This paper explores the possibility of using diachronic case study comparisons to shed light on continuity and change in policy interventions to manage plant closures. It compares the early results of a survey of workers retrenched in the 2017 closure of Australia’s passenger vehicle manufacturing industry with the results of a similar survey of workers who lost their jobs in the 2005 closure of Mitsubishi’s Adelaide engine-casting and components plant. Despite the 12 years of accumulated expertise in plant closure and structural adjustment management, this comparison shows remarkable similarities in the profile of the cohort of retrenched workers and remarkable similarities in their employment outcomes. The discussion reflects on conditions that produce continuity and change.
Background Non-medical prescribing is one healthcare reform strategy that has the potential to create health system savings and offer equitable and timely access to scheduled medicines. Podiatrists are well positioned to create health system efficiencies through prescribing, however, only a small proportion of Australian podiatrists are endorsed to prescribe scheduled medicines. Since scheduled medicines prescribed by Australian podiatrists are not subsidised by the Government, there is a lack of data available on the prescribing practices of Australian podiatrists. The aim of this research was to investigate the prescribing practices among Australian podiatrists and to explore barriers and facilitators that influence participation in endorsement. Methods Participants in this quantitative, cross-sectional study were registered and practicing Australian podiatrists who were recruited through a combination of professional networks, social media, and personal contacts. Respondents were invited to complete a customised self-reported online survey, developed using previously published research, research team’s expertise, and was piloted with podiatrists. The survey contained three sections: demographic data including clinical experience, questions pertaining to prescribing practices, and barriers and facilitators of the endorsement pathway. Results Respondents ( n = 225) were predominantly female, aged 25–45, working in the private sector. Approximately one quarter were endorsed (15%) or in training to become endorsed (11%). Of the 168 non-endorsed respondents, 66% reported that they would like to undertake training to become an endorsed prescriber. The most common indications reported for prescribing or recommending medications include nail surgery (71%), foot infections 474 (88%), post-operative pain (67%), and mycosis (95%). The most recommended Schedule 2 medications were ibuprofen, paracetamol, and topical terbinafine. The most prescribed Schedule 4 medicines among endorsed podiatrists included lignocaine (84%), cephalexin (68%), flucloxacillin (68%), and amoxicillin with clavulanic acid (61%). Conclusion Podiatrists predominantly prescribe scheduled medicines to assist pain, inflammatory, or infectious conditions. Only a small proportion of scheduled medicines available for prescription by podiatrists with endorsed status were reportedly prescribed. Many barriers exist in the current endorsement for podiatrists, particularly related to training processes, including mentor access and supervised practice opportunities. Suggestions to address these barriers require targeted enabling strategies.
Background The coronavirus pandemic resulted in unique challenges for podiatrists in Australia. Podiatrists were tasked with having to make triage decisions about face-to-face care without clear guidelines. This research aimed to develop podiatry triage tools to understand individual risk for adults and children, and explore the face validity of both tools. Methods An online three-round modified Delphi technique was used to elicit podiatrists’ opinions on conditions, assessments and social factors that elevate risk. Additional elements of known foot and/or leg risk were informed by a synchronous scoping review. Australian podiatrists who held a clinical role treating patients or directly managing podiatrists treating patients within the past six months were recruited. Where 70% of participants reported the same or similar theme in Round 1, statements were accepted with consensus. Where 50–69% of participants reported a similar theme, these were returned to participants to rate agreement using a four-point Likert agreement scale. Statements identified in the scoping review were added at Round 2, if not already identified by participants. The final round presented participants with triage tools, and a series of mock patient scenarios.. Participants were asked to indicate if they would or would not provide face to face podiatry service based on these scenarios. Results There were 40 participants who responded to Round 1 (Adult presentations), of these, 23 participants also provided paediatric presentation responses. Participants developed and agreed upon 20 statements about risk in podiatry service delivery for both adults and children across Rounds 1 and 2. The PodEssential and Paed-PodEssential were developed based on these statements indicating stand-alone condition risk (tier 1), elements that should elevate risk (in the absence of a stand-alone condition) (tier 2), and assessments results identifiying a limb at risk (tier 3) in adults and children respectively. Participants utilising these tools in Round 3 more frequently indicated face-to-face service when mock patient scenarios included a greater number elements, suggesting the tool can be useful in making triage decisions. Conclusion The PodEssential and Paeds-PodEssential tools direct conditions requiring urgent attention as well as providing considered elements to a person’s health status to assist in making triage decisions.
