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Meet Graham and Almost Impossible Cancer Spaghetti: The intersection between injury prevention and the arts

22 Nov, 16 | by Sheree Bekker

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“The artist is distinguished from all other responsible actors in society — the politicians, legislators, educators, and scientists — by the fact that he is his own test tube, his own laboratory, working according to very rigorous rules, however unstated these may be, and cannot allow any consideration to supersede his responsibility to reveal all that he can possibly discover concerning the mystery of the human being.

Society must accept some things as real; but he must always know that visible reality hides a deeper one, and that all our action and achievement rest on things unseen. A society must assume that it is stable, but the artist must know, and he must let us know, that there is nothing stable under heaven. One cannot possibly build a school, teach a child, or drive a car without taking some things for granted.

The artist cannot and must not take anything for granted, but must drive to the heart of every answer and expose the question the answer hides”

 ~ James Baldwin*

Meet Graham

Over this past weekend I met Graham: the only person designed to survive on our roads. Graham is a remarkable sculpture. He has been designed with the bodily features that humans would need if we were to withstand motor vehicle crashes:

As much as we like to think we’re invincible, we’re not. But what if we were to change? What if our bodies were built to survive a low impact crash? What might we look like? The result of these questions is Graham, a reminder of just how vulnerable our bodies really are.

The piece forms part of the Towards Zero campaign – a vision for a future free of deaths and serious injuries on Australian roads:

In a shift from its traditional road safety campaigns, the Transport Accident Commission has collaborated with a leading trauma surgeon, a crash investigation expert and a world-renowned Melbourne artist to produce ‘Graham’, an interactive lifelike sculpture demonstrating human vulnerability.

Meeting Graham over the weekend was a revelation. As an injury prevention researcher, it is always exciting to be able to view and interact with innovative campaigns that take knowledge translation to the next level. This installation makes use of Google Tango, an immersive augmented reality technology, to allow the viewer to learn more about Graham’s unique features (such as his ribcage – my favourite feature – think airbags rather than armour). The campaign also features a school curriculum, and the ability to Meet Graham online – where one can view the sculpture in 360 degrees, as well as see videos from the surgeon, researcher, and artist.

Almost Impossible Cancer Spaghetti

In an innovative move, The BMJ is working with interactive data visualisation designerWill Stahl-Timmins, to present medical research findings in more visually appealing ways. His infographic development process, as detailed in the blog post Almost Impossible Cancer Spaghetti, is a fascinating study in attention to detail – something that communication and information designers are skilled at.

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The knowledge translation gap

We know that a 17 year gap exists between research and its translation. The field of injury prevention – as an area of public health research – has a long and successful history with educational, media, and social marketing campaigns aimed at reducing this gap. In the quest for more rapid distribution of knowledge, many journals have moved toward open access publishing. Researchers are increasingly working to present research findings in more useful formats, including developing consensus statements, guidelines, and posters, as well as in more engaging formats such as apps, or – in the latest craze – designing their own infographics.

A pertinent question must be raised here: when does the pursuit of knowledge translation through formatting information in new and colourful ways tip over into the realm of creating “too much information” – merely adding to the sea of white noise rather than effectively increasing knowing and influencing behaviour change? We know that viral does not necessarily equal effective, and the problem remains that even if people do know about scientific evidence, they fail to use it anyway.

The intersection between injury prevention and the arts

In the age of viral marketing, art – to my mind – has a different quality, with new and exciting possibilities for better injury prevention knowledge and knowledge translation. Art provides the visual language for the kind of aesthetic knowing that is currently lacking in the ways in which we approach research and knowledge translation in this field. The arts are situated in the liminal space which moves us towards a different kind of embodied knowledge. Perhaps it is because art speaks to the unseen, in the words of James Baldwin.

Is there space in our field for fine art, design, sculpture, craft, poetry, spoken word, performance art, dance, music, photography, film-making? Should there be? What can we learn from other fields of research that do make use of arts-based methods? What can we learn from art itself?

This is not to say that researchers should necessarily be creating art and designing visual information themselves. We need to leave art to the artists, and design to the designers**. But perhaps we do need to collaborate with, and commission, artists and designers (and pay them!) to convey our messages in new and exciting ways – as the above two examples show. Further, the possibilities of arts-based research methods hold possibilities for the generation of different kinds of knowledge in our field, thereby enriching our understanding of injury and its prevention. A recent webinar from artist and academic Dr Mandy Archibald – on the intersection between the arts, research and knowledge translation – sheds light on this practice.

The examples of Meet Graham and the Almost Impossible Cancer Spaghetti have left me wholly inspired as to the possibilities of the art and science of injury prevention research and knowledge translation.

The science of injury prevention is ripe for collaboration with the arts.

I am curious as to other similar initiatives that sit at the intersection of injury prevention and art – please do share links in the comments section below.

*Of course, this was written at a time before the recognition of the importance of gender-neutral language

**Of course, all humans are creative and should all be making art – this statement refers solely to using art for knowledge translation purposes as part of specific research/advocacy projects

 

Safe Travels – or Tampere and back again (and everything in between)

23 Oct, 16 | by Sheree Bekker

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[SB] Our guest blogger is Russ Milner – reporting on his experiences at the recent Safety conference (follow him on Twitter @RussMilner)

[RM] I was fortunate enough to win the inaugural Australian Injury Prevention Network (AIPN) Travel Subsidy to support my attendance at Safety 2016, the 12th World Conference on Injury Prevention and Safety Promotion in Tampere, Finland.

As delighted as I was to receive this news, I soon realised that arranging the various approvals and logistics to allow my attendance was a pressing issue that I had minimal control over. After a couple of anxious weeks, I had every box ticked and a suitcase to pack – but what to pack? I wasn’t familiar with Tampere prior to the conference, but it was described to me as (close to) “the home of Father Christmas”, and we all know Santa dresses for the cold. The conference information gave the vague dress code of “smart casual”, while other people suggested I invest in thermal underwear. I packed as best I could to include casual wear, warm options, and suitable clothes to represent both the AIPN and my employer, the Department of Health Western Australia, at a World Conference of international experts in my profession.

