Autonomous healing of fatigue cracks via cold welding.

Fatigue in metals involves gradual failure through incremental propagation of cracks under repetitive mechanical load. In structural applications, fatigue accounts for up to 90% of in-service failure1,2. Prevention of fatigue relies on implementation of large safety factors and inefficient overdesign3. In traditional metallurgical design for fatigue resistance, microstructures are developed to either arrest or slow the progression of cracks. Crack growth is assumed to be irreversible. By contrast, in other material classes, there is a compelling alternative based on latent healing mechanisms and damage reversal4-9. Here, we report that fatigue cracks in pure metals can undergo intrinsic self-healing. We directly observe the early progression of nanoscale fatigue cracks, and as expected, the cracks advance, deflect and arrest at local microstructural barriers. However, unexpectedly, cracks were also observed to heal by a process that can be described as crack flank cold welding induced by a combination of local stress state and grain boundary migration. The premise that fatigue cracks can autonomously heal in metals through local interaction with microstructural features challenges the most fundamental theories on how engineers design and evaluate fatigue life in structural materials. We discuss the implications for fatigue in a variety of service environments.

The Buffalo Concussion Treadmill and Bike Tests in People With Mild-to-Moderate Traumatic Brain Injury: An Exploratory Clinical Audit.

OBJECTIVE: To assess the performance on the Buffalo Concussion Treadmill and Bike Tests in nonathletic people following a mild-to-moderate traumatic brain injury. SETTING: An outpatient rehabilitation clinic. PARTICIPANTS: Forty-nine patients with mild-to-moderate traumatic brain injury who underwent the Buffalo Concussion Treadmill or Bike Test as usual clinical care. DESIGN: A retrospective clinical audit. MAIN MEASURES: Demographics and brain injury-specific clinical data, Depression Anxiety Stress Scale; Rivermead Post-Concussion Symptom Questionnaire, and performance outcomes on the Buffalo Concussion Treadmill or Bike Test. RESULTS: Forty-nine patients (mean age: 33.7 ± 13.0 years), on average 56.2 ± 36.4 days post-injury, completed the Buffalo Concussion Treadmill or Bike Test. Fourteen patients stopped the test due to symptom exacerbation with a mean test duration of 8.1 ± 4.5 minutes, reaching an age-predicted maximum heart rate of 72.9% ± 12.4% and reporting a rating of perceived exertion of 13.4 ± 2.2. Those who terminated the test for other reasons had a significantly longer test duration (14.0 ± 4.7 minutes, P = .01), with a higher age-predicted maximum heart rate (83.3% ± 12.8%, P = .01) and rating of perceived exertion (17.0 ± 2.5, P = .01). Within the group who stopped for other reasons, 10 were due to symptoms deemed unrelated to the injury at the time of the test and 2 were stopped by the therapist for safety reasons. A significant but weak correlation between heart rate and rating of perceived exertion existed only for those who terminated the test for other reasons ( r = 0.38, P = .02). Overall, a shorter test duration was associated with higher scores of both self-reported depression ( r = -0.41, P < .01) and late postconcussion symptoms ( r = -0.40, P < .01). CONCLUSION: The Buffalo Concussion Treadmill or Bike Test can be used in the nonathletic mild-to-moderate traumatic brain injury population to differentiate between those who experience symptom exacerbation during exercise and those who do not based on symptom exacerbation, test duration, and poor perception of exertion. Further research is required to determine whether other reasons for test termination are related to the injury.

A Systematic Review of Outcomes Measured Following New Wheelchair and Seating-Prescription Interventions in Adults.

Objectives: To determine the outcomes and outcome-measurement tools currently used during the prescription of new wheelchairs and/or seating systems. A systematic review of studies was performed to identify outcome-measurement tools. Data Sources: MEDLINE, CINAHL, EMBASE, and PsycINFO were searched from earliest available to March 2022. Study Selection: Studies were included if they focused on a new wheelchair or seating-system prescription with adults. Data Extraction: Data extraction and quality assessments were conducted by 2 reviewers; disagreements were resolved by consensus. Risk of bias was assessed using the PEDro scale (for randomized controlled trials) and the Newcastle-Ottawa Quality Assessment Scale (for non-randomized studies). Data Synthesis: 48 articles were included which identified 37 standardized outcome-measurement tools. Use of study-specific outcome-measurement tools was common. Wheelchair use, user satisfaction, activity, and participation were the most studied outcome domains. Commonly used standardized assessments included the QUEST 2.0, functional independence measure, WHODAS II, IPPA, and PIADS. Conclusion: Outcome measures to evaluate wheelchair and seating-system prescription vary, and the use of study-specific outcome-measurement tools is high. There is a need to choose consistent outcome measures that are reliable and valid, and deal with this complex area through ensuring carefully constructed study designs.