Algorithms, data, and AI (ADA) technologies permeate most societies worldwide because of their proven benefits in different areas of life. Governments are the entities in charge of harnessing the benefits of ADA technologies above and beyond providing government services digitally. ADA technologies have the potential to transform the way governments develop and deliver services to citizens, and the way citizens engage with their governments. Conventional public engagement strategies employed by governments have limited both the quality and diversity of deliberation between the citizen and their governments, and the potential for ADA technologies to be employed to improve the experience for both governments and the citizens they serve. In this article we argue that ADA technologies can improve the quality, scope, and reach of public engagement by governments, particularly when coupled with other strategies to ensure legitimacy and accessibility among a broad range of communities and other stakeholders. In particular, we explore the role “narrative building” (NB) can play in facilitating public engagement through the use of ADA technologies. We describe a theoretical implementation of NB enhanced by adding natural language processing, expert knowledge elicitation, and semantic differential rating scales capabilities to increase gains in scale and reach. The theoretical implementation focuses on the public’s opinion on ADA-related technologies, and it derives implications for ethical governance.
Background Pressure offloading treatment is critical for healing diabetes-related foot ulcers (DFU). Yet the 2011 Australian DFU guidelines regarding offloading treatment are outdated. A national expert panel aimed to develop a new Australian guideline on offloading treatment for people with DFU by adapting international guidelines that have been assessed as suitable to adapt to the Australian context. Methods National Health and Medical Research Council procedures were used to adapt suitable International Working Group on the Diabetic Foot (IWGDF) guidelines to the Australian context. We systematically screened, assessed and judged all IWGDF offloading recommendations using best practice ADAPTE and GRADE frameworks to decide which recommendations should be adopted, adapted or excluded in the Australian context. For each recommendation, we re-evaluated the wording, quality of evidence, strength of recommendation, and provided rationale, justifications and implementation considerations, including for geographically remote and Aboriginal and Torres Strait Islander peoples. This guideline, along with five accompanying Australian DFU guidelines, underwent public consultation, further revision and approval by ten national peak bodies (professional organisations). Results Of the 13 original IWGDF offloading treatment recommendations, we adopted four and adapted nine. The main reasons for adapting the IWGDF recommendations included differences in quality of evidence ratings and clarification of the intervention(s) and control treatment(s) in the recommendations for the Australian context. For Australians with plantar DFU, we recommend a step-down offloading treatment approach based on their contraindications and tolerance. We strongly recommend non-removable knee-high offloading devices as first-line treatment, removable knee-high offloading devices as second-line, removable ankle-high offloading devices third-line, and medical grade footwear as last-line. We recommend considering using felted foam in combination with the chosen offloading device or footwear to further reduce plantar pressure. If offloading device options fail to heal a person with plantar DFU, we recommend considering various surgical offloading procedures. For people with non-plantar DFU, depending on the type and location of the DFU, we recommend using a removable offloading device, felted foam, toe spacers or orthoses, or medical grade footwear. The six new guidelines and the full protocol can be found at: https://diabetesfeetaustralia.org/new-guidelines/ . Conclusions We have developed a new Australian evidence-based guideline on offloading treatment for people with DFU that has been endorsed by ten key national peak bodies. Health professionals implementing these offloading recommendations in Australia should produce better DFU healing outcomes for their patients, communities, and country.