The journey to Tampere, in a nutshell, involved 18 hours in the air, 11 hours in airports, 30 minutes on a bus, and a couple of short walks. Teleporters* need to become a reality sooner rather than later. 30 hours in total, but hey, that time had to be spent somewhere, and I had plenty of time to peruse the comprehensive conference program. Said program was filled with plenary speakers, state of the art sessions, parallel sessions, pitching sessions, poster displays, poster walks, business meetings, side events, and social events—well and truly jam-packed with content. As much fun as I had in transit, all good things must come to an end, and finally I reached my accommodation. With an evening free I stretched my legs with a short walk, freshened up, unpacked, and got ready for a busy four-day conference.

Sunday

According to the conference program, the official opening ceremony started at 15:00 on the Sunday, but keen beans had the opportunity to attend pre-conference sessions from 10:00. For better or for worse, one of these sessions was entitled ‘Achieving population level changes in health: A dialogue on pathways to progress’ piquing my interest enough to make me an aforementioned keen bean. As chance would have it, I entered the impressive Tampere Hall (“Tampere-talo”, to the locals) 20 metres behind a colleague from Perth. It’s a small world after all. An interesting series of presentations and group discussions quickly revealed that across the globe, many issues and challenges are shared by injury prevention and safety promotion (IPSP) practitioners. It was comforting to realise that we’re all in this together, yet concerning that we haven’t found a way to solve the problems altogether. I mustered the courage to take the roving microphone in this session and reflect both on what I’d heard during the session and my experiences from back home in Perth. Thankfully, my comments were praised by the moderator and generated some further discussion from other interested delegates in the room. We were off and running.

The afternoon rolled around and we were officially welcomed to Tampere the city and the conference itself. Luminaries from the Government of Finland, the World Health Organization (WHO), Finland’s National Institute for Health and Welfare, and the International Organizing Committee all made us very comfortable while stressing the importance of IPSP. This welcome was capped by a video message from Michael Bloomberg who in August 2016 was named the WHO Global Ambassador for Noncommunicable Diseases, a role Mr Bloomberg strongly emphasised included injuries. This is a fantastic coup for the IPSP community, to have someone of such prominence as our Global Ambassador.

Some light entertainment followed, which included a string trio performing classical music, before a series of circus acts of contortion, corde-lisse and jump rope – all performed safely to the relief of the audience!

The first plenary session was scheduled to run from 17:00 to 18:30 on a Sunday – a curious timeslot for those of us used to Australian customs, but they were as captivating as they were entertaining – a great way to spend a Sunday evening, truly! Professor Adnan Hyder kicked off with a passionate presentation on what remains unacceptable across the field of IPSP, providing seven suggestions for turning evidence into policy and practice, and challenging delegates to take one thing from the conference they could implement after returning home. The session was concluded in theatrical fashion by Australia’s own Dr Dale Hanson, who proved to be a multitalented performer while brilliantly performing a one-man show on the 1854 cholera outbreak in London – a case study I vividly remember from Public Health 101 from my university days, albeit not so well presented.

The Sunday program concluded with a get together reception hosted by Bloomberg Philanthropies, providing the first real opportunity to mingle and meet other delegates over canapés and drinks. Delegates compared travel stories and commented on how enjoyable the opening day of the conference was. The scene was set for an engaging few days to come.

Monday

If I’m honest, Monday was a bit of a blur. The conference program ran from 08:30 until 18:00, followed by a welcome reception that started at 19:00. As I walked back to my hotel to freshen up in the hour between events, I reflected on the fact I had seen 36 world-class presentations throughout the day, while countless** others occurred in other rooms during parallel sessions. Not only that, but I’d also browsed the many posters on display during a much-needed coffee break, only adding to the sea of content I found myself swimming in. Twitter also played a part in keeping highlights trickling through under the hashtag #safety2016fin. As such, it’s a fruitless task to try and summarise the content into a paragraph or two. However, for the record, I attended sessions focussed on Indigenous safety; Falls; Traffic safety; Child and adolescent safety; and Strategies, legislation action plans and policies. Thankfully, the BMJ Injury Prevention, October 2016, Volume 22, Issue 5 contains abstracts on every presentation from the conference, a useful resource into the future.

Of note, it was nice to see Australia well represented throughout the day, with 9 of the 36 presentations I saw coming from ‘back home’, including one on the falls prevention grants program delivered by the Injury Control Council of WA in partnership with my team at the Department of Health WA. I was both pleased and proud to note how well our presentations stacked up against those from other countries on the world stage. Throughout the day I tried to actively tweet [see Twitter timeline] a few highlights as they caught my attention. Based on the amount of others doing the same, and taking photos of slides rather than scribbling notes, it seems modern technology has redefined how notes are taken these days, rather than the traditional pad-and-pen method.

Needless to say, I was pretty happy when my head hit the pillow on Monday night.

Tuesday

Tuesday was another big day, with lots of content and a couple of social events. The plenary session for the day focussed on Safety and Sustainable Development, before parallel sessions where I jumped from Child safety to Drowning and water safety – both topic areas I am involved in back home. It was great to see a presentation from Kidsafe WA on their Child Safety Online Demonstration House, another initiative delivered in partnership with my team. Continuing the theme of strong linkages to the WA setting, I attended a state of the art session on Safety in rural and remote areas in the stunning Maestro theatre of Tampere Hall. A morning and early afternoon well spent with some great presentations to ponder, and more importantly, names and faces with experience to share.

Those of us who were active in the Twittersphere took the opportunity to meet up in person during the afternoon coffee break, which was great to put a physical face to a digital name. From memory, in the quick half hour I met four Finns, three Canadians, one Australian and one Estonian. No partridge in a pear tree, however.

