Systems-based accident analysis in the led outdoor activity domain: application and evaluation of a risk management framework.

Safety-compromising accidents occur regularly in the led outdoor activity domain. Formal accident analysis is an accepted means of understanding such events and improving safety. Despite this, there remains no universally accepted framework for collecting and analysing accident data in the led outdoor activity domain. This article presents an application of Rasmussen's risk management framework to the analysis of the Lyme Bay sea canoeing incident. This involved the development of an Accimap, the outputs of which were used to evaluate seven predictions made by the framework. The Accimap output was also compared to an analysis using an existing model from the led outdoor activity domain. In conclusion, the Accimap output was found to be more comprehensive and supported all seven of the risk management framework's predictions, suggesting that it shows promise as a theoretically underpinned approach for analysing, and learning from, accidents in the led outdoor activity domain. STATEMENT OF RELEVANCE: Accidents represent a significant problem within the led outdoor activity domain. This article presents an evaluation of a risk management framework that can be used to understand such accidents and to inform the development of accident countermeasures and mitigation strategies for the led outdoor activity domain.

Developing a contributing factor classification scheme for Rasmussen's AcciMap: Reliability and validity evaluation.

One factor potentially limiting the uptake of Rasmussen's (1997) Accimap method by practitioners is the lack of a contributing factor classification scheme to guide accident analyses. This article evaluates the intra- and inter-rater reliability and criterion-referenced validity of a classification scheme developed to support the use of Accimap by led outdoor activity (LOA) practitioners. The classification scheme has two levels: the system level describes the actors, artefacts and activity context in terms of 14 codes; the descriptor level breaks the system level codes down into 107 specific contributing factors. The study involved 11 LOA practitioners using the scheme on two separate occasions to code a pre-determined list of contributing factors identified from four incident reports. Criterion-referenced validity was assessed by comparing the codes selected by LOA practitioners to those selected by the method creators. Mean intra-rater reliability scores at the system (M = 83.6%) and descriptor (M = 74%) levels were acceptable. Mean inter-rater reliability scores were not consistently acceptable for both coding attempts at the system level (MT1 = 68.8%; MT2 = 73.9%), and were poor at the descriptor level (MT1 = 58.5%; MT2 = 64.1%). Mean criterion referenced validity scores at the system level were acceptable (MT1 = 73.9%; MT2 = 75.3%). However, they were not consistently acceptable at the descriptor level (MT1 = 67.6%; MT2 = 70.8%). Overall, the results indicate that the classification scheme does not currently satisfy reliability and validity requirements, and that further work is required. The implications for the design and development of contributing factors classification schemes are discussed.

Exposure factors of Victoria's active motorcycle fleet related to serious injury crash risk.

OBJECTIVE: The purpose of this study was to describe the nature and extent of current powered 2-wheeler (PTW) risk exposures in order to support future efforts to improve safety for this mode of transport. METHODS: A cross-sectional analysis of the control arm of a population-based case-control study was conducted. The control sample was selected from 204 sites on public roads within 150 km of the city of Melbourne that were locations of recent serious injury motorcycle crashes. Traffic observations and measurements at each site were sampled for a mean of 2 h on the same type of day (weekday, Saturday, or Sunday) and within 1 h of the crash time. Photographs of passing riders during this observation period recorded data relating to characteristics of PTWs, age of riders, travel speed of PTWs and all vehicles, time gaps between vehicles, visibility, and protective clothing use. RESULTS: Motorcycles and scooters represented 0.6% of all traffic (compared with 4% of all vehicle registrations). Riders were significantly more likely to have larger time gaps in front and behind when compared to other vehicles. The average travel speed of motorcycles was not significantly different than the traffic, but a significantly greater proportion were exceeding the speed limit when compared to other vehicles (6 vs. 3%, respectively). The age of registered owners of passing motorcycles was 42 years. Over half of riders were wearing dark clothing with no fluorescent or reflective surfaces. One third of motorcyclists had maximum coverage of motorcycle-specific protective clothing. CONCLUSIONS: A very low prevalence of motorcyclists combined with relatively higher rates of larger time gaps to other vehicles around motorcycles may help explain their overrepresentation in injury crashes where another vehicle fails to give way. An increased risk of injury in the event of a crash exists for a small but greater proportion of motorcyclists (compared to other vehicle types) who were exceeding the speed limit. An apparent shift toward older age of the active rider population may be reducing injury crash risk relative to exposure time. There is significant scope to improve the physical conspicuity of motorcyclists and the frequency of motorcycle specific protective clothing use. These results can be used to inform policy development and monitor progress of current and future road safety initiatives.

