Menopause as a long-term risk to health : implications of general practitioner accounts of prevention for women’s choice and decision-making

Over the past two decades medical researchers and modernist feminist researchers have contested the meaning of menopause. In this article we examine various meanings of menopause in major medical and feminist literature and the construction of menopause in a semi-structured interview study of general practitioners in rural South Australia. Three discursive themes are identified in these interviews; (i) the hormonal menopause – symptoms, risk, prevention; (ii) the informed menopausal woman; and (iii) decision-making and hormone replacement therapy. By using the discourse of prevention, general practitioners construct menopause in relation to women's health care choices, empowerment and autonomy. We argue that the ways in which these concepts are deployed by general practitioners in this study produces and constrains the options available to women. The implications of these general practitioner accounts are discussed in relation to the proposition that medical and feminist descriptions of menopause posit alternative but equally-fixed truths about menopause and their relationship with the range of responses available to women at menopause. Social and cultural explanations of disease causality (c.f.Germov 1998, Hardey 1998) are absent from the new menopause despite their being an integral part of the framework of the women's health movement and health promotion drawn on by these general practitioners. Further, the shift of responsibility for health to the individual woman reinforces practice claims to empower women, but oversimplifies power relations and constructs menopause as a site of self-surveillance. The use of concepts from the women's health movement and health promotion have nevertheless created change in both the positioning of women as having ‘choices’ and the positioning of some general practitioners in terms of greater information provision to women and an attention to the woman's autonomy. In conclusion, we propose that a new menopause has evolved from a discursive shift in medicine and that there exists within this new configuration, claiming the empowerment of women as an integral part of health care for menopause, the possibility for change in medical practice which will broaden, strengthen, and maintain this position.

School-based first aid training and the implications for traffic injury prevention : a randomised controlled trial

Adolescent injury remains a significant public health concern and is often the result of at-risk transport related behaviours. When a person is injured actions taken by bystanders are of crucial importance and timely first aid appears to reduce the severity of some injuries (Hussain & Redmond, 1994). Accordingly, researchers have suggested that first aid training should be more widely available as a potential strategy to reduce injury (Lynch et al., 2006). Further research has identified schools as an ideal setting for learning first aid skills as a means of injury prevention (Maitra, 1997). The current research examines the implications of school based first aid training for young adolescents on injury prevention, particularly relating to transport injuries. First aid training was integrated with peer protection and school connectedness within the Skills for Preventing Injury in Youth (SPIY) program (Buckley & Sheehan, 2009) and evaluated to determine if there was a reduction in the likelihood of transport related injuries at six months post-intervention. In Queensland, Australia, 35 high schools were recruited and randomly assigned to intervention and control conditions in early April 2012. A total of 2,000 Year nine students (mean age 13.5 years, 39% male) completed surveys six months post-intervention in November 2012. Analyses will compare the intervention students with control group students who self-reported i) first aid training with a teacher, professional or other adult and ii) no first aid in the preceding six months. Using the Extended Adolescent Injury Checklist (E-AIC) (Chapman, Buckley & Sheehan, 2011) the transport related injury experiences included being injured while “riding as a passenger in a car”, “driving a car off road” and “riding a bicycle”. It is expected that students taught first aid within SPIY will report significantly fewer transport related injuries in the previous three months, compared to the control groups described above. Analyses will be conducted separately for sex and socio-economic class of schools. Findings from this study will provide insight into the value of first aid in adolescent injury prevention and provide evidence as to whether teaching first aid skills within a school based health education curriculum has traffic safety implications.