The later sessions included presentations on Technology – solutions and applications for safety, and Consumer Safety. The first presentation highlighted another partnership between the Department of Health WA and the Injury Control Council of WA—the Know Injury knowledge hub (http://knowinjury.org.au/), in particular the CONNECT.ed networking program (http://knowinjury.org.au/connect/connected/)—both links I would encourage readers of this report to click.

The great majority of delegates then boarded a convoy of buses and headed out to Tampereen Messu- ja Urheilukeskus at Ilmailunkatu 20 (ahem), or “Star Arena”, as it was described at the English-speaking conference. This was the site for the conference dinner, where many a good time was had. I joined an Australian and New Zealand contingent and made a table with a group of Finnish locals who made us very welcome. It was only at this point that I gained an appreciation of the fact that for the Finns, English was most certainly a ‘second’ language that they had to concentrate to speak fluently, and importantly, understand the various accents of their global guests. Despite their admitted limitations, one could be forgiven for thinking they spoke English as well as we do. They were fantastic hosts. They were also fantastic dancers, hitting the dance floor the moment the band played their opening licks and stayed on their feet (no pun intended, well, maybe a little) until the last song had been sung.

Wednesday

Now, this was my first world conference, but I was told by multiple reliable sources that the early morning session after the conference dinner would be the least well attended of the program. I can confirm that to be the case to any readers who may be awaiting their first conference (Bangkok in 2018, by the way). Regardless, those who did muster the energy early on the fourth and final day had an early choice between six different parallel sessions or 22(!) different poster walks. Did I mention it was a busy conference?

The late morning session offered the last of the state of the art sessions, I selected the Child and adolescent safety option. Stoically forgoing the scheduled lunch break, I instead joined a World Health Organization-hosted business meeting that I had been graciously invited to over dinner the previous night. Entitled, Implementing the Regional Action Plan for the prevention of violence and injuries in the Western Pacific (2016-2020), the meeting seemed to pose the question of “how can the injury prevention sector across the Western Pacific region better work together?”. Hopefully, the Know Injury knowledge hub and CONNECT.ed program I hyperlinked above can contribute to the solution.

The final afternoon included a plenary session on Solutions for the future and a Closing ceremony that included the awarding of International Safety Media Awards and proclamation of the Tampere Declaration. Finally, the baton was passed to Bangkok for the 13th World Conference on Injury Prevention and Safety Promotion, and delegates were able to say their goodbyes and prepare for their journey home. AIPN President, Associate Professor Kerrianne Watt and I posed for a photo to mark the occasion.

Summary

So, after four days of a conference that attracted 1,200 delegates from 80+ countries, and produced 1,000+ presentations and 5,000+ tweets, how can I summarise a few key take home messages for readers of this report? A tough task indeed. Hopefully the following points are of value:

  • Networks of people are important. There is so much to be shared and learned across the IPSP portfolio, yet too often we are ‘siloed’ by geography or topic area.
  • IPSP issues across the globe are very similar. The contexts and settings may change, but the key topics largely stay the same. Programs in other countries may be modified and adapted for your local context.
  • Research, Context and Practice are equally important components of a successful solution. The best methods, with the best fit, and the best practice.
  • The United Nations’ Sustainable Development Goals were commonly referenced by plenary speakers. Available here.
  • We know more than we give ourselves credit for. Many effective prevention strategies are already well understood by IPSP professionals. The key is to translate this to the communities we live in. Share, communicate, network.
  • Information, tools and resources are available. We need to share and promote these to each other and the community.

I would like to sincerely thank the AIPN for the funding and opportunity to attend Safety 2016. Thanks also to the Department of Health WA for supporting my attendance. It was an experience I greatly enjoyed, and will no doubt provide benefit to my future endeavours to prevent injury in Western Australia. Kiitos!

*In typing this, Microsoft Word informed me that ‘Teleporters’ is not a word. Not yet, Microsoft. Not yet…

**137, I counted for the sake of this report.

The Lancet Series on Urban Design, Transport and Health: cities planned for humans rather than cars

19 Oct, 16 | by Sheree Bekker

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“Worldwide, the majority of people already live in cities and by 2050, it is estimated that 75% of 10 billion people have cities as an important social determinant of health. Air pollution, physical inactivity, noise, social isolation, unhealthy diets, and exposure to crime play a very important part in the non-communicable disease burden. This 3-part Series explores how integrated multisector city planning, including urban design and transport planning, can be used as an important and currently underused force for health and wellbeing within the framework of the Sustainable Development Goals in both high-income countries and low-income and middle-income countries” Executive Summary

The Lancet recently launched a new series on Urban Design, Transport and Health. Of interest to Injury Prevention readers will be the outcomes around the United Nations Sustainable Development Goal 3: good health and wellbeing – of which this series focuses on targets around the reduction of road trauma:

“The health impacts we looked at were those that had a direct relationship to the transport system and and our urban form, and we also looked at what I call the byproduct of our motorised society – which is road injury and deaths” ~ Mark Stevenson

In particular, the second paper in the series – Land use, transport, and population health: estimating the health benefits of compact cities – quantifies the relationship between land use, urban design, population density and transport systems, and the public health impact thereof in 6 international cities (Melbourne, London, Boston, Sao Paulo, Delhi, and Copenhagen).

A central recommendation of this research, within the framework of the UN Sustainable Development Goals, is for ‘compact cities’ in which people are able to live and work in neighborhoods with safe infrastructure that makes everyday active transport possible. In other words: cities planned for humans rather than cars. The key benefits of such compact cities are two-fold: a reduction in road trauma due to fewer cars being on the road, and and increase in physical activity due to more (safe) active transport options.

Compact cities and active transport = an injury prevention/public health win-win.

Read more:

Urban Design, Transport and Health | The Lancet

Cities for Healthier Lives | The University of Melbourne Pursuit

Quantifying the burden of injury in ‘data-poor’ setting; a local-need- driven approach?

