Location and access to health courses for rural students: an Australian audit.

BACKGROUND: The undersupply of health professionals in rural areas impacts healthcare access for those living in rural Australia. A strategy to increase the rural health workforce is to recruit and educate rural people. However, long-standing inequities for rural Australians in accessing tertiary education persist. The aim of this study was to audit the 2023 offerings of Australian allied health, nursing, dental and medical university courses to identify geographical availability and those delivered online. METHODS: A desktop audit of Australian allied health, nursing, dental and medical courses offered in 2023 was undertaken to identify the courses and delivery modes of those courses offered in regional, rural and remote locations. The audit involved searching lists of professionally accredited courses and university websites, which is publicly available information about health courses. Data were tabulated and descriptive statistics used for data analysis. RESULTS: There were marked differences in online and rural course offerings across health professions in Modified Monash (MM) Model category 2-7 locations. Nursing/midwifery had the most courses while pharmacy, podiatry, dental and medicine had few offerings and optometry had none. Social work, nursing/midwifery and psychology also had the most online course offerings. Most courses were offered in MM2 and MM3 locations with few offerings in rural or remote areas. The availability of studying part-time was very limited and often this was only for the early years of the course. Inconsistencies relating to the course information on university websites existed relating to course delivery mode descriptions. CONCLUSIONS: There is a lack of rural on-campus or online course offerings for some allied health disciplines, dentistry and medicine. Provision of end-to-end, flexible courses in rural areas or online is needed to reduce access barriers for rural students and to enable sustainable rural health workforce development.

FEEDBACK trial - A randomised control trial to investigate the effect of personalised feedback and financial incentives on reducing the incidence of road crashes.

BACKGROUND: Road crashes continue to pose a significant threat to global health. Young drivers aged between 18 and 25 are over-represented in road injury and fatality statistics, especially the first six months after obtaining their license. This study is the first multi-centre two-arm parallel-group individually randomised controlled trial (the FEEDBACK Trial) that will examine whether the delivery of personalised driver feedback plus financial incentives is superior to no feedback and no financial incentives in reducing motor vehicle crashes among young drivers (18 to 20 years) during the first year of provisional licensing. METHODS: A total of 3,610 young drivers on their provisional licence (P1, the first-year provisional licensing) will participate in the trial over 28 weeks, including a 4-week baseline, 20-week intervention and 4-week post-intervention period. The primary outcome of the study will be police-reported crashes over the 20-week intervention period and the 4-week post-intervention period. Secondary outcomes include driving behaviours such as speeding and harsh braking that contribute to road crashes, which will be attained weekly from mobile telematics delivered to a smartphone app. DISCUSSION: Assuming a positive finding associated with personalised driver feedback and financial incentives in reducing road crashes among young drivers, the study will provide important evidence to support policymakers in introducing the intervention(s) as a key strategy to mitigate the risks associated with the burden of road injury among this vulnerable population. TRIAL REGISTRATION: Registered under the Australian New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12623000387628p on April 17, 2023.

A framework for considering the utility of models when facing tough decisions in public health: a guideline for policy-makers.

The COVID-19 pandemic has brought the combined disciplines of public health, infectious disease and policy modelling squarely into the spotlight. Never before have decisions regarding public health measures and their impacts been such a topic of international deliberation, from the level of individuals and communities through to global leaders. Nor have models-developed at rapid pace and often in the absence of complete information-ever been so central to the decision-making process. However, after nearly 3 years of experience with modelling, policy-makers need to be more confident about which models will be most helpful to support them when taking public health decisions, and modellers need to better understand the factors that will lead to successful model adoption and utilization. We present a three-stage framework for achieving these ends.

Development of a Computational Policy Model for Comparing the Effect of Compensation Scheme Policies on Recovery After Workplace Injury.