Sample Preparation and Experimental Design for In Situ Multi-Beam Transmission Electron Microscopy Irradiation Experiments.

There is a need to understand materials exposed to overlapping extreme environments such as high temperature, radiation, or mechanical stress. When these stressors are combined there may be synergistic effects that enable unique microstructural evolution mechanisms to activate. Understanding of these mechanisms is necessary for the input and refinement of predictive models and critical for engineering of next generation materials. The basic physics and underlying mechanisms require advanced tools to be investigated. The in situ ion irradiation transmission electron microscope (I³TEM) is designed to explore these principles. To quantitatively probe the complex dynamic interactions in materials, careful preparation of samples and consideration of experimental design is required. Particular handling or preparation of samples can easily introduce damage or features that obfuscate the measurements. There is no one correct way to prepare a sample; however, many mistakes can be made. The most common errors and things to consider are highlighted within. The I³TEM has many adjustable variables and a large potential experimental space, therefore it is best to design experiments with a specific scientific question or questions in mind. Experiments have been performed on large number of sample geometries, material classes, and with many irradiation conditions. The following are a subset of examples that demonstrate unique in situ capabilities utilizing the I3TEM. Au nanoparticles prepared by drop casting have been used to investigate the effects of single ion strikes. Au thin films have been used in studies on the effects of multibeam irradiation on microstructure evolution. Zr films have been exposed to irradiation and mechanical tension to examine creep. Ag nanopillars were subjected to simultaneous high temperature, mechanical compression, and ion irradiation to study irradiation induced creep as well. These results impact fields including: structural materials, nuclear energy, energy storage, catalysis, and microelectronics in space environments.

Effects of the CarFreeMe Traumatic Injuries, a Community Mobility Group Intervention, to Increase Community Participation for People With Traumatic Injuries: A Randomized Controlled Trial With Crossover.

Introduction: After traumatic injuries community participation is a common goal, promoting wellbeing and independence. Community mobility and transportation influence an individual's independence in community participation. With the ability to drive safely often compromised after traumatic injuries, the adverse consequences of driving cessation include a loss of identity and reduced participation in chosen activities. In rehabilitation, individualized community mobility intervention is not routinely provided. The primary aim of this trial was to evaluate whether a group-based intervention, the CarFreeMe TI program was more effective than standard intervention, an information sheet of alternative transport, in improving community mobility for people following traumatic injuries. The secondary aim of this study was to evaluate the effect: types of transport used, transport satisfaction, community mobility self-efficacy, quality of life, goal satisfaction and performance, for people following traumatic injuries; and to undertake a preliminary assessment of the potential resource use associated with the intervention, and lessons for implementation. Design: Prospective, pilot, randomized, blind observer, controlled trial with crossover. Participants: Twenty individuals with traumatic injuries. Intervention: Six-week group-based support and education program, the CarFreeMe TI delivered in community settings (intervention) and standard information related to transport options available (control). Primary Outcome Measures: Community participation using a Global Positioning System device to record the location and number of outings from home. Secondary Outcome Measures: CarFreeMe TI Transport Questionnaire, Community Mobility Self-efficacy Scale, quality of life measures, Modified Canadian Occupational Performance Measure for goals (importance and satisfaction), participant satisfaction survey results and researcher logs. Results: Those who received the intervention were more likely to use public transport and transport services and had an improved quality of life, when compared to the control group. The intervention group also reported high levels of improvement in goal performance and satisfaction. Global Positioning System data collection was incomplete, with geolocation data unusable. There was no significant change in number/type of visits away from home. Conclusions: A group-based community mobility education program promoted modes of active independent transport but did not impact on outings from home. Future research could include passive collection methods using a smartphone to record community participation. Clinical Trial Registration: https://www.anzctr.org.au/, identifier: ACTRN12616001254482.

Irradiation-induced grain boundary facet motion: In situ observations and atomic-scale mechanisms.