12 Oct, 16 | by Brian Johnston

Editor’s Note: earlier this year the journal published injury data from the Global Burden of Disease project. In an accompanying editorial I noted that many of the regional or sub-national estimates were “derived from aggregation and extrapolation of limited primary sources “and yet could “become the basis for policy or programming at an intensely local level.”

I saw this as a challenge to researchers, a call to “crowd source” burden of disease data from  the subregions and subpopulations unrepresented, or simply estimated, in the global aggregate. If we identified those needs and provided resources for good data collection, data management and data reporting , the information collected would be immediately useful at the global scale and  – one hopes – at the local level too. 

Dr. Safa Abdalla, a member of our editorial board, approaches that suggestion with some caution and – in this guest post – draws distinctions between the needs and experience of researchers and public health professionals in “data-rich” and “data poor” environments. – Brian Johnston (Editor-in-Chief)

 

safa-abdallaSome parts of the world, typically in the low- and middle- income country classification range, lack solid basic information about frequency and distribution of injuries in their population. That is not to say that they lack the sources or the capacity to measure them, but in those same places, the public health practice machinery had been occupied (not entirely unduly of course) with a cluster of conditions like communicable diseases that international actors have been investing heavily to tackle. In such environment, local objective assessments of all potentially impactful conditions may not have been deemed necessary. As a result, priority setting has been skewed towards those conditions of historical focus without heavy reliance on local epidemiological evidence.
The very first global burden of disease and injury assessment and subsequent versions have highlighted the need to consider the burden of all realistically possible conditions that affect human health – including injuries – in a way that allows objective comparisons and consequently objective priority setting. Arguably, data from so called ‘data-poor’ countries had not always been sufficient and/or accessible enough to feed into these global-level estimation projects and data gaps were filled with an assortment of methods that continue to evolve to date, probably at a rate that surpasses the rate of improvement in the quantity and quality of data from those countries.
The burden of disease assessment methodology is very demanding, not only computationally but in terms of data input, requiring epidemiological estimates at the very granular level of disease and injury sequelae, and synthesizing those into a range of novel summary measures (Disability-adjusted life years for example). Yet, incidence, prevalence and mortality of any condition at a broader level are key inputs for country- or locality-level policy development and health service planning and monitoring. It is in measuring those epidemiological quantities that the value of country-level estimation in data-poor settings lies, without necessarily delving into the complexities (and relatively unnecessary luxury for the time-being) of summary measure calculation. In addition, country-level assessments can uncover gaps in data systems that, when addressed, can create a seamless flow of better quality data for local decision making.
But with whom does the onus of carrying out such local-level estimation reside? Undeniably, global estimation efforts have produced country-specific estimates, stimulated country data hunts that fed data into their machinery and, in a few ‘data-rich’ countries, facilitated full burden of disease and injury assessments too. However, to date, injury burden estimates for the vast majority of ‘data-poor’ countries come from indirect estimation in these global projects. One can argue that alternatively, an approach that is driven by the need for public health action (be it strategy updating or service development) would be the most beneficial for producing estimates for those very countries at national, sub-national or subgroup levels. This approach entails that a local team of researchers, public health practitioners and other stakeholders evaluate all their data sources, use them in a simple and transparent fashion to develop the best estimates that fit their purpose, and take action based on the estimates and other relevant input while also identifying the data gaps and working on filling them. Arguably, informing local public health action should take priority over informing the global view, but global burden estimation efforts can still (and must) benefit from the products of this process. However, the process needs to be driven by local demand for estimates and not by the need to fill gaps for the global estimates. It should also be led, undertaken and owned by local teams of public health practitioners, analysts and researchers. The reason for this is that assessing and using health data are basic public health functions that all public health practitioners and analysts in any country should be capable of carrying out. Relying on external support from ‘global project’ teams to develop country estimates denies public health practitioners and researchers in those ‘data-poor’ countries the opportunity to hone their skills in public health data assessments and epidemiological estimation. It also denies them ownership of any subsequent efforts to improve data availability via epidemiological studies or administrative data collection.
This approach need not be limited to injury burden assessment but is much more needed for that latter. This is mainly because injuries in many low- and middle- income countries had been neglected for so long that epidemiological assessments of other conditions traditionally associated with those countries are likely more abundant. Hopefully as more and more country teams assess, use and improve their own injury data sources, this reality will eventually change.

Safa Abdalla
drsafa@yahoo.com
twitter: @Safa12233

Guest Blog: ‘Breaking Down Walls – Taking Translation and Dissemination to the Next Level’

26 Sep, 16 | by Angy El-Khatib

 

Often, when people think of translational research, it is through the lens of Grand Rounds, seminars, and conference presentations. It is usually clinical in nature and comes directly from the researcher. There is another type of translational research – NIH calls it Type 2 translation.

I am part of a Type 2 translational research team at a child injury research center. Our team of five has a mission to educate and empower the vast audience of people who care about kids and keeping them safe. We do this by sharing information on child injury in a format that is accessible by meeting health literacy guidelines and providing opportunities for prevention through realistic, actionable safety steps.

That’s a pretty lofty goal but we are very good at what we do. When researchers from our center publish papers, it is not unusual for their work to be picked up by media around the world. In the last six months, we’ve had two papers that had over one billion impressions (estimates of potential audience size), and two others that have had around one million impressions. It helps that our product is related to kids – it makes people care. But there is more to it than that.

In working with media, we strive to understand their needs and how to create value for them to cover our work. This is not as simple as it sounds. We spend several days working on a press release. Our hospital sees the value in the work we do and often contributes resources for us to create supporting videos, including sound bites, demonstrations, and B-roll.

