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Vertical loading rate could be associated with residuum and whole body injuries affecting individuals fitted with transtibial prostheses. The objective of this study was to outline one out of five automated methods of extraction of vertical loading rate that stacked up the best against manual detection, which is considered the gold standard during pseudo-prosthetic gait. The load applied on the long axis of the leg of three males was recorded using a transducer fitted between a prosthetic foot and physiotherapy boot while walking on a treadmill for circa 30 min. The automated method of extraction of vertical loading rate, combining the lowest absolute average and range of 95% CI difference compared to the manual method, was deemed the most accurate and precise. The average slope of the loading rate detected manually over 150 strides was 5.56 ± 1.33 kN/s, while the other slopes ranged from 4.43 ± 0.98 kN/s to 6.52 ± 1.64 kN/s depending on the automated detection method. An original method proposed here, relying on progressive loading gradient-based automated extraction, produced the closest results (6%) to manual selection. This work contributes to continuous efforts made by providers of prosthetic and rehabilitation care to generate evidence informing reflective clinical decision-making.

Primary aeromedical retrievals are a direct scene response to patients with a critical injury or illness using a medically equipped aircraft. They are often high-acuity taskings. In Australia, information on primary retrieval taskings is housed by service providers, of which there are many across the country. This exploratory literature review aims to explore the contemporary peer-reviewed literature on primary aeromedical retrievals in Australia. The focus is on adult primary aeromedical retrievals undertaken in Australia and clinical tools used in this pre-hospital setting. Included articles were reviewed for research theme (clinical and equipment, systems and/or outcomes), data coverage and appraisal of the evidence. Of the 37 articles included, majority explored helicopter retrievals (n = 32), retrieval systems (n = 21), compared outcomes within a service (n = 10) and explored retrievals in the state of New South Wales (n = 19). Major topics of focus included retrieval of trauma patients and airway management. Overall, the publications had a lower strength of evidence because of the preponderance of cross-sectional and case-study methodology. This review provides some preliminary but piecemeal insight into primary retrievals in Australia through a localised systems lens. However, there are several areas for research action and service outcome improvements suggested, all of which would be facilitated through the creation of a national pre-hospital and retrieval registry. The creation of a registry would enable consideration of the frequency and context of retrievals, comparison across services, more sophisticated data interrogation. Most importantly, it can lead to service and pre-hospital and retrieval system strengthening.

Introduction: Natural disasters often damage or destroy the protective public health service infrastructure (PHI) required to maintain the health and well-being of people with noncommunicable diseases (NCDs). This interruption increases the risk of an acute exacerbation or complication, potentially leading to a worse long-term prognosis or even death. Disaster-related exacerbations of NCDs will continue, if not increase, due to an increasing prevalence and sustained rise in the frequency and intensity of disasters, along with rapid unsustainable urbanization in flood plains and storm-prone coastal zones. Despite this, the focus of disaster and health systems preparedness and response remains on communicable diseases, even when the actual risk of disease outbreaks post-disaster is low, particularly in developed countries. There is now an urgent need to expand preparedness and response beyond communicable diseases to include people with NCDs.Hypothesis/Problem: The developing evidence-base describing the risk of disaster-related exacerbation of NCDs does not incorporate the perspectives, concerns, and challenges of people actually living with the conditions. To help address this gap, this research explored the key influences on patient ability to successfully manage their NCD after a natural disaster.Methods: A survey of people with NCDs in Queensland, Australia collected data on demographics, disease, disaster experience, and primary concern post-disaster. Descriptive statistics and chi-square tests with a Bonferroni-adjustment were used to analyze data.Results: There were 118 responses to the survey. Key influences on the ability to self-manage post-disaster were access to medication, medical services, water, treatment and care, power, and food. Managing disease-specific symptoms associated with cardiovascular disease, diabetes, mental health, and respiratory diseases were primary concerns following a disaster. Stress and anxiety, loss of sleep, weakness or fatig

The increasing noncommunicable disease burden and frequency of natural disasters across the world has created an immediate need to implement strategies for reducing the risk of indirect mortality and morbidity post disaster. People at greatest risk of their condition worsening or even death post disaster are those with cancer, cardiovascular conditions, diabetes, renal diseases and respiratory diseases. To help reduce this risk, this study ranked and prioritized mitigation strategies based on the perspectives of people with noncommunicable diseases and disaster responders, coordinators and government officials. Data was collected through a sequential modified Delphi process in Queensland, Australia. This included three phases: questionnaire (n = 14); workshop (n = 18); and survey (n = 552). Descriptive statistics were used to group differences and to rank and prioritize mitigation strategies. The research identified 31 mitigation strategies across 12 public health service infrastructure themes. Specific mitigation strategies included: “The need for water treatment plants with back-up power”; “Designated primary healthcare hubs post disaster over health services being designed to be disaster resilient”; and “Streamlining processes for patients to access medication after a disaster”. Access to water was the highest priority public health service infrastructure theme followed by the strategies related to communication, sanitation, workforce, supplies All mitigation strategies are interrelated and together provide a theoretical basis for addressing this problem. To implement they must be integrated into monitoring and performance measures for the disaster and health sectors during non-disaster periods. The result would be a sustainable approach towards reducing indirect mortality and morbidity from noncommunicable diseases post natural disaster.

Issue addressed: Coronial data provide rich information on drowning causal factors. Coroners may make recommendations to prevent future drowning events. Rivers are the leading drowning location in Australia. This study examines coronial recommendations associated with unintentional fatal drowning in Australian rivers from an injury prevention perspective. Methods: All river drowning cases in Australia between 1 July 2002 and 30 June 2012 were extracted from the National Coronial Information System (NCIS). Recommendations were thematically analysed. Using a deductive process, each unique recommendation was coded to a category aligned to the Hierarchy of Control's 6 levels. An inductive process was used for those not categorised. Recommendations were also coded against a modified SMART principle. Results: Of the 730 river drownings, 58 cases (7.9%) resulted in 71 unique recommendations. Victorian cases (X2 = 32.1; P < 0.01) and multiple fatality events (X2 = 41.9; P < 0.01) were more likely to have recommendations. Common categories of recommendations were administrative (39.4%) and signage‐related (18.3%). Recommendations were often low on the Hierarchy; namely administrative (67.6%) and behaviour (19.1%). Half (50.7%) satisfied four of six modified SMART principle components. Conclusion: Coronial recommendations associated with river drowning in Australia are reasonably rare. Recommendations provide opportunities for organisations to enact change, however, they could be strengthened with a specified time period and higher order control strategies recommended. So what? SMART coronial recommendations may be more successful in achieving the behavioural, social and societal change required to prevent future river drownings. The recommendations examined in this study can be used as a benchmark for what could be considered appropriate safety actions.