Metals subjected to irradiation environments undergo microstructural evolution and concomitant degradation, yet the nanoscale mechanisms for such evolution remain elusive. Here, we combine in situ heavy ion irradiation, atomic resolution microscopy, and atomistic simulation to elucidate how radiation damage and interfacial defects interplay to control grain boundary (GB) motion. While classical notions of boundary evolution under irradiation rest on simple ideas of curvature-driven motion, the reality is far more complex. Focusing on an ion-irradiated Pt Σ3 GB, we show how this boundary evolves by the motion of 120° facet junctions separating nanoscale {112} facets. Our analysis considers the short- and mid-range ion interactions, which roughen the facets and induce local motion, and longer-range interactions associated with interfacial disconnections, which accommodate the intergranular misorientation. We suggest how climb of these disconnections could drive coordinated facet junction motion. These findings emphasize that both local and longer-range, collective interactions are important to understanding irradiation-induced interfacial evolution.

Physical exercise for people with mild traumatic brain injury: A systematic review of randomized controlled trials.

BACKGROUND: Recent research recommends physical exercise rather than rest following a mild traumatic brain injury (mTBI). OBJECTIVE: To determine the effect of physical exercise on persistent symptoms in people with mTBI. METHODS: A search of randomized controlled trials was conducted in CINAHL, Cochrane Library, EMBASE, MEDLINE, SportDiscus and Web of Science, from 2010 to January 2021. Studies were included if they described the effects of a physical exercise intervention in people with mTBI on persistent symptoms. Study quality, intervention reporting, and confidence in review findings were assessed with the CASP, TIDieR and GRADE respectively. RESULTS: 11 eligible studies were identified for inclusion. Study interventions broadly comprised of two categories of physical exercise, i.e., aerobic (n = 8) and vestibular (n = 3). A meta-analysis (n = 3) revealed the aerobic exercise group improvement was significantly larger compared to the usual care group -0.39 (95% CI: -0.73 to -0.05, p = 0.03). Only three studies using vestibular exercise reported on persistent symptoms and yielded mixed results. CONCLUSIONS: This study demonstrated that the use of aerobic exercise is supported by mixed quality evidence and moderate certainty of evidence, yet there is limited evidence for the use of vestibular exercise for improving persistent symptoms in people with mTBI.

Integrating community participation in the transition of older adults from hospital to home: a scoping review.

INTRODUCTION: Benefits of community participation and physical activity for the health and wellbeing of older adults are well documented. This review aims to answer the question; "How is community participation considered for older adults in the transition from hospital to home?" MATERIALS AND METHODS: This scoping review searched key databases using subject headings and keywords. Two independent reviewers selected studies based on a systematic procedure. Inclusion criteria were adults aged ≥60 years, transitioning from hospital to home, reporting on community participation, inclusive of leisure activities, social activities, and physical activity. RESULTS: Of 2206 initial unique articles, 19 met inclusion criteria. Articles covered a range of diagnoses, most frequently stroke, hip replacement, or fracture. Numerous measures of community participation were reported, identifying "low" and "reduced" community participation in ten studies. Measures of physical activity, health-related quality of life, sleep quality, and loneliness were variable. Five studies reported interventions and four reported improved components of community participation. Numerous barriers to community participation were identified, with recommendations for future transition care services considered. CONCLUSION: There are considerable barriers to promoting community participation in transition care services for older people. Older adults need information to prepare for returning home from hospital and to regain valued leisure and social activities for health-related quality of life.IMPLICATIONS FOR REHABILITATIONCommunity participation is an important component of healthy ageing which health professionals should consider beyond discharge.Levels of mobility and endurance should be considered in terms of facilitating community participation for older adults.Transition care services should provide adequate information to prepare individuals expectations of returning home following hospital stay, whilst attempting to maintain valued leisure and social activities.

Chair design for older immobile people: Comparison of pressure mapping and manual handling outcomes.

The number of older adults unable to transfer or ambulate independently is increasing. High support chairs enable people experiencing loss of mobility to be mobile, but current chair designs are associated with global functional loss and pressure ulcers. This pilot study compared the functionality of a traditional design high support chair to a new design of motorised high support chair: 1) a motion laboratory study compared joint angles and pressure at the hip, knee, ankle, elbow and spine when pushing each chair, and 2) a pressure mapping study compared the interface pressure when older people with limited mobility used the chairs. Significant reduction in joint angles for the person pushing the chair (degree difference range -3.6 to 14.2) and decreased seated pressure (w/kg difference range -0.2 to 2.1) for the seated user were identified for the motorised chair. Longitudinal investigations are required to determine if the significant differences identified in this pilot study result in less manual handling injuries and pressure areas.

