Can early dietetic intervention improve outcomes in patients with hip fracture?

Aim: To assess whether the introduction of a new approach to nutritional care for hip fracture patients, in both acute and subacute admissions, can improve nutritional status, length of stay and pressure injuries. Methods: Medical records of patients admitted to Austin Health, Melbourne, Australia with a fractured hip between January and June 2014 after implementation of a new nutritional care guideline were compared to a historical control group admitted between January and June 2013 prior to introduction of the guideline. Data were collected for both acute and subacute admissions and included length of stay, date of first contact with a dietitian, subjective global assessment category and occurrence of pressure injuries. Results: There was a significantly shorter length of stay overall for patients who received care under the new guideline (21.6 ± 15.1 vs 26.4 ± 20.4 days; P = 0.043) and during the subacute admission (20.1 ± 10.6 vs 28.8 ± 15.8 days; P < 0.001); however, there was no significant difference in the acute hospital length of stay period. The post-guideline group had a significantly shorter time between admission and first contact with a dietitian (4.8 ± 3.3 vs 7.5 ± 6.2 days; P < 0.001). Post-guideline patients also had a significantly lower incidence of pressure injuries with 29, compared to 41 in pre-guideline patients (P = 0.045). There were significantly less malnourished patients in the post-guideline group compared to the pre-guideline group across both acute and subacute admissions (29% vs 35%; P = 0.015). Conclusions: A nutritional care guideline for patients with hip fractures is associated with improved patient outcomes with a significant reduction in overall and subacute length of stay and pressure injury incidence and earlier dietetic assessment and intervention.

Corporate liability for workplace deaths and injuries-reflecting on Victoria's laws in the light of the Esso Longford explosion

The purpose of this article is to consider some different legal models for the liability of corporations for the deaths and serious injuries of their employees, with particular emphasis on the law in Victoria.

Two recent developments in Victoria prompt this consideration. First, on 30 July 2001, the Victorian Supreme Court handed down its sentencing decision in the case arising from the explosion on 25 September 1998 at the Longford gas plant operated by Esso Australia Pty Ltd. The decision marked the end of the formal public consideration of a devastating event in Victorian industrial history, which began with the Royal Commission set up on 20 October 1998 to investigate the causes of an explosion in which two workers died and eight others were injured. Second, in early 2002, the Victorian Government failed in its attempt to introduce new criminal offences for corporate employers whose employees are killed or seriously injured at work. In spite of their failure to be passed by the Legislative Council in Victoria, these proposals warrant consideration. They represent a growing trend by policy makers in attempting to address more effectively the question of the liability for deaths and serious injuries of workers to employers who operate through the corporate form.

Critical injuries ; collaborative Indigenous life writing and the ethics of criticism

The publication of collaborative Indigenous life writing places both the text and its production under public scrutiny. The same is true for the criticism of life writing. For each, publication has consequences. Taking as its starting point the recent critical concern for harm occasioned in life writing, this
article argues that in the reading of collaborative Indigenous life writing, injury may eventuate from critical commentary itself. The critical work of G Thomas Couser and his concern for vulnerable subjects, whose life narratives reach published form through the efforts or with the assistance of another, has its
parallel in the critical attention given to collaboratively produced Indigenous life writing in Australia and Canada. In some cases, however, such analysis is generated without consultation with the Indigenous producers of collaborative texts. Criticism directing its arguments toward the conditions
of editorial constraint by which the Indigenous subject is enclosed or silenced has the ironic and surely unintended consequence of removing the Indigenous participants of collaboration from the field of critical engagement. With particular regard to the collaborative texts Ingelba and the Five Black Matriarchs and Stolen Life: the journey of a Cree woman, this article argues that literary criticism can benefit from the practice of consultation with the Indigenous subjects whose representations it comments upon.

Effect of the manufacturing process on the interlaminar fracture toughness of 2/2 twill weave fabric carbon/epoxy composites

A 2/2 twill weave fabric carbon fibre reinforced epoxy matrix composite MTM56/CF0300 was used to investigate the effect of different manufacturing processes on the interlaminar fracture toughness. Double cantilever beam tests were performed on composites manufactured by hot press, autoclave and 'Quickstep' processes. The 'Quickstep' process was recently developed in Perth, Western Australia for the manufacture of advanced composite components. The values of the mode I critical strain energy release rate (G1d were compared and the results showed that the composite specimens manufactured by the autoclave and the 'Quickstep' process had much higher interlaminar fracture toughness than the specimen produced by the hot press. When compared to specimens manufactured by the hot press, the interlaminar fracture toughness values of the Quickstep and autoclave samples were 38% and 49% higher respectively. The 'Quickstep' process produced composite specimens that had comparable interlaminar fracture toughness to autoclave manufactured composites. Scanning electron microscopy (SEM) was employed to study the topography of the mode I interlaminar fracture surface and dynamic mechanical analysis (DMA) was performed to investigate the fibre/matrix interphase. SEM micrography and DMA spectra indicated that autoclave and 'Quickstep' produced composites with stronger fibre/matrix adhesion than hot press.