Fire performance of LSF walls made of hollow flange section studs

Load bearing Light Gauge Steel Frame (LSF) walls made of cold-formed steel studs and tracks are commonly used in residential and commercial buildings. Fire safety of these walls is essential to minimize the damage caused by fire related accidents. Past investigations on the fire performance of load bearing LSF wall systems have been limited to LSF walls made of conventional lipped channel section studs. Although structurally efficient hollow flange steel sections are available in the building industry, they are not used as LSF wall studs due to the lack of fire performance data for such walls. The hollow flange sections have torsionally rigid hollow flanges that eliminate the occurrence of local and distortional buckling to an extent, thereby increasing their structural efficiency. The weaknesses of hollow flange sections such as lower lateral distortional buckling capacity are also eliminated when they are used as studs of LSF walls as the plasterboard restraints will prevent any lateral movement. Therefore hollow flange sections can be considered as structurally more efficient studs for use in LSF wall systems. This paper reports the full scale fire tests of LSF walls made of hollow flange section studs under standard fire conditions. The frames were made of 1.6 mm thick and 150 mm deep hollow flange section studs with two closed rectangular flanges of 45 mm width x 15 mm depth. Dual plasterboards were attached on both sides of the test wall panels. The load ratio was varied and the failure times, the lateral deflections and the axial displacements of the test walls were obtained. The failure behaviour of LSF walls made of hollow flange section studs was found to be different to that of LSF walls made of conventional lipped channel section studs. The results of these fire tests show that hollow flange section studs have a higher potential in being used in load bearing LSF Walls.

Design of LSF wall studs under fire conditions

Cold-formed steel lipped channels are commonly used in LSF wall construction as load bearing studs with plasterboards on both sides. Under fire conditions, cold-formed thin-walled steel sections heat up quickly resulting in fast reduction in their strength and stiffness. Usually the LSF wall panels are subjected to fire from one side which will cause thermal bowing, neutral axis shift and magnification effects due to the development of non-uniform temperature distributions across the stud. This will induce an additional bending moment in the stud and hence the studs in LSF wall panels should be designed as a beam column considering both the applied axial compression load and the additional bending moment. Traditionally the fire resistance rating of these wall panels is based on approximate prescriptive methods. Very often they are limited to standard wall configurations used by the industry. Therefore a detailed research study is needed to develop fire design rules to predict the failure load and hence the failure time of LSF wall panels subject to non-uniform temperature distributions. This paper presents the details of an investigation to develop suitable fire design rules for LSF wall studs under non-uniform elevated temperature distributions. Applications of the previously developed fire design rules based on AISI design manual and Eurocode 3 Parts 1.2 and 1.3 to LSF wall studs were investigated in detail and new simplified fire design rules based on AS/NZS 4600 and Eurocode 3 Part 1.3 were proposed in the current study with suitable allowances for the interaction effects of compression and bending actions. The accuracy of the proposed fire design rules was verified by using the results from full scale fire tests and extensive numerical studies.

Experimental study of load bearing cold-formed steel wall systems under fire conditions

Light Gauge Steel Framing (LSF) walls made of cold-formed and thin-walled steel lipped channel studs with plasterboard linings on both sides are commonly used in commercial, industrial and residential buildings. However, there is limited data about their structural and thermal performance under fire conditions while past research showed contradicting results about the benefits of using cavity insulation. A new composite wall panel was recently proposed to improve the fire resistance rating of LSF walls, where an insulation layer was used externally between the plasterboards on both sides of the wall frame instead of using it in the cavity. In this research 11 full scale tests were conducted on conventional load bearing steel stud walls with and without cavity insulation, and the new composite panel system to study their thermal and structural performance under standard fire conditions. These tests showed that the use of cavity insulation led to inferior fire performance of walls, and provided supporting research data. They demonstrated that the use of insulation externally in a composite panel enhanced the thermal and structural performance of LSF walls and increased their fire resistance rating. This paper presents the details of the LSF wall tests and the thermal and structural performance data and fire resistance rating of load-bearing wall assemblies lined with varying plasterboard-insulation configurations under two different load ratios. Fire test results including the time–temperature and deflection profiles are presented along with the failure times and modes.