Introduction The direct comparison of real-world workers' compensation scheme management policies and their impact on aspects of scheme performance such as health and return to work outcomes, financial sustainability, and client experience metrics is made difficult through existing differences in scheme design that go beyond the factors of interest to the researcher or policymaker. Disentangling effects that are due purely to the result of policy and structural differences between schemes or jurisdictions to determine 'what works' can be difficult. Method We present a prototype policy exploration tool, 'WorkSim', built using an agent-based model and designed to enable workers' compensation system managers to directly compare the effect of simulated policies on the performance of workers compensation systems constructed using agreed and transparent principles. Results The utility of the model is demonstrated through and case-study comparison of overall scheme performance metrics across 6 simple policy scenarios. Discussion Policy simulation models of the nature described can be useful tools for managers of workplace compensation and rehabilitation schemes for trialing policy and management options ahead of their real-world implementation.

Associations between classroom climate and children's externalizing symptoms: The moderating effect of kindergarten children's parasympathetic reactivity.

Classrooms are key social settings that impact children's mental health, though individual differences in physiological reactivity may render children more or less susceptible to classroom environments. In a diverse sample of children from 19 kindergarten classrooms (N = 338, 48% female, M age = 5.32 years), we examined whether children's parasympathetic reactivity moderated the association between classroom climate and externalizing symptoms. Independent observers coded teachers' use of child-centered and teacher-directed instructional practices across classroom social and management domains. Children's respiratory sinus arrhythmia reactivity to challenge tasks was assessed in fall and a multi-informant measure of externalizing was collected in fall and spring. Both the social and the management domains of classroom climate significantly interacted with children's respiratory sinus arrhythmia reactivity to predict spring externalizing symptoms, controlling for fall symptoms. For more reactive children, as classrooms shifted toward greater proportional use of child-centered methods, externalizing symptoms declined, whereas greater use of teacher-dominated practices was associated with increased symptoms. Conversely, among less reactive children, exposure to more teacher-dominated classroom management practices was associated with lower externalizing. Consistent with the theory of biological sensitivity to context, considering variability in children's physiological reactivity aids understanding of the salience of the classroom environment for children's mental health.

The perils of perfect performance; considering the effects of introducing autonomous vehicles on rates of car vs cyclist conflict.

How humans will adapt and respond to the introduction of autonomous vehicles (AVs) is uncertain. This study used an agent-based model to explore how AVs, human-operated vehicles, and cyclists might interact based on the introduction of flawlessly performing AVs. Under two separate experimental conditions, results of experiment 1 showed that, despite no conflicts occurring between cyclists and AVs, modelled conflicts among human-operated cars and cyclists increased with the introduction of AVs due to cyclists' adjusted expectations of the behaviour and capability of human-operated and autonomous cars. Similarly, when human-operated cars were replaced with AVs over time in experiment 2, cyclist conflict rates did not follow a linear reduction consistent with the replacement rate but decreased more slowly in the early stages of replacement before 50% substitution. It is concluded that, although flawlessly performing AVs might reduce total conflicts, the introduction of AVs into a transport system where humans adjust to the behaviour and risk presented by AVs could create new sources of error that offset some of AVs assumed safety benefits. Practitioner summary: Ergonomics is an applied science that studies interactions between humans and other elements of a system, including non-human agents. Agent-Based Modelling (ABM) provides an approach for exploring dynamic and emergent interactions between agents. In this article, we demonstrate ABM through an analysis of how cyclists and pedestrians might interact with Autonomous Vehicles (AVs) in future road transport systems. Abbreviations: ABM: agent-based model; AV: autonomous vehicle; ODD; overview, design concepts and details; RW: rescorla-wagner.

Computational modelling and systems ergonomics: a system dynamics model of drink driving-related trauma prevention.