Background Attention Deficit Hyperactivity Disorder (ADHD) is the most prevalent childhood neurodevelopmental disorder. It shares some genetic risk with Autism Spectrum Disorder (ASD), and the conditions often occur together. Both are potentially associated with abnormal glutamate and GABA neurotransmission, which can be modelled by measuring the synaptic activity in the retina with an electroretinogram (ERG). Reduction of retinal responses in ASD has been reported, but little is known about retinal activity in ADHD. In this study, we compared the light-adapted ERGs of individuals with ADHD, ASD and controls to investigate whether retinal responses differ between these neurodevelopmental conditions. Methods Full field light-adapted ERGs were recorded from 15 ADHD, 57 ASD (without ADHD) and 59 control participants, aged from 5.4 to 27.3 years old. A Troland protocol was used with a random series of nine flash strengths from −0.367 to 1.204 log photopic cd.s.m ⁻² . The time-to-peak and amplitude of the a- and b-waves and the parameters of the Photopic Negative Response (PhNR) were compared amongst the three groups of participants, using generalised estimating equations. Results Statistically significant elevations of the ERG b-wave amplitudes, PhNR responses and faster timings of the b-wave time-to-peak were found in those with ADHD compared with both the control and ASD groups. The greatest elevation in the b-wave amplitudes associated with ADHD were observed at 1.204 log phot cd.s.m ⁻² flash strength ( p < .0001), at which the b-wave amplitude in ASD was significantly lower than that in the controls. Using this measure, ADHD could be distinguished from ASD with an area under the curve of 0.88. Conclusions The ERG b-wave amplitude appears to be a distinctive differential feature for both ADHD and ASD, which produced a reversed pattern of b-wave responses. These findings imply imbalances between glutamate and GABA neurotransmission which primarily regulate the b-wave formation. Abnormalities in the b-wave amplitude could provisionally serve as a biomarker for both neurodevelopmental conditions.
Intention measures are used as a proxy for future behaviour. Although there is often a gap between intentions and subsequent behaviour, little is known about why the intention-behaviour gap (IB-gap) occurs. This longitudinal study across Australia, New Zealand and China quantifies the IB-gap in the context of donating money, goods, and time to charities. The factors underpinning the IB-gap are documented (i.e., why intenders don’t act and non-intenders do), resulting in the development of a framework summarising 12 key reasons. Findings show that intenders don’t follow through due to perceived time/effort constraints or lack of resources. Non-intenders subsequently give due to heightened awareness and attitudes about a charity/cause, or an intrinsic motivation such as empathy. Our findings allow researchers and marketers to better understand and interpret intention metrics, with guidance on how to minimise barriers to action across three types of support behaviours.
This paper examines the asymmetric spillovers and connectedness between the spot prices of West Texas Intermediate crude oil and six popular currencies—the Euro, Japanese Yen, British Pound, Australian Dollar, Swiss Franc, and Canadian Dollar. We analyze the asymmetric realized volatility spillovers spot prices as well as the higher moments such as their realized skewness and kurtosis. The estimated results indicate that these markets are strongly interconnected and that the currencies of larger economies as well as resource exporters are mainly net transmitters of volatility. However, this attribute is time-varying, especially during global economic events/shocks. The asymmetric volatility analysis finds that bad volatilities trump good ones on average. This attribute of the sample markets is also time-varying. The evaluation of directional networks in semi-variances reveals the dominance of bad volatilities over good ones and that bad volatilities from the currencies of larger and resource-based economies and the crude oil market are imparted for the most part. Moreover, the bad volatility of the British Pound, especially in the wake of Brexit, is a key contributor of its good volatility. However, in the wake of the COVID-19 pandemic, currencies of resource-based economies as well as the crude oil appear to impart small magnitudes of good volatilities. These findings have important implications for policymakers and highlight the need for responses tailored to different periods and markets.
