Dying in hospital: medical failure or natural outcomes?

The purpose of this study was to describe patterns of medical and nursing practice in the care of patients dying of oncological and hematological malignancies in the acute care setting in Australia. A tool validated in a similar American study was used to study the medical records of 100 consecutive patients who died of oncological or hematological malignancies before August 1999 at The Canberra Hospital in the Australian Capital Territory. The three major indicators of patterns of end-of-life care were documentation of Do Not Resuscitate (DNR) orders, evidence that the patient was considered dying, and the presence of a palliative care intention. Findings were that 88 patients were documented DNR, 63 patients' records suggested that the patient was dying, and 74 patients had evidence of a palliative care plan. Forty-six patients were documented DNR 2 days or less prior to death and, of these, 12 were documented the day of death. Similar patterns emerged for days between considered dying and death, and between palliative care goals and death. Sixty patients had active treatment in progress at the time of death. The late implementation of end-of-life management plans and the lack of consistency within these plans suggested that patients were subjected to medical interventions and investigations up to the time of death. Implications for palliative care teams include the need to educate health care staff and to plan and implement policy regarding the management of dying patients in the acute care setting. Although the health care system in Australia has cultural differences when compared to the American context, this research suggests that the treatment imperative to prolong life is similar to that found in American-based studies.

A lawyer's duty of care : beware the failure to advise of contingencies and foreseeable risks

It is trite law that a lawyer owes their client a duty of care requiring the lawyer to take reasonable steps to avoid their client suffering foreseeable economiic loss: Hawkins v Clayton. In the context of a property transaction this will include a duty to warn the client of anything that is unusual or anything which may affect the client obtaining the full benefit of the contract entered into: Macindoe v Parbery.

Shear thinning and shear thickening non-Newtonian confined fluid flow over rotating cylinder

In present work, numerical solution is performed to study the confined flow of power-law non Newtonian fluids over a rotating cylinder. The main purpose is to evaluate drag and thermal coefficients as functions of the related governing dimensionless parameters, namely, power-law index (0.5 ≤ n ≤ 1.4), dimensionless rotational velocity (0 ≤ α ≤ 6) and the Reynolds number (100 ≤ Re ≤ 500). Over the range of Reynolds number, the flow is known to be steady. Results denoted that the increment of power law index and rotational velocity increases the drag coefficient due to momentum diffusivity improvement which is responsible for low rate of heat transfer, because the thicker the boundary layer, the lower the heat transfer is implemented.

The effects of deep cracks on the rain-induced instability of slopes : A case study

Rainfall can disrupt the balance of natural soil slope. This imbalance will be accelerated by existence of cracks in soil slope, which lead to decreasing shear strength and increasing hydraulic conductivity of the soil slope. Some research works have been conducted on the effects of surface-cracks on slope stability. However, the influence of deep-cracks is yet to be investigated. Limited availability of deep crack data due to the lack of effective sub-soil investigation methods could be one of the obstacles. To emphasize the effects of deep cracks in soil slope on its rain-induced instability, a natural soil slope in Indonesia that failed in 31st October 2010 due to heavy rainfall was analyzed for stability with and without deep cracks in the slope. The slope stability analysis was conducted using SLOPE/W coupling with the results of transient seepage analysis (SEEP/W) that simulate the pore-water pressure development in the slope during the rainfall. The results of Electrical Resistivity Tomography (ERT) survey, bore-hole tests and geometrical survey conducted on the slope before its failure were used to identify the soil layers’ stratification including deep cracks, the properties of different soil layers, and geometrical parameters of the slope for the analysis. The results showed that it is vital to consider the existence of deep crack in soil slopes in analysing their instability induced by rainfalls.

Disclosure obligations on ex parte application for freezing order - duty of practitioners to the court - failure to comply with duty - serious dereliction of duty to court - supplemental order for costs against solicitors personally

The decision of Applegarth J in Heartwood Architectural & Joinery Pty Ltd v Redchip Lawyers [2009] QSC 195 (27 July 2009) involved a costs order against solicitors personally. This decision is but one of several recent decisions in which the court has been persuaded that the circumstances justified costs orders against legal practitioners on the indemnity basis. These decisions serve as a reminder to practitioners of their disclosure obligations when seeking any interlocutory relief in an ex parte application. These obligations are now clearly set out in r 14.4 of the Legal Profession (Solicitors) Rule 2007 and r 25 of 2007 Barristers Rule. Inexperience or ignorance will not excuse breaches of the duties owed to the court.