We pay attention to the ever-changing way the masses consume information, staying up to date on the pulse of the public to meet them where they are. Gone are the early days of technology where you could create a website, direct people there, and then forget about it. Now, a website must stay fresh, providing new content frequently. It must also stay current in the way it looks. If its appearance is outdated, no one will look at your information because there will be the assumption (correct or not) that what is on the site is also likely outdated. People may believe you and/or your organization are outdated, or worse yet, irrelevant. We constantly assess social media platforms, analyze how we can best use them for maximum effect, and then develop our marketing plans.

We talk to doctors, administrators, researchers, and other public health professionals about the findings of our research. We also train them to effectively communicate with those who trust them and look to them for guidance. After that, we can’t sit back and rest on our laurels – we have to do it all over again, and then again. By doing all of this, we increase the likelihood of and the speed with which our research can lead to changes in policy, regulation, and behavior.

In the realm of translational research, teams like ours are not the norm and our team didn’t become this successful overnight. When our manager began her quest to have a team devoted to translational research, translation and dissemination were barely on the radar. Beyond journal publication, dissemination typically just meant printing  copies of a paper and having it available upon request or presenting it at conferences. Our manager had a vision of something bigger and better. She specializes in health communication and has the passion and drive to push for what she believes in. Her director supported her vision and was willing to take a chance on, and fund, something that really hadn’t been done.

Slowly, she grew her team. What makes us effective and successful is that although we each have our own projects to manage, we bring our complementary sets of skills and experiences to the table, both literally and figuratively, collaborating on all of our products. These products include press releases, multi-media releases, media interviews, blog articlescynthia-anderson-profile-picture, website development and management, social media outreach, toolkits, photo shoots, conference planning, and network building. We hone our work through brainstorming sessions, writes, edits, and re-writes. Our work is always better after it has been through the rounds of the team.

Our manager began winning over colleagues one researcher at a time, as they saw the reach and the impact of their work grow. It took 10 years for her to get her team to where we are now – having a big impact and doing innovative work that can help keep kids safer.

Written by:
Cynthia Anderson, MPH, CHES.
She is a Program Coordinator at The Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio. She can be contacted at cynthia.anderson@nationwidechildrens.org.

 

 

Life post-injury, aka preventing further injury

20 Sep, 16 | by Bridie Scott-Parker

While we as injury-prevention professionals, practitioners and policy-makers work tirelessly to prevent injury, the reality is – never more evident than at the Safety 2016 conference underway as I type in Tampere, Finland – that

“Beyond deaths tens of millions of people suffer injuries that lead to hospitalization, emergency department visits, and treatment by general practitioners. Many are left with temporary or permanent disabilities….”  Etienne Krug, MD, MPH, Director, Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization.

Moreover, diseases such as diabetes, heart disease, cancer, mental illness, and respiratory conditions to name a few, arguably lead to injury and disability, therefore we must continue in our efforts to reduce the incidence of disease wherever possible.

Now, to the other side of the coin…..

If you are one of the many lucky people out there who has never had to live with an injury (whether it was temporary or permanent) or a disease (particularly one that you have incurred through no fault of your own), try being the one living with that injury or that disease. Try then to prevent incurring further injury. As a person who has tango-ed for many years with the she-beast Multiple Sclerosis (MS), I can tell you it is pretty darn hard. Having recently visited our developed-nation’s capital, Canberra, for a conference, I was dismayed to encounter  injury-prevention issues every day. Two examples:

Example 1. I can no longer traverse stairs without a great deal of difficulty (and hilarity as my Students and/or Research Assistants are required to act as my ‘squishies’ by forming a human beanbag around me in case I fall during the journey up or down), and while there was an elevator that was available to use in an adjoining building (a casino), despite being advised by building b (my hotel) that I could use this elevator during casino hours, casino security advised me I was unable to use it as I was not a casino-patron. Despite all of my conference colleagues traversing the steps within 30 feet of the elevator, I had to leave the building to repeat my early morning trek of a (now uphill) ramp, road, broken paving (again uphill), footpath, and construction zone, using my walking stick and my wheelie bag to keep me upright, with an overall distance that was at least 3 times that of my able-bodied colleagues. I fall quite regularly and I am always very careful in how I land as if I lose the use of one or more arms through an injury my capacity to care for myself, let alone work, be a mother etc, will be greatly impacted upon. Managing fatigue is very important for staying upright, and having a finite pool of energy which is impacted upon by MS, this is not the way to prevent further physical injury. How about offering assistance or solutions that are not only realistic but also allow me some independence? I am not my disease or my disability.

 

Broken paving which strikes fear in the heart of anyone who is a falls' risk

Broken paving which strikes fear in the heart of anyone who is a falls’ risk

 

Example 2. There was a delay with our return flight home, as there often is as we leave our nation’s capital, and as I have mobility issues I need assistance to board the plane. My friend and colleague was kind enough to assist me through this process, and we were ‘bumped’ to the head of the queue so that we could get seated with as little difficulty as possible. Unfortunately as we traveled down the ramp to the plane a fellow traveler yelled out ‘So what did you do to yourself?’, to which I stopped, steadied myself with the handrail and turned around before replying ‘I didn’t do anything to myself, I have multiple sclerosis’. Understandably the gentleman was very apologetic, however it can be very confronting to have complete strangers ask you why you walk the way you do, or you use a stick, or you are in a wheelchair. Some days it just rolls right off me, but other days when your reserves might be low, you might already have had a dozen people ask you, and you have managed to get through airport security with a walking stick (no easy feat itself!), you just feel like saying ‘Give me a break, did I ask if you have hemorrhoids?’ I am pretty resilient – indeed I could be the poster child for resilience and tenacity, despite my husband saying it is just plain pigheadedness and stubbornness – but even I reach my limits. We are already coping with a pretty full load, 24 hours a day, 7 days a week, with no break EVER. Someone stronger may not be able to cope with the constant questioning. This is not the way to prevent further mental injury. Again, how about offering assistance or solutions that are not only realistic but also allow me some independence? I am not my disease or my disability.