Interactive effects of sleep deprivation, time of day, and driving experience on a driving task.

Performance decrements after more than 24 hours of sleep deprivation (SD) are not only a monotonic function of the duration of SD, but are the result of an interaction between SD and time of day. The major deteriorations in performance during SD are still evident throughout the night, as in the non-sleep-deprived state. Twelve experienced and 12 inexperienced drivers drove a driving simulator for 20 minutes at 0800, 1100, 1400, 1700, and 2000 hours on two testing days. One testing day was conducted after a normal night's sleep, and the other after one night of SD. Reaction time (RT) was also measured while driving. The standard deviation of both lateral position and speed were significantly higher during SD. Performance steadily improved across the day between 0800 and 2000 hours, and the absence of any sleep-by-time interactions suggests that the rhythm of driving performance across the day was similar after both normal sleep and SD. Inexperienced drivers had higher RTs than experienced drivers in both sleep-deprived and non-sleep-deprived conditions. These results have important implications for those involved in the transport industry.

Methadone injecting in Australia: a tale of two cities.

AIMS: The injection of methadone syrup designed for oral consumption is potentially associated with increased morbidity and mortality. Previous reports from Sydney, Australia have suggested a high prevalence of methadone injecting by clients in methadone programmes and by heroin users not in methadone treatment. This study sought to estimate the prevalence of methadone injecting by clients in community based methadone programmes in Melbourne, Australia, which operate under different take away policies. DESIGN: The study used a cross-sectional survey of methadone clients using a self-complete questionnaire. Subjects were recruited from randomly selected methadone dispensing pharmacies across Melbourne. Participation was voluntary. PARTICIPANTS: One hundred and sixty-eight methadone clients were recruited to the study. The mean age was 34.2 years; 59% were male. FINDINGS: Two of 168 methadone clients reported having injected methadone within the preceding 6-month period. CONCLUSIONS: The lower prevalence of methadone injecting in Melbourne (compared to Sydney) is thought to be due to the less liberal take-away policy, and the mandatory dilution of methadone take-aways to 200 ml of liquid. Implications for methadone take-away policies and procedures are discussed.

Mutation at codon 210 (V210I) of the prion protein gene in a North African patient with Creutzfeldt-Jakob disease.

A point mutation at codon 210 of the prion protein gene (PRNP), resulting in the substitution of isoleucine for valine (V210I) has been found in a 54-year-old Moroccan patient affected with Creutzfeldt-Jakob disease (CJD). This patient is the first carrier of the PRNP V210I mutation reported from North Africa. The clinical presentation of the patient was rather similar to that seen in classical CJD, except that unusual early sensory symptoms were observed. The mother of the proband, aged 72, is a further example of an asymptomatic elderly carrier of the PRNP V210I mutation, suggesting an incomplete penetrance of the disease.

Withdrawal from methadone maintenance treatment: prognosis and participant perspectives.

OBJECTIVE: To determine the proportion of clients engaged in methadone maintenance treatment who have favourable prognosis for withdrawal, and to examine client perceptions and expectations of withdrawal. METHODS: A broad cross-section of 856 methadone clients was sampled across Melbourne, Sydney and Brisbane. Self-complete surveys were developed for the clients, their clinic staff or pharmacists, and methadone prescribers. The client survey examined aspects of the clients' perspectives of withdrawal, and the surveys for the service providers collected information about each client's current treatment episode. Informed consent was provided by clients to obtain information from their clinic staff member or pharmacist, and their methadone prescriber. RESULTS: Most clients (70%) were at least very interested in methadone withdrawal. Clients were also more optimistic about their own post-withdrawal outcomes (in terms of opioid use) than both their clinic staff and prescribing doctors. Clinical criteria indicated that 31% of clients had a reasonable prognosis for withdrawal. However, when considering all factors, 17% had good withdrawal prognosis, were interested in methadone withdrawal, and believed it was very likely they would remain opioid-free for three months post-withdrawal. CONCLUSIONS: Despite the likely continued increase in client numbers in substitution maintenance treatment, the majority of methadone clients have a poor prognosis for withdrawal and should not be encouraged to cease treatment. IMPLICATIONS: Clients who do not meet key clinical criteria are likely to have poor clinical outcomes regardless of how withdrawal is attempted.

Time of day variations in driving performance.

