Work related musculoskeletal disorders amongst therapists in physically demanding roles: Qualitative analysis of risk factors and strategies for prevention

Background Physiotherapy and occupational therapy are two professions at high risk of work related musculoskeletal disorders (WRMD). This investigation aimed to identify risk factors for WRMD as perceived by the health professionals working in these roles (Aim 1), as well as current and future strategies they perceive will allow them to continue to work in physically demanding clinical roles (Aim 2). Methods A two phase exploratory investigation was undertaken. The first phase included a survey administered via a web based platform with qualitative open response items. The second phase involved four focus group sessions which explored topics obtained from the survey. Thematic analysis of qualitative data from the survey and focus groups was undertaken. Results Overall 112 (34.3%) of invited health professionals completed the survey; 66 (58.9%) were physiotherapists and 46 (41.1%) were occupational therapists. Twenty-four health professionals participated in one of four focus groups. The risk factors most frequently perceived by health professionals included: work postures and movements, lifting or carrying, patient related factors and repetitive tasks. The six primary themes for strategies to allow therapists to continue to work in physically demanding clinical roles included: organisational strategies, workload or work allocation, work practices, work environment and equipment, physical condition and capacity, and education and training. Conclusions Risk factors as well as current and potential strategies for reducing WRMD amongst these health professionals working in clinically demanding roles have been identified and discussed. Further investigation regarding the relative effectiveness of these strategies is warranted.

Falls after discharge from hospital : is there a gap between older peoples' knowledge about falls prevention strategies and the research evidence?

Purpose: The aim of this study was to examine whether older people are prepared to engage in appropriate falls prevention strategies after discharge from hospital. Design and Methods We used a semi-structured interview to survey older patients about to be discharged from hospital and examined their knowledge regarding falls prevention strategies to utilize in the post-discharge period. The study was part of a prospective cohort study, nested within a larger, randomized controlled trial. Participants (n = 333) were asked to suggest strategies to reduce their falls risk at home after discharge, and their responses were compared with current reported research evidence for falls prevention interventions.  Results Participants’ strategies (n = 629) were classified into 7 categories: behavioral, support while mobilizing, approach to movement, physical environment, visual, medical, and activities or exercise. Although exercise has been identified as an effective falls risk reduction strategy, only 2.9% of participants suggested engaging in exercises. Falls prevention was most often conceptualized by participants as requiring 1 (35.4%) or 2 (40.8%) strategies for avoiding an accidental event, rather than engaging in sustained multiple risk reduction behaviors.  Implications Results demonstrate that older patients have low levels of knowledge about appropriate falls prevention strategies that could be used after discharge in spite of their increased falls risk during this period. Findings suggest that health care workers should design and deliver falls prevention education programs specifically targeted to older people who are to be discharged from hospital.

Assessment of tumor prevention in Type 1 Neurofibromatosis using a nitroxide compound

Background Type 1 Neurofibromatosis (NF1) is a genetic disorder linked to mutations of the NF1 gene. Clinical symptoms are varied, but hallmark features of the disease include skin pigmentation anomalies (café au lait macules, skinfold freckling) and dermal neurofibromas. Method These dermal manifestations of NF1 have previously been reported in a mouse model where Nf1+/− mice are topically treated with dimethylbenz[a]anthracene (DMBA) and 12-O-tetradecanoylphorbol-13-acetate (TPA). We adopted this mouse model to test the protective effects of a nitroxide antioxidant, 5-carboxy-1,1,3,3-tetramethylisoindolin-2-yloxyl (CTMIO). Antioxidants have previously been shown to increase longevity in nf1-deficient fruitflies. Doses of 4 μM and 40 μM CTMIO provided ad libitum in drinking water were given to Nf1-deficient mice. Results Consistent with previous reports, Nf1-deficient mice showed a 4.7-fold increase in papilloma formation (P < 0.036). However, neither dose of CTMIO had any significant affect on papilloma formation. A non-significant decrease in skin pigmentation abnormalities was seen with 4 μM but not 40 μM CTMIO. Subsequent analysis of genomic DNA isolated from papillomas indicated that DMBA/TPA induced tumors did not exhibit a local loss of heterozygosity (LOH) at the Nf1 locus. Conclusion These data reveal that oral antioxidant therapy with CTMIO does not reduce tumor formation in a multistage cancer model, but also that this model does not feature LOH for Nf1.