System dynamics is a computational modelling method that is used to understand the dynamic interactions influencing behaviour in complex systems. In this article we argue that the method provides a useful tool for ergonomists wishing to model the behaviour of complex systems. We present a system dynamics model that simulates the behaviour of a drink driving-related trauma system and explore the potential impact of different road safety policy interventions. The model was simulated over thirty-year periods with different policy interventions. The findings suggest that the greatest reduction in drink driving-related trauma can be achieved by policies that integrate standard road safety interventions (e.g. education and enforcement) with interventions designed to address the societal issue of alcohol misuse and addiction. In closing we discuss the potential use of system dynamics modelling in future ergonomics applications and outline its strengths and weaknesses in relation to existing systems ergonomics methods. Practitioner Summary: The outputs of systems ergonomics methods are typically static and cannot simulate behaviour over time. We propose system dynamics as a useful approach for modelling the behaviour of complex systems. Applied to drink driving-related road trauma, the method was able to dynamically model the potential impacts of different policy interventions.

Who is to blame for crashes involving autonomous vehicles? Exploring blame attribution across the road transport system.

The introduction of fully autonomous vehicles is approaching. This warrants a re-consideration of road crash liability, given drivers will have diminished control. This study, underpinned by attribution theory, investigated blame attribution to different road transport system actors following crashes involving manually driven, semi-autonomous and fully autonomous vehicles. It also examined whether outcome severity alters blame ratings. 396 participants attributed blame to five actors (vehicle driver/user, pedestrian, vehicle, manufacturer, government) in vehicle-pedestrian crash scenarios. Different and unique patterns of blame were found across actors, according to the three vehicle types. In crashes involving fully autonomous vehicles, vehicle users received low blame, while vehicle manufacturers and government were highly blamed. There was no difference in the level of blame attributed between high and low severity crashes regarding vehicle type. However, the government received more blame in high severity crashes. The findings have implications for policy and legislation surrounding crash liability. Practitioner summary: Public views relating to blame and liability in transport accidents is a vital consideration for the introduction of new technologies such as autonomous vehicles. This study demonstrates how a systems ergonomics framework can assist to identify the implications of changing public opinion on blame for future road transport systems. Abbreviation: ANOVA: analysis of variance; DAT: defensive attribution theory; IV: independent variable.

Preliminary aggregate safety and immunogenicity results from three trials of a purified inactivated Zika virus vaccine candidate: phase 1, randomised, double-blind, placebo-controlled clinical trials.

BACKGROUND: A safe, effective, and rapidly scalable vaccine against Zika virus infection is needed. We developed a purified formalin-inactivated Zika virus vaccine (ZPIV) candidate that showed protection in mice and non-human primates against viraemia after Zika virus challenge. Here we present the preliminary results in human beings. METHODS: We did three phase 1, placebo-controlled, double-blind trials of ZPIV with aluminium hydroxide adjuvant. In all three studies, healthy adults were randomly assigned by a computer-generated list to receive 5 µg ZPIV or saline placebo, in a ratio of 4:1 at Walter Reed Army Institute of Research, Silver Spring, MD, USA, or of 5:1 at Saint Louis University, Saint Louis, MO, USA, and Beth Israel Deaconess Medical Center, Boston, MA, USA. Vaccinations were given intramuscularly on days 1 and 29. The primary objective was safety and immunogenicity of the ZPIV candidate. We recorded adverse events and Zika virus envelope microneutralisation titres up to day 57. These trials are registered at ClinicalTrials.gov, numbers NCT02963909, NCT02952833, and NCT02937233. FINDINGS: We enrolled 68 participants between Nov 7, 2016, and Jan 25, 2017. One was excluded and 67 participants received two injections of Zika vaccine (n=55) or placebo (n=12). The vaccine caused only mild to moderate adverse events. The most frequent local effects were pain (n=40 [60%]) or tenderness (n=32 [47%]) at the injection site, and the most frequent systemic reactogenic events were fatigue (29 [43%]), headache (26 [39%]), and malaise (15 [22%]). By day 57, 52 (92%) of vaccine recipients had seroconverted (microneutralisation titre ≥1:10), with peak geometric mean titres seen at day 43 and exceeding protective thresholds seen in animal studies. INTERPRETATION: The ZPIV candidate was well tolerated and elicited robust neutralising antibody titres in healthy adults. FUNDING: Departments of the Army and Defense and National Institute of Allergy and Infectious Diseases.