Background Neratinib is a pan-ErbB tyrosine kinase inhibitor used for extended adjuvant treatment of HER2-positive breast cancer. Diarrhea is the main adverse event associated with neratinib treatment. We aimed here to determine whether antibiotic-induced gut microbial shifts altered development of neratinib-induced diarrhea. Methods Female Albino Wistar rats (total n = 44) were given antibiotics (vancomycin, neomycin, or a cocktail of vancomycin, neomycin and ampicillin) in drinking water for four weeks, and then treated daily with neratinib (50 mg/kg) for 28 days. Diarrhea, along with markers of gastrointestinal damage and microbial alterations were measured by histopathology and 16S sequencing, respectively. Results Rats treated with vancomycin or neomycin had significantly lower levels of diarrhea than rats treated with neratinib alone. In the distal ileum, neratinib was associated with a statistically significant increase in histological damage in all treatment groups expect the antibiotic cocktail. Key features included villous blunting and fusion and some inflammatory infiltrate. Differences in microbial composition at necropsy in vehicle control, neratinib and neratinib + neomycin groups, were characterized by a neratinib-induced increase in gram-negative bacteria that was reversed by neomycin. Neomycin shifted bacterial composition so that Blautia become the dominant genus. Conclusions Narrow spectrum antibiotics reduced neratinib-induced diarrhea. This suggests that the microbiome may play a key role in the development and prolongation of diarrhea following neratinib treatment, although further research is required to understand the key bacteria and mechanisms by which they reduce diarrhea, as well as how this may impact presentation of diarrhea in clinical cohorts.
In this study, we examine the frequency volatility spillovers, connectedness, and quantile dependence between precious metals futures (gold, palladium, platinum, and silver) and the main US foreign exchange rates of Australia, Canada, China, Eurozone, Japan, Switzerland, and the UK. We use them as a hedging tool for developed currency markets. We further investigate the key drivers of frequency spillovers, before and during COVID-19, and the property of precious metals as a hedge and safe haven against currency risk exposure. We performed the quantile coherency analysis and found that the dependence is positive among the currencies and negative between currencies and precious material in most cases. Using the time-frequency spillovers analysis, we show that gold and silver are net transmitters of spillover to the other markets; however, palladium is a net receiver of spillover for all three horizons. The EUR is a net contributor of risk regardless of the time horizon. Using the quantile regression model, we demonstrate that the effect of the West Texas Intermediate crude oil price (WTI), Economic Policy Uncertainty (EPU) index, volatility index (VIX), and USD index (USDX) on total spillover varies over quantiles in terms of magnitude and direction. Finally, we show that all precious metals can be used as a strong hedge against these major currencies.
Latent heat thermal energy storage systems can regulate the intermittency of electricity generation in a grid powered by renewable energy sources. Such systems could be used in conjunction with Brayton power generation cycles operating at high temperatures (520 °C–750 °C) delivering higher efficiency. However, a trade-off of higher thermal efficiency can be higher thermal stresses. The isothermal latent heat thermal energy storage and release can reduce the thermal stresses for a specific design. This study investigates the impact of the orientation on the melting process and the consequent thermal stresses in a lab-scale latent heat shell and tube system using a combination of transient computational fluid dynamics and finite element analyses. With a high temperature phase change material melting at 705.8°C, two initial temperatures of 700°C and 650°C were considered in transient analyses, leading to a 50 K and 100 K initial temperature difference across the tubes, respectively. For the structural analysis, an elastic method was employed for the condition of 50 K temperature difference, and an elastic-plastic analysis for the condition of 100 K to account for plastic deformation. The results of the elastic analysis presented the maximum thermal stresses of 63.5 MPa and 106.7 MPa in tubes in the horizontal and vertical orientations, respectively. The stress in the tube sheet was slightly higher (94.5 MPa) for the horizontal system compared with 90.4 MPa in the vertical position. For the condition of 100 K, the results of the elastic-plastic analysis identified the highest stresses of 172.5 MPa and 147.4 MPa in the tube sheets of the horizontal and vertical systems, respectively. For both initial temperature conditions, the stress level in tubes is lower in the horizontal orientation, which is where most cost occurs in a shell and tube system. Particularly important for the 100 K condition, the results show a lower stress of 100 MPa in tubes for a horizontal system compared with 140 MPa in a vertical orientation. In general, the lowest thermal stress occurs where a melt layer forms around tubes during the early stages of a melting process. A higher stress occurred in parts in contact with argon. The highest level of stress occurred in parts in contact with solid PCM, which has direct implications for larger vessel designs. This study provides insights into hydrothermal and mechanical design of a PCM system to prevent and/or manage localised maximum thermal stresses for a cost-effective thermal energy storage system.