Symmetry of in-shoe force signatures in athletes under field conditions : an application for injury prevention

The aetiology behind overuse injuries such as stress fractures is complex and multi-factorial. In sporting events where the loading is likely to be uneven (e.g. hurdling and jumps), research has suggested that the frequency of stress fractures seems to favour the athlete’s dominant limb. The tendency for an individual to have a preferred limb for voluntary motor acts makes limb selection a possible factor behind the development of unilateral overuse injuries, particularly when repeatedly used during high loading activities. The event of sprint hurdling is well suited for the study of loading asymmetry as the hurdling technique is repetitive and the limb movement asymmetrical. Of relevance to this study is the high incidence of Navicular Stress Fractures (NSF) in hurdlers, with suggestions there is a tendency for the fracture to develop in the trail leg foot, although this is not fully accepted. The Ground Reaction Force (GRF) with each foot contact is influenced by the hurdle action, with research finding step-to-step loading variations. However, it is unknown if this loading asymmetry extends to individual forefoot joints, thereby influencing stress fracture development. The first part of the study involved a series of investigations using a commercially available matrix style in-shoe sensor system (FscanTM, Tekscan Inc.). The suitability of insole sensor systems and custom made discrete sensors for use in hurdling-related training activities was assessed. The methodology used to analyse foot loading with each technology was investigated. The insole and discrete sensors systems tested proved to be unsuitable for use during full pace hurdling. Instead, a running barrier task designed to replicate the four repetitive foot contacts present during hurdling was assessed. This involved the clearance of a series of 6 barriers (low training hurdles), place in a straight line, using 4 strides between each. The second part of the study involved the analysis of "inter-limb" and "within foot loading asymmetries" using stance duration as well as vertical GRF under the Hallux (T1), the first metatarsal head (M1) and the central forefoot peak pressure site (M2), during walking, running, and running with barrier clearances. The contribution to loading asymmetry that each of the four repetitive foot contacts made during a series of barrier clearances was also assessed. Inter-limb asymmetry, in forefoot loading, occurred at discrete forefoot sites in a non-uniform manner across the three gait conditions. When the individual barrier foot contacts were compared, the stance duration was asymmetrical and the proportion of total forefoot load at M2 was asymmetrical. There were no significant differences between the proportion of forefoot load at M1, compared to M2; for any of the steps involved in the barrier clearance. A case study testing experimental (discrete) sensors during full pace sprinting and hurdling found that during both gait conditions, the trail limb experienced the greater vertical GRF at M1 and M2. During full pace hurdling, increased stance duration and vertical loading was a characteristic of the trail limb hurdle foot contacts. Commercially available in-shoe systems are not suitable for on field assessment of full pace hurdling. For the use of discrete sensor technology to become commonplace in the field, more robust sensors need to be developed.

Numerical modelling of load bearing LSF Walls under fire conditions

Abstract. Fire safety of light gauge cold-formed steel frame (LSF) stud walls is significant in the design of buildings. In this research, finite element thermal models of both the traditional LSF wall panels with cavity insulation and the new LSF composite wall panels were developed to simulate their thermal behaviour under standard and real design fire conditions. Suitable thermal properties were proposed for plasterboards and insulations based on laboratory tests and literature review. The developed models were then validated by comparing their results with available fire test results. 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.

Risk management and injury prevention : competencies, behaviours, and attitudes to safety in the construction industry

Work in the Australian construction industry is fraught with risk and the potential for serious harm. The industry is consistently placed within the three most hazardous industries to work along with other industries such as mining and transport (National Occupational Health and Safety Commission, 2003). In the 2001 to 2002 period, construction work killed 39 people and injured 13,250 more. Hence, more effort is required to reduce the injury rate and maximise the value of the rehabilitation/back-to-work process.

Numerical and experimental studies of cold-formed steel floor systems under standard fire conditions