Numerous factors may contribute to the 24-hour pattern of automobile accidents. One factor may be a time of day variation in driving ability. In the present study, 11 male subjects operated a driving simulator for 30 minutes at six times of day. Subjects were instructed to maintain a stable position in the left-hand lane and to drive at a constant speed of 80 km/hour. In addition subjects performed a secondary reaction time task. Subjective mood was measured at the beginning and end of each session. Driving performance was measured in terms of the mean and standard deviation of lateral position and speed. The mean and standard deviation of speed varied significantly across the day for both curved and straight segments. Reaction time was also affected by time of day. Performance was more impaired at 0600 and 0200 hours, with improvements in driving performance between 1000 and 2200 hours and an early afternoon dip. These results suggest that driving performance is subject to diurnal variations. Of particular importance is the result that impairments in driving performance in the early afternoon are of a similar magnitude to those occurring in the late evening and early morning.

Injury prevention during physical activity in the Australian Defence Force.

INTRODUCTION: Injuries sustained by Australian Defence Force (ADF) personnel during non-combat military training and sports activity are associated with increasing costs due to work days lost, medical treatment, compensation, and early retirement. In 2001, the ADF commissioned a systematic review of the evidence-base for reducing injuries associated with physical activity, while at the same time improving physical activity participation rates to sustain a trained, fit and deployable workforce. METHOD: Literature from on-line library databases, relevant unclassified military reports, and material from previously published sport-specific injury countermeasure reviews were systematically and critically analysed to address the study aims. RESULTS: Modification of intensity, frequency and duration of basic military training activities and improved equipment is likely to reduce injury occurrence. Sports injury countermeasures used for the civilian population have merit for the ADF physical activity program. Injury countermeasures should be designed to minimise any possible deterrent effect on the motivation to participate in regular physical activity. Increasing the participation of ADF personnel in physical activity in the presence of evidence-based injury prevention strategies has the potential to increase health, fitness and deployability with minimal impact on injury frequency. CONCLUSION: Recommendations arising from the review include injury intervention trials in basic military training and sports. These and other interventions should be supported by refinement to ADF injury surveillance systems. Research should focus on interventions with the greatest gain for fitness, deployability, and cost effectiveness.

Impairment of simulated motorcycle riding performance under low dose alcohol.

Crash statistics that include the blood alcohol concentration (BAC) of vehicle operators reveal that crash involved motorcyclists are over represented at low BACs (e.g., ≤0.05%). This riding simulator study compared riding performance and hazard response under three low dose alcohol conditions (sober, 0.02% BAC, 0.05% BAC). Forty participants (20 novice, 20 experienced) completed simulated rides in urban and rural scenarios while responding to a safety-critical peripheral detection task (PDT). Results showed a significant increase in the standard deviation of lateral position in the urban scenario and PDT reaction time in the rural scenario under 0.05% BAC compared with zero alcohol. Participants were most likely to collide with an unexpected pedestrian in the urban scenario at 0.02% BAC, with novice participants at a greater relative risk than experienced riders. Novices chose to ride faster than experienced participants in the rural scenario regardless of BAC. Not all results were significant, emphasising the complex situation of the effects of low dose BAC on riding performance, which needs further research. The results of this simulator study provide some support for a legal BAC for motorcyclists below 0.05%.

A novel mutation (G114V) in the prion protein gene in a family with inherited prion disease.

Inherited prion diseases are characterized by mutations in the PRNP gene encoding the prion protein (PrP). We report a novel missense mutation in the PRNP gene (resulting in a G114V mutation in PrP) in members of a Uruguayan family with clinical and histopathologic features of prion disease. Affected individuals were characterized by an early age at onset, initial neuropsychiatric symptoms, late dementia with prominent pyramidal and extrapyramidal symptoms, and long disease duration.

Ultrastructural characteristics of hybrids derived from normal and hand wart keratinocytes after serial passages.

Somatic hybrids realized between mouse fibroblasts 3T3.4E and normal human keratinocytes or hand wart keratinocytes were examined from the 6th to the 30th passages by scanning and transmission electron microscopy. Whatever the passage, hybrid cells showed a fibroblastic morphology but, as keratinocytes, they had the capability to stratify. Branched mitochrondria were observed in hybrids whereas normal mitochondria were present in mouse fibroblasts. In human keratinocytes, most of the mitochondria were normal but sometimes few of them were branched. In wart hybrids heterogeneous nucleoli were detected instead of normal nucleoli in normal keratinocyte hybrids, 3T3.4E cells and human keratinocytes.