Characterization and analysis of delamination fracture and nanocreep properties in carbon epoxy composites manufactured by different processes

Delamination resistance and nanocreep properties of 2/2 twill weave carbon epoxy composites manufactured by hot press, autoclave, and Quickstep^TM process are characterized and analyzed. Quickstep is a fluid filled, balanced pressure heated floating mold technology, which is recently developed in Perth, Western Australia for the manufacture of advanced composite components. Mode I and Mode II interlaminar fracture toughness tests, and nanoindentation creep tests on matrix materials show that the fast ramp rate of the Quickstep process provides mechanical properties comparable to that of autoclave at a lower cost for composite manufacturing. Low viscosity during ramping process and good fiber wetting are believed to be the reasons that this process produces composites with high delamination and creep-resistant properties. Nanocreep properties are analyzed using a Kelvin–Voigt model.

Equal channel angular pressing of metal matrix composites: effect on particle distribution and fracture toughness

An Al6061-20%Al₂O₃ powder metallurgy (PM) metal matrix composite (MMC) with a strongly clustered particle distribution is subjected to equal channel angular pressing (ECAP) at a temperature of 370 °C. The evolution of the homogeneity of the particle distribution in the material during ECAP is investigated by the quadrat method. The model proposed by Tan and Zhang [Mater Sci Eng 1998;244:80] for estimating the critical particle size which is required for a homogeneous particle distribution in PM MMCs is extended to the case of a combination of extrusion and ECAP. The applicability of the model to predict a homogeneity of the particle distribution after extrusion and ECAP is discussed. It is shown that ECAP leads to an increase of the  uniformity of the particle distribution and the fracture toughness.

Manufacturing influence on the delamination fracture behavior of the T800H/3900-2 carbon fiber reinforced polymer composites

'Torayca' T800H/3900-2 is the first material qualified on Boeing Material Specification (BMS 8-276) which utilizes the thermoplastic-particulate interlayer toughening technology. Two manufacturing processes, the autoclave process and the fast heating rated Quickstep™ process, were employed to cure this material. The Quickstep process is a unique composite production technology which utilizes the fast heat transfer rate of fluid to heat and cure polymer composite components. The manufacturing influence on the mode I delamination fracture toughness of laminates was investigated by performing double cantilever beam tests. The composite specimens fabricated by two processes exhibited dissimilar delamination resistance curves (R-curves) under mode I loading. The initial value of fracture toughness GIC-INIT was 564 J/m2 for the autoclave specimens and 527 J/m2 for the Quickstep specimens. However, the average propagation fracture toughness GIC-PROP was 783 J/m2 for the Quickstep specimens, which was 2.6 times of that for the autoclave specimens. The mechanism of fracture occurred during delamination was studied under scanning electron microscope (SEM). Three types of fracture were observed: the interlayer fracture, the interface fracture, and the intralaminar fracture. These three types of fracture played different roles in affecting the delamination resistance curves during the crack growth. More fiber bridging was found in the process of delamination for the Quickstep specimens. Better fiber/matrix adhesion was found in the Quickstep specimens by conducting indentation-debond tests.

Effect of susceptibility to interfacial fracture on fatigue properties of spot-welded high strength sheet steel

While advanced high strength steels (AHSS) have numerous advantages for the automotive industry, they can be susceptible to interfacial fracture when spot-welded. In this study, the susceptibility of interfacial fracture to spot-weld microstructure and hardness is examined, as well as the corresponding relationships between fatigue, overload performance, and interfacial fracture for a TRIP (transformation induced plasticity) steel. Simple post-weld heat-treatments were used to alter the weld microstructure. The effect on interfacial fracture of diluting the weld pool by welding the TRIP material to non-TRIP steel was examined, along with the effect of altering the base material microstructure. Results show that weld hardness is not a good indicator of either the susceptibility to interfacial fracture, or the strength of the joint, and that interfacial fracture does not necessarily lead to a decrease in strength compared to conventional weld-failure mechanisms, i.e. button pullout. It was also found that while interfacial fracture does affect low cycle to failure behavior, there was no effect on high cycle fatigue.

