level of evidence, 1.Methods:Five databases were searched to identify randomized controlled trials comparing clinical and functional outcomes after the addition of LEAPs to an isolated primary ACLR. Study selection was performed in accordance with the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Assessment of methodological quality for included studies was undertaken using the Cochrane Risk of Bias 2 tool for randomized controlled trials. Studies were eligible for meta-analysis if an outcome measure utilizing similar time points was present across ≥2 studies and reported in mean difference or standard deviation.Results:Meta-analysis of 10 studies showed that the addition of LEAPs to an ACLR can reduce rates of rotatory instability (risk ratio, 1.45 [95% CI, 1.17-1.79]; P = .0006; I2 = 0%) and graft rupture (risk ratio, 0.21 [95% CI, 0.08-0.55]; P < .001; I2 = 0%). As supported by studies eligible for meta-analysis, this review showed that the addition of LEAPs to an ACLR can reduce rotatory instability. Short-term morbidity, including increased pain, joint stiffness, and muscle weakness, as compared with isolated ACLRs was resolved by 12 months after surgery.Conclusion:ACLR in combination with a LEAP results in superior clinical outcomes when compared with an isolated ACLR. Despite early postoperative outcomes concerning pain and function favoring isolated ACLRs, any negative effects were not still observed 6 months after surgery. A conclusion around the correlation between LEAPs and accelerated knee osteoarthritis could not be drawn, owing to the lack of long-term prospective studies available
Ultra-short-term versus short-term measures of heart rate variability in specialist police units: A pilot reliability study
Get PDFPolice officers are exposed to high levels of stress. Serving on Special Weapons and Tactics (SWAT) teams is a highly demanding duty that may further increase levels of stress in police personnel. This stress may accumulate, thereby increasing allostatic load. As such, holistic stress measures may be valuable for quantifying multifactorial stress accumulation in SWAT personnel. Heart rate variability (HRV) is one field-deployable measure that may be suitable in this context. However, with logistical challenges present in this population, determining if 30 s; rather than more the typical 5-min ECG data collection, provides sufficient reliability may be beneficial for reducing the logistical barrier to adoption of HRV monitoring in SWAT personnel. This study compared 30-s to 5-min HRV analyses of ECG data obtained from 15 male SWAT personnel. Findings demonstrated good (ICC >0.8) reliability only in the VLF, HF, SD1, and SD2 HRV domains. The VLF and SD2 measures may be erroneous, as 5-min may still insufficiently characterize these measures. However, this study confirms the robust quality of nonlinear HRV analysis, as the SD1 value demonstrated the highest ICC reported here (0.902). Therefore, while 5-min ECGs may still preferable, the 30-s measure may still be viable for organizations considering HRV assessment.</p