Evidence for the 'safety in density' effect for cyclists: validation of agent-based modelling results.

The safety in numbers (SiN) effect for cyclists is widely observed but remains poorly understood. Although most studies investigating the SiN phenomenon have focused on behavioural adaptation to 'numbers' of cyclists in the road network, previous work in simulated environments has suggested SiN may instead be driven by increases in local cyclist spatial density, which prevents drivers from attempting to move through groups of oncoming cyclists. This study therefore set out to validate the results of prior simulation studies in a real-world environment. Time-gap analysis of cyclists passing through an intersection was conducted using 5 hours of video observation of a single intersection in the city of Melbourne, Australia, where motorists were required to 'yield' to oncoming cyclists. Results demonstrated that potential collisions between motor vehicles and cyclists reduced with increasing cyclists per minute passing through the intersection. These results successfully validate those observed under simulated conditions, supporting evidence of a proposed causal mechanism related to safety in density rather than SiN, per se. Implications of these results for transportation planners, cyclists and transportation safety researchers are discussed, suggesting that increased cyclist safety could be achieved through directing cyclists towards focused, strategic corridors rather than dispersed across a network.

Towards a complex systems approach in sports injury research: simulating running-related injury development with agent-based modelling.

OBJECTIVES: There have been recent calls for the application of the complex systems approach in sports injury research. However, beyond theoretical description and static models of complexity, little progress has been made towards formalising this approach in way that is practical to sports injury scientists and clinicians. Therefore, our objective was to use a computational modelling method and develop a dynamic simulation in sports injury research. METHODS: Agent-based modelling (ABM) was used to model the occurrence of sports injury in a synthetic athlete population. The ABM was developed based on sports injury causal frameworks and was applied in the context of distance running-related injury (RRI). Using the acute:chronic workload ratio (ACWR), we simulated the dynamic relationship between changes in weekly running distance and RRI through the manipulation of various 'athlete management tools'. RESULTS: The findings confirmed that building weekly running distances over time, even within the reported ACWR 'sweet spot', will eventually result in RRI as athletes reach and surpass their individual physical workload limits. Introducing training-related error into the simulation and the modelling of a 'hard ceiling' dynamic resulted in a higher RRI incidence proportion across the population at higher absolute workloads. CONCLUSIONS: The presented simulation offers a practical starting point to further apply more sophisticated computational models that can account for the complex nature of sports injury aetiology. Alongside traditional forms of scientific inquiry, the use of ABM and other simulation-based techniques could be considered as a complementary and alternative methodological approach in sports injury research.

Recovery Within Injury Compensation Schemes: A System Mapping Study.

Purpose Many industrialised nations have systems of injury compensation and rehabilitation that are designed to support injury recovery and return to work. Despite their intention, there is now substantial evidence that injured people, employers and healthcare providers can experience those systems as difficult to navigate, and that this can affect injury recovery. This study sought to characterise the relationships and interactions occurring between actors in three Australian injury compensation systems, to identify the range of factors that impact on injury recovery, and the interactions and inter-relationships between these factors. Methods This study uses data collected directly from injured workers and their family members via qualitative interviews, analysed for major themes and interactions between themes, and then mapped to a system level model. Results Multiple factors across multiple system levels were reported by participants as influencing injury recovery. Factors at the level of the injured person's immediate environment, the organisations and personnel involved in rehabilitation and compensation processes were more commonly cited than governmental or societal factors as influencing physical function, psychological function and work participation. Conclusions The study demonstrates that injury recovery is a complex process influenced by the decisions and actions of organisations and individuals operating across multiple levels of the compensation system. Changes occurring 'upstream', for instance at the level of governmental or organisational policy, can impact injury recovery through both direct and diffuse pathways.