Finite element modelling of load bearing cold-formed steel wall systems under fire conditions

Light Gauge Steel Framing (LSF) walls are made of cold-formed, thin-walled steel lipped channel studs with plasterboard linings on both sides. However, these thin-walled steel sections heat up quickly and lose their strength under fire conditions despite the protection provided by plasterboards. A new composite wall panel was recently proposed to improve the fire resistance rating of LSF walls, where an insulation layer was used externally between the plasterboards on both sides of the wall frame instead of using it in the cavity. A research study using both fire tests and numerical studies was undertaken to investigate the structural and thermal behaviour of load bearing LSF walls made of both conventional and the new composite panels under standard fire conditions and to determine their fire resistance rating. This paper presents the details of finite element models of LSF wall studs developed to simulate the structural performance of LSF wall panels under standard fire conditions. Finite element analyses were conducted under both steady and transient state conditions using the time-temperature profiles measured during the fire tests. The developed models were validated using the fire test results of 11 LSF wall panels with various plasterboard/insulation configurations and load ratios. They were able to predict the fire resistance rating within five minutes. The use of accurate numerical models allowed the inclusion of various complex structural and thermal effects such as local buckling, thermal bowing and neutral axis shift that occurred in thin-walled steel studs under non-uniform elevated temperature conditions. Finite element analyses also demonstrated the improvements offered by the new composite panel system over the conventional cavity insulated system.

Review of current fire design rules for cold-formed steel wall systems

Light gauge steel frame wall systems are commonly used in industrial and commercial buildings, and there is a need for simple fire design rules to predict their load capacities and fire resistance ratings. During fire events, the light gauge steel frame wall studs are subjected to non-uniform temperature distributions that cause thermal bowing, neutral axis shift and magnification effects and thus resulting in a combined axial compression and bending action on the studs. In this research, a series of full-scale fire tests was conducted first to evaluate the performance of light gauge steel frame wall systems with eight different wall configurations under standard fire conditions. Finite element models of light gauge steel frame walls were then developed, analysed under transient and steady-state conditions and validated using full-scale fire tests. Using the results from fire tests and finite element analyses, a detailed investigation was undertaken into the prediction of axial compression strength and failure times of light gauge steel frame wall studs in standard fires using the available fire design rules based on Australian, American and European standards. The results from both fire tests and finite element analyses were used to investigate the ability of these fire design rules to include the complex effects of non-uniform temperature distributions and their accuracy in predicting the axial compression strength of wall studs and the failure times. Suitable modifications were then proposed to the fire design rules. This article presents the details of this investigation on the fire design rules of light gauge steel frame walls and the results.

Development of improved fire design rules for cold-formed steel wall systems

Traditionally the fire resistance rating of LSF wall systems is based on approximate prescriptive methods developed using limited fire tests. Therefore a detailed research study into the performance of load bearing LSF wall systems under standard fire conditions was undertaken to develop improved fire design rules. It used the extensive fire performance results of eight different LSF wall systems from a series of full scale fire tests and numerical studies for this purpose. The use of previous fire design rules developed for LSF walls subjected to non-uniform elevated temperature distributions based on AISI design manual and Eurocode3 Parts 1.2 and 1.3 was investigated first. New simplified fire design rules based on AS/NZS 4600, North American Specification and Eurocode 3 Part 1.3 were then proposed in this study with suitable allowances for the interaction effects of compression and bending actions. The importance of considering thermal bowing, magnified thermal bowing and neutral axis shift in the fire design was also investigated. A spread sheet based design tool was developed based on the new design rules to predict the failure load ratio versus time and temperature curves for varying LSF wall configurations. The accuracy of the proposed design rules was verified using the test and FEA results for different wall configurations, steel grades, thicknesses and load ratios. This paper presents the details and results of this study including the improved fire design rules for predicting the load capacity of LSF wall studs and the failure times of LSF walls under standard fire conditions.