A study of the accuracy of the Fitbit Zip in measuring steps both indoors and outdoors in a mixed rehabilitation population.

OBJECTIVE: To assess (1) step count accuracy of the Fitbit Zip, compared to manual step count, in people receiving outpatient rehabilitation, in indoor and outdoor conditions, and (2) impact of slow walking speed on Fitbit accuracy. DESIGN: Observational study. SETTING: A metropolitan rehabilitation hospital. SUBJECTS: Adults (n = 88) attending a subacute rehabilitation outpatient clinic with walking speeds of between 0.4 and 1.0 m/s. INTERVENTIONS: Two 2-minute walk tests, one indoors and one outdoors, completed in random order. MAIN MEASURES: Step count recorded manually by observation and by a Fitbit Zip, attached to the shoe on the dominant or non-affected side. Subgroup analysis included assessment accuracy for those considered limited community walkers (slower than 0.8 m/s) and those considered community walkers (faster than 0.8 m/s). RESULTS: The Fitbit significantly (P < 0.05) undercounted steps compared to manual step count, indoors and outdoors, with percentage agreement slightly higher outdoors (mean 92.4%) than indoors (90.1%). Overall, there was excellent consistent agreement between the Fitbit and manual step count for both indoor (ICC 0.83) and outdoor (ICC 0.88) walks. The accuracy of the Fitbit was significantly (P < 0.05) reduced in those who walked slower than 0.8 m/s outdoors (ICC 0.80) compared to those who walk faster than 0.8 m/s (ICC 0.90). CONCLUSIONS: The Fitbit Zip shows high step count accuracy with manual step count in a mixed subacute rehabilitation population. However, accuracy is affected by walking speed, with decreased accuracy in limited community walkers.

Photo-exfoliation of MoS2quantum dots from nanosheets: anin situtransmission electron microscopy study.

Fabrication of transition metal dichalcogenide quantum dots (QDs) is complex and requires submerging powders in binary solvents and constant tuning of wavelength and pulsed frequency of light to achieve a desired reaction. Instead of liquid state photoexfoliation, we utilize infrared laser irradiation of free-standing MoS2flakes in transmission electron microscope (TEM) to achieve solid-state multi-level photoexfoliation of QDs. By investigating the steps involved in photochemical reaction between the surface of MoS2and the laser beam, we gain insight into each step of the photoexfoliation mechanism and observe high yield production of QDs, led by an inhomogeneous crystalline size distribution. Additionally, by using a laser with a lower energy than the indirect optical transition of bulk MoS2, we conclude that the underlying phenomena behind the photoexfoliation is from multi-photon absorption achieved at high optical outputs from the laser source. These findings provide an environmentally friendly synthesis method to fabricate QDs for potential applications in biomedicine, optoelectronics, and fluorescence sensing.

Towards a Clinical Decision-Making Algorithm Guiding Locomotor Therapy Modality in Subacute Stroke: An Exploratory Study.

OBJECTIVES: To propose a clinical decision-making algorithm guiding modality choice and transition from the Lokomat® robotic to body-weight supported treadmill training in subacute stroke, due to current evidence being limited, making clinical decisions difficult. MATERIALS AND METHODS: For 10 adult patients with subacute stroke completing Lokomat® therapy, physiotherapist clinical judgement regarding body-weight supported treadmill training readiness and the following objective measurements were collected; Functional Ambulation Category; sit to stand/standing ability; Lokomat® settings; maximal active hip and knee flexion in standing; and gait biomechanics during body-weight supported treadmill training. Based on observed patterns a proposed clinical decision-making algorithm was developed. RESULTS: Clinical judgement deemed four of 10 participants ready to transition to body-weight supported treadmill training. Unlike participants judged not ready, these participants had: a) a Functional Ambulation Category of 1; b) independence with sit to stand and standing with even weight bearing; c) Lokomat®: Body-Weight Support <30%, Guidance Force <30-35%, speed >2.0kph; d) >45° standing active hip and knee flexion; e) no significant issues with physiological stepping in treadmill training or only requiring assistance from one therapist to achieve this. CONCLUSION: Participants judged ready for transition from the Lokomat® to body-weight supported treadmill training presented with increased independent functional ability, more challenging Lokomat® settings, greater active volitional lower-limb control, and less issues with physiological stepping in treadmill training, than those participants judged not ready. Results were translated into a proposed clinical decision-making algorithm guiding transition from the Lokomat® to body-weight supported treadmill training, to be further tested in clinical trials.