Autologous hematopoietic cell transplantation for HIV-related lymphoma: results of the BMT CTN 0803/AMC 071 trial.

Autologous hematopoietic cell transplant (AHCT) for HIV-infected patients is largely limited to centers with HIV-specific expertise. The Blood and Marrow Transplant Clinical Trials Network 0803/AIDS Malignancy Consortium 071 trial is a multicenter phase 2 study of AHCT for patients with HIV-related lymphoma (HRL). Eligible patients had chemotherapy-sensitive relapsed/persistent HRL, were >15 years of age, and had treatable HIV infection. Patients were prepared using carmustine, etoposide, cytarabine, and melphalan and received consistent management of peritransplant antiretroviral treatment. The primary endpoint was 1-year overall survival. Forty-three patients were enrolled; 40 underwent AHCT. Pretransplant HIV viral load was undetectable (<50 copies/mL) in 32 patients (80%); the median CD4 count was 249/µL (range, 39-797). At a median follow-up of 24.8 months, 1-year and 2-year overall survival probabilities were 87.3% (95% confidence interval [CI], 72.1-94.5) and 82% (95% CI, 65.9-91), respectively. The probability of 2-year progression-free survival was 79.8% (95% CI, 63.7-89.4). One-year transplant-related mortality was 5.2%. Median time to neutrophil and platelet recovery was 11 days and 18 days, respectively. Nine patients experienced a total of 13 unexpected grade 3-5 adverse events posttransplant (10 grade 3 and 3 grade 4 events). Twenty-two patients had at least 1 infectious episode posttransplant. At 1 year post-AHCT, median CD4(+) T-cell count was 280.3 (range, 28.8-1148.0); 82.6% had an undetectable HIV viral load. Trial patients were compared with 151 matched Center for International Bone Marrow Transplant Research controls. Outcomes between HIV-infected patients and controls were not statistically significantly different. HRL patients should be considered candidates for AHCT if they meet standard transplant criteria. The trial was registered at www.clinicaltrials.gov as #NCT01141712.

Land use, transport, and population health: estimating the health benefits of compact cities.

Using a health impact assessment framework, we estimated the population health effects arising from alternative land-use and transport policy initiatives in six cities. Land-use changes were modelled to reflect a compact city in which land-use density and diversity were increased and distances to public transport were reduced to produce low motorised mobility, namely a modal shift from private motor vehicles to walking, cycling, and public transport. The modelled compact city scenario resulted in health gains for all cities (for diabetes, cardiovascular disease, and respiratory disease) with overall health gains of 420-826 disability-adjusted life-years (DALYs) per 100 000 population. However, for moderate to highly motorised cities, such as Melbourne, London, and Boston, the compact city scenario predicted a small increase in road trauma for cyclists and pedestrians (health loss of between 34 and 41 DALYs per 100 000 population). The findings suggest that government policies need to actively pursue land-use elements-particularly a focus towards compact cities-that support a modal shift away from private motor vehicles towards walking, cycling, and low-emission public transport. At the same time, these policies need to ensure the provision of safe walking and cycling infrastructure. The findings highlight the opportunities for policy makers to positively influence the overall health of city populations.

Randomized Controlled Trial of Inner Resources Meditation for Family Dementia Caregivers.

OBJECTIVE: This randomized controlled trial examined the comparative effectiveness of 2 interventions for improving diurnal cortisol slope and life satisfaction and reducing stress symptoms among older female dementia family caregivers. METHOD: Thirty-one family dementia caregivers were randomized to 8 weeks of Inner Resources for Stress mindfulness meditation and mantra training (IR) or psychoeducation and telephone support (PTS). RESULTS: Intention-to-treat analyses revealed statistically significant pre-post improvements in diurnal cortisol slope and overall life satisfaction, but not depression or self-efficacy, in the IR relative to the PTS group. Adherence to between-session meditation practice was significantly associated with decreases in depression and self-reported improvements in ability to cope with stress. In addition, IR participants rated the overall benefits of the program more highly than the PTS group. CONCLUSION: These results indicate that mindfulness meditation and mantra has promise as a feasible and effective caregiver intervention for quality of life and physiological responding to stress.