Light gauge cold-formed steel frame (LSF) structures are increasingly used in industrial, commercial and residential buildings because of their non-combustibility, dimensional stability, and ease of installation. A floor-ceiling system is an example of its applications. LSF floor-ceiling systems must be designed to serve as fire compartment boundaries and provide adequate fire resistance. Fire rated floor-ceiling assemblies formed with new materials and construction methodologies have been increasingly used in buildings. However, limited research has been undertaken in the past and hence a thorough understanding of their fire resistance behaviour is not available. Recently a new composite panel in which an external insulation layer is used between two plasterboards has been developed at QUT to provide a higher fire rating to LSF floors under standard fire conditions. But its increased fire rating could not be determined using the currently available design methods. Research on LSF floor systems under fire conditions is relatively recent and the behaviour of floor joists and other components in the systems is not fully understood. The present design methods thus require the use of expensive fire protection materials to protect them from excessive heat increase during a fire. This leads to uneconomical and conservative designs. Fire rating of these floor systems is provided simply by adding more plasterboard sheets to the steel joists and such an approach is totally inefficient. Hence a detailed fire research study was undertaken into the structural and thermal performance of LSF floor systems including those protected by the new composite panel system using full scale fire tests and extensive numerical studies. Experimental study included both the conventional and the new steel floor-ceiling systems under structural and fire loads using a gas furnace designed to deliver heat in accordance with the standard time- temperature curve in AS 1530.4 (SA, 2005). Fire tests included the behavioural and deflection characteristics of LSF floor joists until failure as well as related time-temperature measurements across the section and along the length of all the specimens. Full scale fire tests have shown that the structural and thermal performance of externally insulated LSF floor system was superior than traditional LSF floors with or without cavity insulation. Therefore this research recommends the use of the new composite panel system for cold-formed LSF floor-ceiling systems. The numerical analyses of LSF floor joists were undertaken using the finite element program ABAQUS based on the measured time-temperature profiles obtained from fire tests under both steady state and transient state conditions. Mechanical properties at elevated temperatures were considered based on the equations proposed by Dolamune Kankanamge and Mahendran (2011). Finite element models were calibrated using the full scale test results and used to further provide a detailed understanding of the structural fire behaviour of the LSF floor-ceiling systems. The models also confirmed the superior performance of the new composite panel system. The validated model was then used in a detailed parametric study. Fire tests and the numerical studies showed that plasterboards provided sufficient lateral restraint to LSF floor joists until their failure. Hence only the section moment capacity of LSF floor joists subjected to local buckling effects was considered in this research. To predict the section moment capacity at elevated temperatures, the effective section modulus of joists at ambient temperature is generally considered adequate. However, this research has shown that it leads to considerable over- estimation of the local buckling capacity of joist subject to non-uniform temperature distributions under fire conditions. Therefore new simplified fire design rules were proposed for LSF floor joist to determine the section moment capacity at elevated temperature based on AS/NZS 4600 (SA, 2005), NAS (AISI, 2007) and Eurocode 3 Part 1.3 (ECS, 2006). The accuracy of the proposed fire design rules was verified with finite element analysis results. A spread sheet based design tool was also developed based on these design rules to predict the failure load ratio versus time, moment capacity versus time and temperature for various LSF floor configurations. Idealised time-temperature profiles of LSF floor joists were developed based on fire test measurements. They were used in the detailed parametric study to fully understand the structural and fire behaviour of LSF floor panels. Simple design rules were also proposed to predict both critical average joist temperatures and failure times (fire rating) of LSF floor systems with various floor configurations and structural parameters under any given load ratio. Findings from this research have led to a comprehensive understanding of the structural and fire behaviour of LSF floor systems including those protected by the new composite panel, and simple design methods. These design rules were proposed within the guidelines of the Australian/New Zealand, American and European cold- formed steel structures standard codes of practice. These may also lead to further improvements to fire resistance through suitable modifications to the current composite panel system.

Fire Tests of Cold-formed Steel Wall Systems

Cold-formed steel stud walls are an important component of Light Steel Framing (LSF) building systems used in commercial, industrial and residential buildings. In the conventional LSF stud wall systems, thin-walled steel studs are protected from fire by placing one or two layers of plasterboard on both sides with or without cavity insulation. However, there is very limited data about the structural and thermal performance of these wall systems while past research showed contradicting results about the benefits of cavity insulation. This research proposed a new LSF stud wall system in which a composite panel made of two plasterboards with insulation between them was used to improve the fire rating of walls. Full scale fire tests were conducted using both conventional steel stud walls with and without the use of cavity insulation and the new composite panel system. Eleven full scale load bearing wall specimens were tested to study the thermal and structural performances of the load bearing wall assemblies under standard fire conditions. These tests showed that the use of cavity insulation led to inferior fire performance of walls while also providing good explanations and supporting test data to overcome the incorrect industry assumptions about cavity insulation. Tests demonstrated that the use of external insulation in a composite panel form enhanced the thermal and structural performances of stud walls and increased their fire resistance rating significantly. This paper presents the details of the full scale fire tests of load-bearing wall assemblies lined with plasterboards and different types of insulation under varying load ratios. Test results including the temperature and deflection profiles of walls measured during the fire tests will be presented along with their failure modes and failure times.