Objective To investigate whether cognitive reserve modifies the relationship between functional connectivity, lesion volume, stroke severity and upper-limb motor impairment and recovery in stroke survivors. Methods Ten patients with first-ever ischemic middle cerebral artery stroke completed the Cognitive Reserve Index Questionnaire at baseline. Upper-limb motor impairment and functional connectivity were assessed using the Fugl-Meyer Assessment and electroencephalography respectively at baseline and 3-months post-stroke. A debiased weighted phase lag index was computed to estimate functional connectivity between electrodes. Partial least squares (PLS) regression identified a connectivity model that maximally predicted variance in the degree of upper-limb impairment. Regression models were generated to determine whether cognitive reserve modified the relationship between neural function (functional connectivity), neural injury (lesion volume), stroke severity (National Institutes of Health Stroke Scale) and upper-limb motor impairment at baseline and recovery at 3-months (Fugl-Meyer Assessment). Results The addition of cognitive reserve to a regression model with a dependent variable of upper-limb motor recovery and independent variables of functional connectivity between the ipsilesional motor cortex and parietal cortex, stroke severity and lesion volume improved model efficiency (∆BIC=-7.07) despite not reaching statistical significance (R²=0.90, p=0.07). Cognitive reserve did not appear to improve regression models examining motor impairment at baseline. Conclusions Preliminary observations suggest cognitive reserve might modify the relationship between neural function, neural injury, stroke severity and upper-limb motor recovery. Further investigation of cognitive reserve in motor recovery post-stroke appears warranted.
Australian accreditation standards specify upper limits for percentages of women recalled for further assessment following screening mammography. These limits have been unchanged since national screening commenced circa 1990, although screening target ages have changed, and technology from analogue to digital mammography. This study compared 2804 women with interval cancers diagnosed since national screening began (cases) with 14,020 cancer-free controls (5 controls per case), randomly selected after matching by age, round, screen type and calendar year of screening episode, to determine the odds of interval cancer by differences in clinic recall to assessment percentages. Within low numbers of recalls that were within accepted accreditation ranges, results did not indicate more frequent recalls to assessment to be associated with fewer interval cancers in the analogue era. However, more frequent recalls were associated with reduced interval cancers for digital screens. These results are not conclusive, requiring confirmation in other screening environments, especially those with larger numbers of digital screens. If confirmed, frequency of recalls to assessment may need adjustment to get the best trade-offs in the digital era between reduced odds of interval cancers from more recalls and increases in financial and non-financial costs, including increased potential for overdiagnosis.
Arteriovenous malformations (AVM) of the brain are congenital, high pressure vascular malformations, which are at risk of haemorrhage. Stereotactic radiosurgery (SRS) can obliterate the nidus by delivering a precise high dose of ionising radiation in a single fraction. This paper updates long term AVM obliteration rates, time to obliteration and retreatment outcomes in LINAC delivered SRS treatment at the Royal Adelaide Hospital. A retrospective review of a prospectively maintained AVM SRS database supplemented by clinical case notes, patient correspondence and electronic medical records was performed. 89 AVMs received primary SRS treatment for which the crude obliteration rate was 61% (68% for 79 patients with adequate follow up). Higher marginal dose, smaller nidus size and lower Pollock-Flickinger (PF) score were significantly associated with AVM obliteration. The crude obliteration rates for patients with adequate follow-up and AVM diameter < 3 cm vs ≥ 3 cm were 76% vs 48%, respectively, and 93% with PF score < 1.0. Median time to obliteration was 36 months. Higher dose and lower PF score were associated with earlier obliteration. The crude obliteration rate after second SRS was 56% (9/16 patients) and no significant associations were found. These obliteration rates after primary and retreatment LINAC SRS are comparable to other studies. Marginal dose and PF score were the main predictors of obliteration overall as well as early (<36 months) obliteration.
