Angelo D'Elia

First return to work following injury: does it reflect a composite or a homogeneous outcome?

Objective To test whether return to work as a binary (yes/no) outcome that includes all persons who returned to work regardless of mode of return reflects a composite or a homogeneous outcome in a cohort of workers who have sustained acute orthopaedic trauma resulting in hospitalisation. Methods Prospective cohort study. One hundred and sixty-eight participants were recruited and followed for 6 months. The study achieved 89% follow-up. Baseline data were obtained at study recruitment and participants were further surveyed by phone at three timepoints during the study. Polytomous logistic regression was used to simultaneously examine the association between potential predictors and different modes of first return to work (RTW). A test of the equality of the ORs associated with the independent predictor variables was also undertaken. Results Of the 152 participants with full follow-up, 46 (30%) returned first to full duties, 58 (38%) returned first to modified work and 48 (32%) did not return to work during the study period. Significant determinants of the two modes of return to work were different. A test of the equality of ORs indicated that the relative ORs for the difference in the slope coefficients for five of the 10 independent factors in the two polytomous logistic regression sub-models corresponding to each mode of return to work were statistically significant. This raises the likelihood that first RTW reflects a composite rather than a homogeneous outcome. Conclusion The study provides evidence that RTW may reflect a composite outcome when it includes different modes of first RTW. The identified predictive factors appear to exert different mechanisms of action depending on the mode of RTW. The findings suggest that the different modes of RTW may need to be considered independently. The results of the study have potentially important implications for research and insurance practice.

The Selective Silylation of d‐Mannitol Assisted by Phenylboronic Acid and the Solid State and Solution Structures of the Intermediate 1,6‐bis(silyl) bis(phenylboronates)

The influence of phenylboronic acid on the silylation of d‐mannitol by TBDMSCl and TBDPSCl has been investigated. Terminal silyation was found to dominate, with PBA significantly enhancing the yield of 1,6 di‐TBDMS d‐mannitol compared to the control. The intermediate 1,6‐disilyl bis(phenylboronates) showed unusually high stability, such that oxidative conditions were required to cleave the boronate esters. X‐ray crystal structures of both bis(phenylboronates) were determined, revealing both diboronate esters to exist as two fused six‐membered rings. The results of 11B NMR experiments suggest that these structures also predominate in solution, whereas the bis(phenylboronate) ester of d‐mannitol itself exists as a mixture of five‐membered and six‐membered cyclic boronates.

Influence of voluntary standards and design modifications on trampoline injury in Victoria, Australia

Purpose To examine the influence of the voluntary Australian trampoline standard (AS 4989-2006) and market-driven design modifications on relevant trampoline injuries. Methods Trend and intervention analysis on frequencies and proportions of hospital-treated trampoline-related injury in Victoria, Australia, extracted from the Victorian Emergency Minimum Dataset from 1 July 1999 to 30 June 2013. The injuries relevant to the AS were contact with spring and frame, and multiple-user injury. Falls from trampolines were relevant for netted trampolines, a market-driven modification. Results Frequency of all trampoline injuries increased by 11.4% (95% CI 10.0% to 11.7%) on average each year. Spring and frame, and fall injuries increased to a lesser extent (8.7%, 95% CI 6.9% to 9.8% and 7.3%, 95% CI 5.8% to 8.3%, respectively). Multiple-user injuries increased by 21.0% (95% CI 16.3% to 21.9%). As a proportion of all trampoline injuries, spring and frame injury and falls injury decreased, while multiple-user injuries increased. The intervention analysis showed no significant change in spring and frame injuries associated with the AS (p=0.17). A significant increase was found for multiple-user injuries (p=0.01), in particular for the 0-year to 4-year age group (p<0.0001), post 2007. Conclusions There was little evidence for an effect of the voluntary standard on spring and frame injury and none for multiple-user injury. Netted trampolines appear to be associated with a decrease in falls from trampolines but an increase in injuries to multiple users. A mandated trampoline safety standard and a safety campaign including warnings about multiple users is recommended. Continued monitoring of injury data will be required.

Pedestrian Injury Outcome as a Function of Vehicle Market Group in Victoria, Australia

Objective: Pedestrians are among the most vulnerable road users in terms of their risk of serious injury when involved in a collision with a vehicle. In Australia, around 200 pedestrians are killed in road crashes annually and over 2,000 are seriously injured. The objective of the current study was to analyze pedestrian death and injury risk by body region across 10 light passenger and commercial vehicle market groups in Victoria, Australia. Methods: This study utilized police-reported crash data linked to insurance injury compensation claims data during the period 2001–2010 to determine whether pedestrian injury outcome is a function of colliding vehicle type. Logistic regression models were developed to measure the risk of pedestrian death or injury as a function of vehicle market group for 4 body region groupings, namely, all body regions; the head, face, or neck; the thorax; and the lower extremities (including pelvis). Results: Analysis focused on head, face, or neck injury found that pedestrians struck by small cars, people movers, large sport utility vehicles (SUVs), vans, or utility vehicles had statistically significantly higher odds of death or injury compared to large cars. When the analysis focused on thoracic injury, it was again found that pedestrians struck by large SUVs and vans had statistically significantly higher odds of death injury compared to large cars. In particular, the odds of death or thoracic injury is 74.4% higher for large SUVs compared to large cars. Analysis focused on lower extremity injury found no market group with statistically significant different odds of death or injury compared to large cars at the 5% level; however, medium cars and vans were found to have statistically significantly lower odds of death or lower extremity injury at the 10% level. Conclusions: The results suggest that the increasing popularity of vehicles such as SUVs has the potential to lead to an increase in the level of pedestrian road trauma. With the general trend toward the use of larger vehicles, the results provide validation of the importance of improved vehicle design and the incorporation of new pedestrian safety features.

Understanding fatal older road user crash circumstances and risk factors

ABSTRACT Objective: This study used medicolegal data to investigate fatal older road user (ORU) crash circumstances and risk factors relating to four key components of the Safe System approach (e.g., roads and roadsides, vehicles, road users, and speeds) to identify areas of priority for targeted prevention activity. Methods: The Coroners Court of Victorias Surveillance Database was searched to identify coronial records with at least one deceased ORU in the state of Victoria, Australia, for 2013–2014. Information relating to the ORU, crash characteristics and circumstances, and risk factors was extracted and analyzed. Results: The average rate of fatal ORU crashes per 100,000 population was 8.1 (95% confidence interval [CI] 6.0–10.2), which was more than double the average rate of fatal middle-aged road user crashes (3.6, 95% CI 2.5–4.6). There was a significant relationship between age group and deceased road user type (χ2(15, N = 226) = 3.56, p < 0.001). The proportion of deceased drivers decreased with age, whereas the proportion of deceased pedestrians increased with age. The majority of fatal ORU crashes involved a counterpart (another vehicle: 59.4%; fixed/stationary object: 25.4%), and occurred “on road” (87.0%), on roads that were paved (94.2%), dry (74.2%), and had light traffic volume (38.3%). Road user error was identified by the police and/or coroner for the majority of fatal ORU crashes (57.9%), with a significant proportion of deceased ORU deemed to have “misjudged” (40.9%) or “failed to yield” (37.9%). Conclusions: Road user error was the most significant risk factor identified in fatal ORU crashes, which suggests that there is a limited capacity of the Victorian road system to fully accommodate road user errors. Initiatives related to safer roads and roadsides, vehicles, and speed zones, as well as behavioral approaches, are key areas of priority for targeted activity to prevent fatal older road user crashes in the future.