Development of a simplified design method to predict the fire rating of LSF walls

Recent fire research into the behaviour of light gauge steel frame (LSF) wall systems has devel-oped fire design rules based on Australian and European cold-formed steel design standards, AS/NZS 4600 and Eurocode 3 Part 1.3. However, these design rules are complex since the LSF wall studs are subjected to non-uniform elevated temperature distributions when the walls are exposed to fire from one side. Therefore this paper proposes an alternative design method for routine predictions of fire resistance rating of LSF walls. In this method, suitable equations are recommended first to predict the idealised stud time-temperature pro-files of eight different LSF wall configurations subject to standard fire conditions based on full scale fire test results. A new set of equations was then proposed to find the critical hot flange (failure) temperature for a giv-en load ratio for the same LSF wall configurations with varying steel grades and thickness. These equations were developed based on detailed finite element analyses that predicted the axial compression capacities and failure times of LSF wall studs subject to non-uniform temperature distributions with varying steel grades and thicknesses. This paper proposes a simple design method in which the two sets of equations developed for time-temperature profiles and critical hot flange temperatures are used to find the failure times of LSF walls. The proposed method was verified by comparing its predictions with the results from full scale fire tests and finite element analyses. This paper presents the details of this study including the finite element models of LSF wall studs, the results from relevant fire tests and finite element analyses, and the proposed equations.

Thermal performance of load bearing cold-formed steel walls under fire conditions using numerical studies

Cold–formed Light gauge Steel Frame (LSF) wall systems are increasingly used in low-rise and multi-storey buildings and hence their fire safety has become important in the design of buildings. A composite LSF wall panel system was developed recently, where a thin insulation was sandwiched between two plasterboards to improve the fire performance of LSF walls. Many experimental and numerical studies have been undertaken to investigate the fire performance of non-load bearing LSF wall under standard conditions. However, only limited research has been undertaken to investigate the fire performance of load bearing LSF walls under standard and realistic design fire conditions. Therefore in this research, finite element thermal models of both the conventional load bearing LSF wall panels with cavity insulation and the innovative LSF composite wall panel were developed to simulate their thermal behaviour under standard and realistic design fire conditions. Suitable thermal properties were proposed for plasterboards and insulations based on laboratory tests and available literature. The developed models were then validated by comparing their results with available fire test results of load bearing LSF wall. This paper presents the details of the developed finite element models of load bearing LSF wall panels and the thermal analysis results. It shows that finite element models can be used to simulate the thermal behaviour of load bearing LSF walls with varying configurations of insulations and plasterboards. Failure times of load bearing LSF walls were also predicted based on the results from finite element thermal analyses. Finite element analysis results show that the use of cavity insulation was detrimental to the fire rating of LSF walls while the use of external insulation offered superior thermal protection to them. Effects of realistic design fire conditions are also presented in this paper.

The HealthyTexts study : A randomized controlled trial to improve skin cancer prevention behaviors among young people

Several randomized trials have found behavior change programs delivered via text messaging to be efficacious to improve preventive health behaviors such as physical activity and stopping smoking; however few have assessed its value in skin cancer prevention or early detection. The HealthyTexts study enrolled 678 participants 18–42 years, and assigned them to receive 21 text messages about skin cancer prevention, skin self-examination or physical activity(attention control) over the course of one year. Baseline data have been collected and outcomes will be assessed at three months and twelve months post intervention. The trial aims to increase the mean overall sun protection habits index score from 2.3 to 2.7 with a standard deviation of 0.5 (effect size of 0.5) and the proportion of people who conduct a whole-body skin self-examination by an absolute 10%. This paper describes the study design and participants' baseline characteristics. In addition, participants' goals for their health, and strategies they apply to achieve those goals are summarized.