Shear strengths of lipped channel beams with stiffened web openings using numerical studies

This paper presents the details of numerical studies on the shear behaviour and strength of lipped channel beams (LCBs) with stiffened web openings. Over the last couple of decades, cold-formed steel beams have been used extensively in residential, industrial and commercial buildings as primary load bearing structural components. Their shear strengths are considerably reduced when web openings are included for the purpose of locating building services. Our research has shown that shear strengths of LCBs were reduced by up to 70% due to the inclusion of web openings. Hence there is a need to improve the shear strengths of LCBs with web openings. A cost effective way to improve the detrimental effects of a large web opening is to attach appropriate stiffeners around the web openings in order to restore the original shear strength and stiffness of LCBs. Hence numerical studies were undertaken to investigate the shear strengths of LCBs with stiffened web openings. In this research, finite element models of LCBs with stiffened web openings in shear were developed to simulate the shear behaviour and strength of LCBs. Various stiffening methods using plate and LCB stud stiffeners attached to LCBs using screw-fastening were attempted. The developed models were then validated by comparing their results with experimental results and used in parametric studies. Both finite element analysis and experimental results showed that the stiffening arrangements recommended by past re-search for cold-formed steel channel beams are not adequate to restore the shear strengths of LCBs with web openings. Therefore new stiffener arrangements were proposed for LCBs with web openings based on experimental and finite element analysis results. This paper presents the details of finite element models and analyses used in this research and the results including the recommended stiffener arrangements.

Shear design of cold-formed steel beams using direct strength method

This paper presents the direct strength method (DSM) equations for cold-formed steel beams subject to shear. Light gauge cold-formed steel sections have been developed as more economical building solutions to the alternative heavier hot-rolled sections in the commercial and residential markets. Cold-formed lipped channel beams (LCB), LiteSteel beams (LSB) and hollow flange beams (HFB) are commonly used as flexural members such as floor joists and bearers. However, their shear capacities are determined based on conservative design rules. For the shear design of cold-formed web panels, their elastic shear buckling strength must be determined accurately including the potential post-buckling strength. Currently the elastic shear buckling coefficients of web panels are determined by assuming conservatively that the web panels are simply supported at the junction between the flange and web elements and ignore the post-buckling strength. Hence experimental and numerical studies were conducted to investigate the shear behaviour and strength of LSBs, LCBs and HFBs. New direct strength method (DSM) based design equations were proposed to determine the ultimate shear capacities of cold-formed steel beams. An improved equation for the higher elastic shear buckling coefficient of cold-formed steel beams was proposed based on finite element analysis results and included in the DSM design equations. A new post-buckling coefficient was also introduced in the DSM equation to include the available post-buckling strength of cold-formed steel beams.

Protection of structural systems and mechanisms from catastrophic and life-threatening failure caused by unforeseeable events

Structural framing systems and mechanisms designed for normal use rarely possess adequate robustness to withstand the effects of large impacts, blasts and extreme earthquakes that have been experienced in recent times. Robustness is the property of systems that enables them to survive unforeseen or unusual circumstances (Knoll & Vogel, 2009). Queensland University of Technology with industry collaboration is engaged in a program of research that commenced 15 years ago to study the impact of such unforeseeable phenomena and investigate methods of improving robustness and safety with protective mechanisms embedded or designed in structural systems. This paper highlights some of the research pertaining to seismic protection of building structures, rollover protective structures and effects of vehicular impact and blast on key elements in structures that could propagate catastrophic and disproportionate collapse.

Rebuilding housing after a disaster : factors for failure

Unlike most normal construction projects, post-disaster housing projects are diverse in nature, have unique socio-cultural and economical requirements, and are extremely dynamic and thus necessitate a meaningful and dynamic response. Post-disaster reconstruction practices that lack a strategy compatible with the severity of disaster, community culture, socio-economic requirements, environmental condition, government legislations, and technical and technological situations, often fail to operate and respond effectively to the needs of the wider affected population. Factors that frequently pose real threats to the eventual success of reconstruction projects are rarely given appropriate consideration when designing such projects. Research into past reconstruction practices has shown that ignoring these factors altogether or failing to give them meaningful consideration can affect housing reconstruction projects. In other words, they either miss their targets altogether or undergo serious modifications after their occupancy, subsequently resulting in an overall loss of project resources. This article touches upon the common factors that negatively impact the outcome of such projects.