Here in Queensland last week was Disability Action Week, with the aim of empowering people with disability, raising awareness of disability issues, and improving access and inclusion throughout the wider community. This year has been pretty tricky. Unfortunately I had a pretty horrid weekend before the DAW, and the doctors at our local hospital were just wonderful despite struggling with my collapsing veins.

You can see the result of two collapsed veins during failed IV insertion, 10 days later (you can’t see the bruise from the one that succeeded, on the back of my hand)

The result of two collapsed veins during IV insertion, 10 days later

 

I had intended to blog last week about the exciting Rio 2016 Paralympic Games and what a great chance for people to see disability and disease through a different lens. Instead I spent much of last week struggling to manage new medication, work, being a mum/wife/daughter/friend, and independence as friends and family acted as chauffeurs and gophers, nurses and hug-machines.

Anyone who knows me knows that I am a do-er. Get in there and get it done! As the saying goes, if you want something done, ask a busy person 🙂 I don’t usually share about how tricky it can be living with MS ALL DAY EVERY DAY, but this seemed the ideal time to give some tiny insight into what it is like to further prevent injury when you already have an injury, which is what we also need to be about if we are to make injury prevention progress.

How to cut violence painlessly: Increase alcohol taxes

1 Sep, 16 | by Sheree Bekker

photo-1455641064490-74f5f8dbf598

[SB] This post is by Nicholas Page and Jonathan Shepherd.

Nicholas Page is a Senior Research Assistant at the Wales Institute of Social and Economic Research, Data and Methods (WISERD) and former Research Associate at Cardiff University’s Violence Research Group. Follow Nick on Twitter @Nick_Alan_Page

Jonathan Shepherd is a Professor of Oral and Maxillofacial Surgery and Director of the award winning Violence Research Group based at Cardiff University. Follow the Violence Society RG on Twitter @ViolenceSociety

[NP & JS] Alcohol abuse is a major risk factor for violence. For this reason, interventions seeking to reduce alcohol consumption often form a central part of violence prevention strategies, both globally and domestically. Increasing the price of alcohol, for instance, has been linked to significant reductions in many alcohol-related disease and injury conditions, including violent injury. A study in England and Wales, for example, found a negative relationship between violent injury and the price of beer, after accounting for other potentially influential factors. The logic here is that higher prices mean we buy and drink less alcohol – an assumption that is well supported by numerous peer-reviewed studies. From this, we understand the relationship between alcohol price and violence as a two-stage process; first, from alcohol price to alcohol consumption and second, from alcohol consumption to acts of violence.

But, in this previous study, violence was measured using rates of emergency department (ED) attendance between 1995 and 2000, and the price of beer was based on the average value of a single pub-bought (tavern-bought) pint over the same period. Acknowledging that purchasing trends and licensing laws have changed over the last two decades, we at Cardiff University’s Violence Research Group – the authors of the original study – repeated the study using the same ED violence measure but substantially extended the scope of the research beyond the price just of beer and on-license prices.

This latest study – recently published online in Injury Prevention – compares violence-related attendances from 100 EDs across England and Wales between 2005 and 2012, with alcohol prices (including beers, wines, spirits, and ‘alcopops’ – flavoured alcoholic beverages) from both on-trade (e.g. pubs and clubs) and off-trade (e.g. supermarkets and off-licenses) alcohol outlets. In support of our previous finding, the risk of violent injury was once more strongly negatively related to the price of alcohol in both outlet types; again, taking into account the influence of other potential confounding factors.

The implications of these findings are both theoretical and practical. First, because alcohol prices are not affected by rates of violence, the argument that links between violence and alcohol simply reflect the propensity of violent people to drink more alcohol than people who are nonviolent can be dismissed in this instance. Second, and most importantly, our findings showed that as little as a 1% increase in alcohol prices could reduce the number of patients attending EDs for treatment of violence-related injuries in England and Wales by around 6,000 patients per year. Crucially, to achieve such a substantial reduction, the price of alcohol must be raised in both on-trade and off-trade outlets. This would mean, since on-trade prices were found to be more influential in driving violence and that alcohol prices in this trade are already far in excess of the proposed minimum unit price (MUP) range of around 45-50 pence in the UK, that alcohol pricing policies which focus on tax increases are likely to have a greater influence on violent injury than MUP.

Together with similar findings from the USA, this research provides compelling evidence that making alcohol more expensive would reduce violence. Increasing the price of alcohol through tax increases is a national intervention which would be relatively straightforward to implement. The evidence speak for itself: even small price increases could substantially reduce alcohol-related harms, lead to safer towns and cities, decrease costs to health and criminal justice services, and increase revenue for governments.

So what are policy makers waiting for?

 

Celebrating science and inspiring the next generation of scientists

22 Aug, 16 | by Bridie Scott-Parker

Last week in Australia was National Science Week, a nation-wide celebration of science and technology via three key pathways.

Pathway one is to inspire the general public to be involved in science – creating new knowledge – through engaging activities such as Citizen Science. This year’s Citizen Scientists are identifying Australian wildlife that are featured in photos captured via automatic cameras, and anyone with internet access can participate whether they have a university qualification or not. This fantastic activity means that science is indeed inclusive, when many times it can feel like science is a members-only club.

The second pathway is through showcasing the contributions of scientists to the world of knowledge through the Australian Institute of Policy and Science Tall Poppy Awards. As the joint-Queensland 2015 winner of this award, I was delighted to attend the 2016 award evening on Wednesday and was pleased to learn about innovative projects across a breadth of disciplines, such as infecting coeliacs with hookworms, the sexual attractiveness of facial hair, and optimising agricultural irrigation to name a few. Next month I will be one of the inaugural Flying Scientists, bringing science to rural regions in which exposure to science can be limited.

The third pathway relates to a flurry of activities to inspire the next generation to be scientists – both today and in their future education and career paths. Recognising the importance of encouraging girls in particular to become – and stay – engaged in scientific pursuits, I was delighted to host the first University of the Sunshine Coast Growing Tall Poppies program in my research unit here at the University of the Sunshine Coast earlier this year.