Researching 'what works' in early intervention and prevention of homelessness : From systematic reviews to collaborative inquiry

Mechanisms of intervention and the contexts they are used in interact in complex ways. This helps explain why we can’t overgeneralize about what works in respect of models of service designed to prevent or respond to homelessness. This said there are some key messages from the totality of evidence that has been accumulated to date. First homelessness would be a lot easier to prevent for first or subsequent episodes if adequate and appropriate (developmentally/ culturally) housing was available. Second (and often dependent on the first) timely support of a particular character ‘works’ both in a preventive sense and in periods when people experience ongoing challenges which may render them vulnerable to further homelessness. This paper reflects on some of the critical features of how we can generate and use evidence, and how these complement each other in important ways.

Cost effectiveness of patient education for the prevention of falls in hospital : economic evaluation from a randomized controlled trial

Background Falls are one of the most frequently occurring adverse events that impact upon the recovery of older hospital inpatients. Falls can threaten both immediate and longer-term health and independence. There is need to identify cost-effective means for preventing falls in hospitals. Hospital-based falls prevention interventions tested in randomized trials have not yet been subjected to economic evaluation. Methods Incremental cost-effectiveness analysis was undertaken from the health service provider perspective, over the period of hospitalization (time horizon) using the Australian Dollar (A$) at 2008 values. Analyses were based on data from a randomized trial among n = 1,206 acute and rehabilitation inpatients. Decision tree modeling with three-way sensitivity analyses were conducted using burden of disease estimates developed from trial data and previous research. The intervention was a multimedia patient education program provided with trained health professional follow-up shown to reduce falls among cognitively intact hospital patients. Results The short-term cost to a health service of one cognitively intact patient being a faller could be as high as A$14,591 (2008). The education program cost A$526 (2008) to prevent one cognitively intact patient becoming a faller and A$294 (2008) to prevent one fall based on primary trial data. These estimates were unstable due to high variability in the hospital costs accrued by individual patients involved in the trial. There was a 52% probability the complete program was both more effective and less costly (from the health service perspective) than providing usual care alone. Decision tree modeling sensitivity analyses identified that when provided in real life contexts, the program would be both more effective in preventing falls among cognitively intact inpatients and cost saving where the proportion of these patients who would otherwise fall under usual care conditions is at least 4.0%. Conclusions This economic evaluation was designed to assist health care providers decide in what circumstances this intervention should be provided. If the proportion of cognitively intact patients falling on a ward under usual care conditions is 4% or greater, then provision of the complete program in addition to usual care will likely both prevent falls and reduce costs for a health service.

Fire safety of buildings based on realistic fire time-temperature curves

In recent times, fire has become a major disaster in buildings due to the increase in fire loads, as a result of modern furniture and light weight construction. This has caused problems for safe evacuation and rescue activities, and in some instances lead to the collapse of buildings (Lewis, 2008 and Nyman, 2002). Recent research has shown that the actual fire resistance of building elements exposed to building fires can be less than their specified fire resistance rating (Lennon and Moore, 2003, Jones, 2002, Nyman, 2002 and Abecassis-Empis et al. 2008). Conventionally the fire rating of building elements is determined using fire tests based on the standard fire time-temperature curve given in ISO 834. This ISO 834 curve was developed in the early 1900s, where wood was the basic fuel source. In reality, modern buildings make use of thermoplastic materials, synthetic foams and fabrics. These materials are high in calorific values and increase both the speed of fire growth and heat release rate, thus increasing the fire severity beyond that of the standard fire curve. Hence it suggests the need to use realistic fire time-temperature curves in tests. Real building fire temperature profiles depend on the fuel load representing the combustible building contents, ventilation openings and thermal properties of wall lining materials. Fuel load is selected based on a review and suitable realistic fire time-temperature curves were developed. Fire tests were then performed for plasterboard lined light gauge steel framed walls for the developed realistic fire curves. This paper presents the details of the development of suitable realistic building fire curves, and the fire tests using them. It describes the fire performance of tested walls in comparison to the standard fire tests and highlights the differences between them. This research has shown the need to use realistic fire exposures in assessing the fire resistance rating of building elements.