Granulite-facies metasedimentary rocks from the Broken Hill Block of the Curnamona Province, south-central Australia, record a prolonged period (c. 1630–1550 Ma) of high thermal gradient metamorphism and anatexis. We present monazite and zircon U–Pb geochronological and REE geochemical data from garnet-bearing paragneisses of the Willyama Supergroup, coupled with garnet trace element mapping and mineral equilibria modelling, to develop a petrochronological model for the Palaeo–Mesoproterozoic metamorphic evolution of this region. Our results indicate that the Curnamona Province underwent an early phase of high-temperature–low-pressure metamorphism between c. 1630–1610 Ma. Peak metamorphism involving wholesale anatexis subsequently occurred under an apparent thermal gradient of 150–170 °C/kbar at c. 1600–1580 Ma during regional compression. Monazite U–Pb dates reveal that suprasolidus conditions were maintained for at least 30 Myr, with final melt crystallisation potentially occurring as late as c. 1550 Ma, indicating that the system remained hot for an extended duration. We suggest that high thermal gradient metamorphism in the Willyama Supergroup was driven by elevated levels of radiogenic heat production hosted within the Willyama succession. Temperatures may have been initially boosted by low-to-moderate degrees of crustal extension, although there is a dearth of coeval magmatism and structural evidence to support this claim. Peak metamorphism coincides with the timing of compressional orogenesis and related metamorphism in other Proterozoic terranes that are inferred to have occupied the eastern margin of proto-Australia. Many of these terranes also exhibit prolonged metamorphic histories and elevated levels of radiogenic heat production, suggesting that radiogenic heating may have had a major influence in pre-disposing these terranes to be the locus of metamorphism and deformation during the final assembly of Nuna.
Background Females with persistent pelvic pain (PPP) report great variability in treatments they are recommended despite the availability of clinical practice guidelines (CPGs) that aim to standardise care. A clear consensus for the best practice care for PPP is required. Objective Identify and summarise treatment recommendations across CPGs for the management of PPP, and appraise their quality. Search strategy MEDLINE, CENTRAL, EMBASE, EmCare, SCOPUS, the Cochrane Database of Systematic Reviews, Web of Science Core Collection, and relevant guideline databases were searched from their inception to June 2021. Selection criteria Included CPGs were those for the management of urogynaecological conditions in adult females published in English, of any publication date, and endorsed by a professional organisation or society. Data collection and Analysis We screened 1,379 records and included 20 CPGs. CPG quality was assessed using The Appraisal of Guidelines for Research and Evaluation II (AGREE-II) tool. Descriptive synthesis compiled treatment recommendations across CPGs. Main Results CPGs for seven conditions provided 281 individual recommendations. On quality appraisal, guidelines on average scored ‘excellent’ for the domains ‘scope and purpose’ (80.6%, SD=13.3) and ‘clarity and presentation’ (74.4%, SD=12.0); for other domains, average scores were satisfactory or poor. Four guidelines (Endometriosis, NICE, RANZCOG, ESHRE; PCOS, Teede et al. 2018) were deemed recommended for use. Recommendations were most frequent for pharmaceutical and surgical interventions. Recommendations were variable for psychological, physiotherapy, and other conservative interventions. Conclusions The quality of CPGs for PPP is generally poor. Several CPGs endorse the consideration of biopsychosocial elements of PPP. Yet most recommend pharmaceutical, surgical, and other biomedical interventions.