Temporary agency workers and the contribution of workplace unfamiliarity to workplace injuries

International and Australian research agrees that temporary agency workers have a higher incidence of workplace injury, and those injuries are more severe. Much less research has been undertaken upon the cause of those injuries. This paper explores one factor contributing to their poorer occupational health and safety through an examination of the role of unfamiliarity with the hosts’ tasks and workplace. The paper commences with a review of the temporary agency employment literature relevant to placing workers in unfamiliar workplaces, and the OHS literature related to timing of injuries. Archival research on investigated workers’ compensation claims for a sample of agency workers and direct hire workers in Victoria is then analysed to assess the importance of unfamiliarity, and training undertaken to overcome that unfamiliarity, for these injured workers. The analysis includes an examination of the timing of the injury in relation to the workers’ placement with the host, and regression analysis on a range of characteristics related to newness at a host’s workplace. The findings confirm that agency workers are especially vulnerable to injury early in their placement, and insufficient attention is given to accommodating unfamiliarity to counter workers’ vulnerability in new workplaces.

Rural sports and recreational injuries in Australia: what do we know?

Objective: It is widely recognised that individuals residing in regional or rural areas have poorer health outcomes than those from metropolitan areas. Factors associated with these poorer health outcomes include geographical isolation, population declines, limited health care provision and higher levels of inactivity compared to urban areas. The mental, social and physical health of individuals and communities in rural areas can be improved through active participation in sport and recreation activities. Unfortunately, participation in such activities can potentially lead to injury. There is a suggestion that there is an increased risk of sports injuries in rural areas due to the lack of health professionals and coaching personnel, fewer available volunteers to organise and deliver sport, and the general attitude towards injuries in rural settings.

Results: There is very limited information about the number and types of injuries sustained during participation in sports activities in rural and regional settings. This is largely related to a lack of formal sporting structures and support mechanisms including research funding and trained personnel.

Conclusion: A range of factors need to be implemented to improve safety for sporting and recreational participants in these areas. These include improved monitoring of injury occurrence, stronger promotion of safety initiatives and wider implementation of education strategies.

The relationship between childhood injuries and family type

This article focuses on the relationship between childhood injuries and family type. Injury is the leading cause of death among children in Australia. While children in sole-parent families were over-represented among the 17 percent of children who sustained an injury in the Growing Up in Australia study, once socio-economic indicators were taken into account, the increased risk for injury for children in a sole-parent family was no longer apparent. The Draft National Injury Prevention Plan was developed by the Australian Government Department of Health and Aging to aid in efforts for the prevention of child injury.

The effect of osteoporotic vertebral fracture of predicted spinal loads in vivo

he aetiology of osteoporotic vertebral fractures is multi-factorial, and cannot be explained solely by low bone mass. After sustaining an initial vertebral fracture, the risk of subsequent fracture increases greatly. Examination of physiologic loads imposed on vertebral bodies may help to explain a mechanism underlying this fracture cascade. This study tested the hypothesis that model-derived segmental vertebral loading is greater in individuals who have sustained an osteoporotic vertebral fracture compared to those with osteoporosis and no history of fracture. Flexion moments, and compression and shear loads were calculated from T2 to L5 in 12 participants with fractures (66.4 ± 6.4 years, 162.2 ± 5.1 cm, 69.1 ± 11.2 kg) and 19 without fractures (62.9 ± 7.9 years, 158.3 ± 4.4 cm, 59.3 ± 8.9 kg) while standing. Static analysis was used to solve gravitational loads while muscle-derived forces were calculated using a detailed trunk muscle model driven by optimization with a cost function set to minimise muscle fatigue. Least squares regression was used to derive polynomial functions to describe normalised load profiles. Regression co-efficients were compared between groups to examine differences in loading profiles. Loading at the fractured level, and at one level above and below, were also compared between groups. The fracture group had significantly greater normalised compression (p = 0.0008) and shear force (p < 0.0001) profiles and a trend for a greater flexion moment profile. At the level of fracture, a significantly greater flexion moment (p = 0.001) and shear force (p < 0.001) was observed in the fracture group. A greater flexion moment (p = 0.003) and compression force (p = 0.007) one level below the fracture, and a greater flexion moment (p = 0.002) and shear force (p = 0.002) one level above the fracture was observed in the fracture group. The differences observed in multi-level spinal loading between the groups may explain a mechanism for increased risk of subsequent vertebral fractures. Interventions aimed at restoring vertebral morphology or reduce thoracic curvature may assist in normalising spine load profiles.

Pathology of chronic achilles-tendon injuries in athletes

Overuse tendon conditions have traditionally been considered to result from an inflammatory process and were treated as such. Microscopic examination of abnormal Achilles-tendon tissues, however, reveals a non-inflammatory degenerative process. The histopathology found in surgical specimens in patients with chronic overuse Achilles tendinopathy and those with Achilles-tendon rupture are reviewed. Seminal studies suggest that so-called tendinitis is a rare condition that might occur occasionally in the Achilles tendon in association with a primary tendinosis. These data have clinical implications and require a review of the traditional classification of pathologies seen in tendon conditions, The authors recommend that nomenclature be based on histopathological findings rather than traditional hypothesis.