Adolescent Risk Research Unit team members Jeanne, Jamie, and Natalie, mentoring Sasha, Isabella, Mikayala, and Sian.

The four Grade 10 students learnt about career paths through and in science, and conducted their own research project under the guidance of members of my team, before making a presentation of their research activities and the key findings before the senior school assembly on Wednesday morning. This presentation was very well-received by the students and teachers in attendance, further breaking silos such as ‘academics’, ‘schools’, and ‘science’ which can pervade.

Bridie with the 4 GTPs after the school assembly presentation

Bridie and the 4 GTP stars after their school assembly presentation.

If we are to continue to effectively prevent injury, we need to make science accessible to everyone, and to the next generation especially.

 

The deadly selfie game – the thrill to end all thrills | The Conversation

8 Aug, 16 | by Sheree Bekker

[SB] This post by Amanda du Preez (University of Pretoriaoriginally appeared on The Conversation Africa on May 18 2016, and is republished in its entirety under a Creative Commons Attribution No Derivatives licence. 

According to the popular press it was more likely in 2015 for a person to die while taking a selfie than to be killed by a shark – this is globally. This means that, officially, the deadly “monster” shark from the “Jaws” movie franchise has become less frightening than capturing your own image on a smartphone – that is if the 12 reported selfie deaths of 2015 are compared with the eight fatal shark attacks in the same year.

These are selfies taken from the top of a skyscraper while dangling in mid-air, or while perched on the brink of an overhanging cliff just before the selfie-taker’s foot slipped.

The invention of the selfie stick – which Wikipedia helpfully explains is “a monopod used to take selfies by positioning a smartphone or digital camera beyond the normal range of the arm” – has worsened the situation. Reports show that tourists in particular no longer look where they are going, but are transfixed by their images on their phones’ screens. Many landmarks and tourist places have started to ban selfies and especially selfie sticks to prevent untimely accidents and even deaths. But putting these safety measures in place does not stop adventurous souls continuing to push the boundaries of dangerous activities.

The latest extreme craze exported from Russia is called “skywalking” (Picture 1). It entails “standing or walking atop very tall structures at dangerous heights, such as the rooftop of a skyscraper building or a bridge”. As such these images are breathtaking and awesome. Provided the taker of the selfie does not slip, he or she may be rewarded with hundreds of “likes” on social media. Takers of dangerous selfies are, after all, considered heroes who unflinchingly put themselves in harm’s way to experience what should probably not be experienced.

Picture 1: Skywalker Alexander Remnev on top of a Moscow skyscraper (2013/14).
Skyscraper Dictionary

But how can we determine what counts as “a selfie death” or “death by selfie”? There are at least three types of deadly selfies:

  • selfies unknowingly taken before death;
  • selfies of death where the taker’s death is almost witnessed; and
  • selfies with death where the taker stands by while someone else dies.

In the first instance (unknowingly before death) the selfie is not the cause of death but is taken just before a tragic event. In these cases the selfies signify more as memorials for the departed, who are remembered in the moments before their demise. These are the selfies where we are confronted with the faces a group of friends in an aeroplane minutes before it destructs, as happened with Mexican singer Jenni Rivera and her crew (Picture 2), or of a motorist just before a fatal accident.

Picture 2: Selfie of Mexican singer Jenni Rivera and her crew before an aeroplane crash in December 2012.

In these cases, the viewer cannot help but interpret the faces looking out at him or her as sad and tragic. In fact, one may even convince oneself that the sadness is palpable in the eyes of the deceased, as in the case of the reggaeton singer Jadiel (real name Ramon Alberto González Adam), who posted a selfie in May 2014 shortly before a fatal motorbike accident in Rochester, New York.

In the cases of selfies of death or death by selfie, we are exposed to the hopeful faces of adventurers, extremists and the unlucky ones. Although these selfies overlap with the previous category of selfies before death, they differ in the sense that they are taken in circumstances that can be considered mortally dangerous.

Particularly arresting is the selfie by the young Russian girl, Xenia Ignatyeva (Picture 3), who in April 2014 climbed a high bridge to impress her friends, but then slipped and fell and was electrocuted when she grabbed live cables. Her beautiful young face looks flushed as she stares into the camera, exhilarated and energised. She stares the sublime in the face as her selfie gazes back at her from the smartphone screen with the devouring abyss at her back. Is this the image of her death framed by expectation and self-grandeur?

Picture 3: Image of selfie taken by Xenia Ignatyeva in 2014.

Lastly, there is the case of selfies taken with death. An example is that of the Turkish police officer who, in September 2014, took a selfie while a person committed suicide in the background by jumping off a bridge (Picture 4). Naturally, the selfie was shared on social media by the police officer. Suffice it to say, the police officer was investigated afterwards.

Picture 4: Image of a police officer taking a selfie with a man who jumps
from a bridge in Ankara, Turkey in 2014.

It is an undeniable thrill – and attention-seeking strategy – to be in the presence of another’s death while experiencing how pain subsides into pleasure. One may speculate whether, if the technology were available during the eighteenth century, for instance, people would not take selfies during executions. No doubt a selfie taken against the background of the beheading of Marie Antoinette – France’s queen, who was executed during the French Revolution – would be considered an “ultimate selfie”.

To be taking a selfie of death is a technologically mediated encounter with the unthinkable and can, therefore, be considered a sublime experience. The contemporary obsession to take an “epic selfie”, an “extreme selfie” or the “ultimate selfie” may be interpreted as an extension of the pursuit of the sublime.

The Conversation

Amanda du Preez, Professor in Visual Culture Studies, University of Pretoria

This article was originally published on The Conversation. Read the original article.