The association between attributions of responsibility for motor vehicle accidents and patient satisfaction: a study within a no-fault injury compensation system.

OBJECTIVE: This study set out to test the relationship between attributions of responsibility for motor vehicle accidents and satisfaction with personal injury compensation systems. DESIGN: The study analysed survey data from 1394 people injured in a motor vehicle accident who were compensated under a no-fault personal injury compensation system. Patients' ratings of satisfaction with the compensation system across five domains (resolves your issues, keeps you up-to-date, treats you as an individual, cares about you, and overall satisfaction) were analysed alongside patient attributions of responsibility for their accident (not responsible, partly responsible, totally responsible). Postaccident physical and mental health status, age, gender, and duration of compensation claim were controlled for in the analysis. RESULTS: A multivariate analysis of covariance indicated attributions of responsibility for accidents were significantly associated with levels of patient satisfaction across all five domains under study (F (10, 2084) = 3.7, p<0.001, η(2) =0.02). Despite access to virtually indistinguishable services, patients who attributed responsibility for their accidents to others were significantly less satisfied with the injury compensation system than those who attributed responsibility to themselves. CONCLUSIONS: Satisfaction with no-fault motor vehicle injury compensation services are associated with patients' attributions of responsibility for their accident. Compensation systems and other rehabilitation services monitoring patient satisfaction should adjust for attributions of responsibility when assessing levels of patient satisfaction between time periods, services, or injured populations. Differences in levels of patient satisfaction observed between compensation or rehabilitation populations may reflect differences in attributions of responsibility for accidents rather than objective service quality.

Sharing Physician Notes Through an Electronic Portal is Associated With Improved Medication Adherence: Quasi-Experimental Study.

BACKGROUND: In surveys, interviews, and focus groups, patients taking medications and offered Web portal access to their primary care physicians' (PCPs) notes report improved adherence to their regimens. However, objective confirmation has yet to be reported. OBJECTIVE: To evaluate the association between patient Internet portal access to primary care physician visit notes and medication adherence. METHODS: This study is a retrospective comparative analysis at one site of the OpenNotes quasi-experimental trial. The setting includes primary care practices at the Geisinger Health System (GHS) in Danville, Pennsylvania. Participants include patients 18 years of age or older with electronic portal access, GHS primary care physicians, and Geisinger health plan insurance, and taking at least one antihypertensive or antihyperlipidemic agent from March 2009 to June 2011. Starting in March 2010, intervention patients were invited and reminded to read their PCPs' notes. Control patients also had Web portal access throughout, but their PCPs' notes were not available. From prescription claims, adherence was assessed by using the proportion of days covered (PDC). Patients with a PDC ≥.80 were considered adherent and were compared across groups using generalized linear models. RESULTS: A total of 2147 patients (756 intervention participants, 35.21%; 1391 controls, 64.79%) were included in the analysis. Compared to those without access, patients invited to review notes were more adherent to antihypertensive medications-adherence rate 79.7% for intervention versus 75.3% for control group; adjusted risk ratio, 1.06 (95% CI 1.00-1.12). Adherence was similar among patient groups taking antihyperlipidemic agents-adherence rate 77.6% for intervention versus 77.3% for control group; adjusted risk ratio, 1.01 (95% CI 0.95-1.07). CONCLUSIONS: Availability of notes following PCP visits was associated with improved adherence by patients prescribed antihypertensive, but not antihyperlipidemic, medications. As the use of fully transparent records spreads, patients invited to read their clinicians' notes may modify their behaviors in clinically valuable ways.