Risk modelling in quality clinical registries : Monitoring lesion treatment failure rate in percutaneous coronary interventions

Aims: This paper describes the development of a risk adjustment (RA) model predictive of individual lesion treatment failure in percutaneous coronary interventions (PCI) for use in a quality monitoring and improvement program. Methods and results: Prospectively collected data for 3972 consecutive revascularisation procedures (5601 lesions) performed between January 2003 and September 2011 were studied. Data on procedures to September 2009 (n = 3100) were used to identify factors predictive of lesion treatment failure. Factors identified included lesion risk class (p < 0.001), occlusion type (p < 0.001), patient age (p = 0.001), vessel system (p < 0.04), vessel diameter (p < 0.001), unstable angina (p = 0.003) and presence of major cardiac risk factors (p = 0.01). A Bayesian RA model was built using these factors with predictive performance of the model tested on the remaining procedures (area under the receiver operating curve: 0.765, Hosmer–Lemeshow p value: 0.11). Cumulative sum, exponentially weighted moving average and funnel plots were constructed using the RA model and subjectively evaluated. Conclusion: A RA model was developed and applied to SPC monitoring for lesion failure in a PCI database. If linked to appropriate quality improvement governance response protocols, SPC using this RA tool might improve quality control and risk management by identifying variation in performance based on a comparison of observed and expected outcomes.

Anisotropic damage mechanics as a novel approach to improve pre-and post-failure borehole stability analysis

Anisotropic damage distribution and evolution have a profound effect on borehole stress concentrations. Damage evolution is an irreversible process that is not adequately described within classical equilibrium thermodynamics. Therefore, we propose a constitutive model, based on non-equilibrium thermodynamics, that accounts for anisotropic damage distribution, anisotropic damage threshold and anisotropic damage evolution. We implemented this constitutive model numerically, using the finite element method, to calculate stress–strain curves and borehole stresses. The resulting stress–strain curves are distinctively different from linear elastic-brittle and linear elastic-ideal plastic constitutive models and realistically model experimental responses of brittle rocks. We show that the onset of damage evolution leads to an inhomogeneous redistribution of material properties and stresses along the borehole wall. The classical linear elastic-brittle approach to borehole stability analysis systematically overestimates the stress concentrations on the borehole wall, because dissipative strain-softening is underestimated. The proposed damage mechanics approach explicitly models dissipative behaviour and leads to non-conservative mud window estimations. Furthermore, anisotropic rocks with preferential planes of failure, like shales, can be addressed with our model.

Shear capacity of reinforced concrete columns strengthened with CFRP sheet

This paper discusses the results of tests on the shear capacity of reinforced concrete columns strengthened with carbon fiber reinforced plastic (CFRP) sheet. The shear transfer mechanism of the specimens reinforced with CFRP sheet was studied. The factors affecting the shear capacity of reinforced concrete columns strengthened with CFRP sheet were analyzed. Several suggestions such as the number of layers, width and tensile strength of the CFRP sheet are proposed for this new strengthening technique. Finally, a simple and practical design method is presented in the paper. The calculated results of the suggested method are shown to be in good agreement with the test results. The suggested design method can be used in evaluating the shear capacity of reinforced concrete columns strengthened with CFRP sheet.

Shear strength tests of lipped channel beams

This paper presents the details of experimental studies on the shear behaviour and strength of lipped channel beams (LCBs). The LCB sections are commonly used as flexural members in residential, industrial and commercial buildings. To ensure safe and efficient designs of LCBs, many research studies have been undertaken on the flexural behaviour of LCBs. To date, however, limited research has been conducted into the strength of LCB sections subject to shear actions. Therefore a detailed experimental study involving 20 tests was undertaken to investigate the shear behaviour and strength of LCBs. This research has shown the presence of increased shear capacity of LCBs due to the additional fixity along the web to flange juncture, but the current design rules (AS/NZS 4600 and AISI) ignore this effect and were thus found to be conservative. Therefore they were modified by including a higher elastic shear buckling coefficient. Ultimate shear capacity results obtained from the shear tests were compared with the modified shear capacity design rules. It was found that they are still conservative as they ignore the presence of post-buckling strength. Hence the AS/NZS 4600 and AISI design rules were further modified to include the available post-buckling strength. Suitable design rules were also developed under the direct strength method (DSM) format. This paper presents the details of this study and the results including the modified shear design rules.