The academic publishing process: A lesson in antifragility

6 Jul, 16 | by Sheree Bekker

Mosaico Trabajos Hércules (M.A.N. Madrid) 02

Image: Mosaico Trabajos Hércules (M.A.N. Madrid) 02 by Luis García under CC BY SA 2.0

“Some things benefit from shocks; they thrive and grow when exposed to volatility, randomness, disorder, and stressors and love adventure, risk, and uncertainty. Yet, in spite of the ubiquity of the phenomenon, there is no word for the exact opposite of fragile. Let us call it antifragile. 

Antifragility is beyond resilience or robustness. The resilient resists shocks and stays the same;

the antifragile gets better”

Antifragile: Things that gain from disorder ~ Nassim Nicholas Taleb

Sheree Bekker and Dr Bridie Scott-Parker have teamed up to write this post on their experiences of the academic publishing process – they provide reflections from the point of view of a rookie researcher (SB) and a more experienced researcher (BSP). 

[Sheree Bekker] Congratulations rained in when I published my first academic paper. I had been open about my publishing journey on social media, and had shared each step it had taken me over the course of eighteen months – with rejections and revisions aplenty. The academic publishing process can be daunting for a rookie researcher, and sharing my failures and then ultimate success with my community on social media gave me a place to both vent and celebrate with others who had been through the process many times before.

As most academics do, I have now come to expect rejection. There is nothing unusual about such in academia – research is built on peer-review and journals with high standards and even higher rejection rates. Rejection is both a rite of passage and a way of life for academics. We are reminded of this often through corridor conversations, mentorship, and our own experiences.

Yet failure is not openly and honestly shared or spoken about in the wider sphere of academia. Sure, we all know that failure is the name of the game, but it is not really spoken about. I remember this negative CV doing the rounds on social media last year – and how radical it seemed at the time that someone was willing to share all their failures (gasp!) in an arena where a career – and for many academics self-worth – is tied to wins. Yet wins cannot be achieved without the failures. Go figure.

I am a big advocate for sharing our life’s work on social media, but have often wondered why we only share our ‘wins’. Do the failures speak to a lack of competency? No, I don’t believe so. Declaring a failure for the world to see speaks to shame and vulnerability – and also to courage and commitment. Now, I am not suggesting that all academics share all their failures all of the time – for I am told that you just get to a point where it does not bother you any longer as there are just too many to share – but I do believe that we owe it to emerging academics to, at the very least, open up the conversation a little more. Indeed, a Guardian piece recently reminded us academics: you are going to fail, so learn how to do it better.

The opposite of fragility is not resilience or robustness, it is antifragility. The ability to be poised to benefit or take advantage of stress, errors and change, the way, say, the mythological Hydra generated two new heads, each time one was cut off. Perhaps it is this antifragility that we need to cultivate as emerging researchers, rather than mere stubborn grit. Growing and learning out of our academic challenges, rather than merely ploughing through them.

[Bridie Scott-Parker] Seven years later, I still recall the daunting – nay terrifying – experience of submitting my first manuscript for peer review. While the paper from my Honours thesis emerged quite organically over a month or so (hilarious that I thought this took forever to happen), I actually spent more than 6 hours frantically checking everything was attached correctly, screens were completed, etcetera, then reading the entire PDF generated by the journal’s online submission system, before clicking ‘yes I want to submit this article for peer-review’ (and no I won’t change my mind because I am not allowed to….). Then the dreaded reviews arrived and I was crushed. Clearly I was a complete failure as a researcher, an academic, and as a human, and I should abandon all hope and live in a cave for the remainder of my life! Again, hilarious as my supervisors said that the comments were pretty good! I could see no good and I took some persuading that it is not personal. Having survived the review-revise-respond-review-revise-respond merry-go-round many many times since then, I have the benefit of hindsight to see that those reviews were indeed quite favourable. I also have the benefit of understanding that this is a normal part of disseminating findings, and that as researchers, academics, and authors, our skills are strengthened considerably each time we receive constructive feedback.

Please note also that I don’t live in fairy land. Sometimes reviews are one or two sentences along the lines of ‘this is rubbish, go away’ or ‘this is good and could be improved by some minor changes’, without actually providing any guidance regarding what was good, what was less good, and how to improve the manuscript. Such reviews are a waste of time for the reviewer, the editor who manages the review process, and the authors who are trying their best to share their research in an engaging and informative manner.

I have found over time that I have become the ‘poster child’ for antifragility. Take all feedback on board – good and bad – and learn from it. Where are my research and writing strengths? Where are my research and writing weakness? Don’t be afraid to ask peers and colleagues for unbiased feedback regarding your strengths and weaknesses. This information will only help you in the long run.

Last week I had the wonderful opportunity to serve as a mentor to a group of PhD students as they traversed the steeplechase-like process of preparing and submitting a paper for peer review. While I have no experience or skills in Indonesian diglostics, storm runoff, and conceptualisation of climate change adaptation, I have antifragility. I shared my own experiences and tips and tricks I have discovered to make the writing process that little bit easier. I also shared what reviewers look for, and cautioned against easy ways to ‘annoy’ reviewers and editors (my personal all-time favourite, don’t use any punctuation!). Yes, I completed my doctoral dissertation by peer-reviewed publication, and yes, I have a steady stream of post-doctoral peer-reviewed publications. However what you don’t see is the many frogs I proverbially had to kiss before the manuscripts turned into princes. My personal best (not my own project, I am pleased to say) was 18 different versions submitted to 9 different journals, and 3 email conversations between myself as corresponding author and the journal editor, before the paper was finally accepted. Each time the paper was revised, and sometimes it was resubmitted to the journal that provided the reviewer feedback (if not outright rejected). Yes, this is frustrating, but the final article (my silk purse) is so much better that the original submission (the sow’s ear). Bear in mind also that revising a manuscript in light of reviewers’ comments – even when you have done so 4 times – does not guarantee that it will be published within that journal.

Again, antifragility is the way to go 🙂

 

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