Background Studies investigating the effects of cold-water immersion (CWI) on the recovery of athletic performance, perceptual measures and creatine kinase (CK) have reported mixed results in physically active populations. Objectives The purpose of this systematic review was to investigate the effects of CWI on recovery of athletic performance, perceptual measures and CK following an acute bout of exercise in physically active populations. Study Design Systematic review with meta-analysis and meta-regression. Methods A systematic search was conducted in September 2021 using Medline, SPORTDiscus, Scopus, Web of Science, Cochrane Library, EmCare and Embase databases. Studies were included if they were peer reviewed and published in English, included participants who were involved in sport or deemed physically active, compared CWI with passive recovery methods following an acute bout of strenuous exercise and included athletic performance, athlete perception and CK outcome measures. Studies were divided into two strenuous exercise subgroups: eccentric exercise and high-intensity exercise. Random effects meta-analyses were used to determine standardised mean differences (SMD) with 95% confidence intervals. Meta-regression analyses were completed with water temperature and exposure durations as continuous moderator variables. Results Fifty-two studies were included in the meta-analyses. CWI improved the recovery of muscular power 24 h after eccentric exercise (SMD 0.34 [95% CI 0.06–0.62]) and after high-intensity exercise (SMD 0.22 [95% CI 0.004–0.43]), and reduced serum CK (SMD − 0.85 [95% CI − 1.61 to − 0.08]) 24 h after high-intensity exercise. CWI also improved muscle soreness (SMD − 0.89 [95% CI − 1.48 to − 0.29]) and perceived feelings of recovery (SMD 0.66 [95% CI 0.29–1.03]) 24 h after high-intensity exercise. There was no significant influence on the recovery of strength performance following either eccentric or high-intensity exercise. Meta-regression indicated that shorter time and lower temperatures were related to the largest beneficial effects on serum CK (duration and temperature dose effects) and endurance performance (duration dose effects only) after high-intensity exercise. Conclusion CWI was an effective recovery tool after high-intensity exercise, with positive outcomes occurring for muscular power, muscle soreness, CK, and perceived recovery 24 h after exercise. However, after eccentric exercise, CWI was only effective for positively influencing muscular power 24 h after exercise. Dose–response relationships emerged for positively influencing endurance performance and reducing serum CK, indicating that shorter durations and lower temperatures may improve the efficacy of CWI if used after high-intensity exercise. Funding Emma Moore is supported by a Research Training Program (Domestic) Scholarship from the Australian Commonwealth Department of Education and Training. Protocol registration Open Science Framework: 10.17605/OSF.IO/SRB9D.
Through systems thinking it is recognised that human error is not a matter of personal control, but an emergent property of overall system design. In the context of rail, Signal Passed at Danger (SPAD) incidents are a weak link in an otherwise safe system and one of the few points where a single failure can have catastrophic consequences. One area overlooked in SPAD research is the investigation process itself, specifically in terms of what investigators do and do not look at when investigating incidents. The aim of this study was to examine the document (i.e. pro forma) investigators use to capture information and attribute SPAD causation, in order to determine the extent which systems thinking is reflected in the information captured. A qualitative cross-sectional multiple-case design was used to categorise a large dataset comprising completed SPAD pro formas (n = 208) from 10 rail organisations across Australasia. Conventional content analysis identified two types of SPAD pro forma (modulated, narrative) varying in length (long, short), and a comprehensive hierarchical description revealed shallow methods of analysis, and the tendency to emphasise and attribute SPAD causation to the individual-level (human error, personal factors) without identification of deeper underlying factors and other system influences. Findings are discussed in relation to the idea that SPAD pro formas are educative tools shaping the focus of investigations, and the observed deficiencies limit the learning that can be drawn from incidents and real change that can be achieved. SPAD pro forma development is needed, scaffolded by further research.
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