Evidence for a High Temperature Whisker Growth Mechanism Active in Tungsten during In Situ Nanopillar Compression.

A series of nanopillar compression tests were performed on tungsten as a function of temperature using in situ transmission electron microscopy with localized laser heating. Surface oxidation was observed to form on the pillars and grow in thickness with increasing temperature. Deformation between 850 °C and 1120 °C is facilitated by long-range diffusional transport from the tungsten pillar onto adjacent regions of the Y2O3-stabilized ZrO2 indenter. The constraint imposed by the surface oxidation is hypothesized to underly this mechanism for localized plasticity, which is generally the so-called whisker growth mechanism. The results are discussed in context of the tungsten fuzz growth mechanism in He plasma-facing environments. The two processes exhibit similar morphological features and the conditions under which fuzz evolves appear to satisfy the conditions necessary to induce whisker growth.

Percolation of Ion-Irradiation-Induced Disorder in Complex Oxide Interfaces.

Mastery of order-disorder processes in highly nonequilibrium nanostructured oxides has significant implications for the development of emerging energy technologies. However, we are presently limited in our ability to quantify and harness these processes at high spatial, chemical, and temporal resolution, particularly in extreme environments. Here, we describe the percolation of disorder at the model oxide interface LaMnO3/SrTiO3, which we visualize during in situ ion irradiation in the transmission electron microscope. We observe the formation of a network of disorder during the initial stages of ion irradiation and track the global progression of the system to full disorder. We couple these measurements with detailed structural and chemical probes, examining possible underlying defect mechanisms responsible for this unique percolative behavior.

The frequency and impact of undiagnosed benign paroxysmal positional vertigo in outpatients with high falls risk.

BACKGROUND: The frequency and impact of undiagnosed benign paroxysmal positional vertigo (BPPV) in people identified with high falls risk has not been investigated. OBJECTIVE: To determine the frequency and impact on key psychosocial measures of undiagnosed BPPV in adult community rehabilitation outpatients identified with a high falls risk. DESIGN: A frequency study with cross-sectional design. SETTING: A Community Rehabilitation Program in Melbourne, Australia. SUBJECTS: Adult community rehabilitation outpatients with a Falls Risk for Older People in the Community Screen score of four or higher. METHODS: BPPV was assessed in 34 consecutive high falls risk rehabilitation outpatients using the Dix-Hallpike test and supine roll test. Participants were assessed for anxiety, depression, fear of falls, social isolation and loneliness using the Hospital Anxiety and Depression Scale, Falls Efficacy Scale-International and De Jong Gierveld 6-Item Loneliness Scale. RESULTS: A total of 18 (53%; 95% confidence interval: 36, 70) participants tested positive for BPPV. There was no significant difference between those who tested positive for BPPV and those who did not for Falls Risk for Older People in the Community Screen scores (P = 0.555), Hospital Anxiety and Depression Scale (Anxiety) scores (P = 0.627), Hospital Anxiety and Depression Scale (Depression) scores (P = 0.368) or Falls Efficacy Scale-International scores (P = 0.481). Higher scores for the De Jong Gierveld 6-Item Loneliness Scale in participants with BPPV did not reach significance (P = 0.056). CONCLUSIONS: Undiagnosed BPPV is very common and associated with a trend towards increased loneliness in adult rehabilitation outpatients identified as having a high falls risk.

Community participation of community dwelling older adults: a cross-sectional study.

BACKGROUND: With the advancing age of the population, and increasing demands on healthcare services, community participation has become an important consideration for healthy ageing. Low levels of community participation have been linked to increased mortality and social isolation. The extent to which community participation has been measured objectively in older adults remains scarce. This study aims to describe where and how older adults participate in the community and determine the feasibility of measurement methods for community participation. METHODS: This observational cross-sectional study obtained data from 46 community dwelling older adults. A combination of Global Positioning Systems (GPS), accelerometry, and self-reported diaries were used over a 7-day monitoring period. Feasibility of methods were determined by calculating the loss of GPS data, questionnaires, and comparison of self-reported locations with GPS co-ordinates. Relationships between community participation, physical activity, social interactions, health related quality of life, sleep quality and loneliness were explored. RESULTS: Older adults took a median (IQR) of 15 (9.25-18.75) trips out of home over the 7-day monitoring period, most frequently visiting commercial and recreational locations. In-home activities were mainly sedentary in nature, with out of home activities dependent on location type. Self-reported and GPS measures of trips out of home and the locations visited were significantly correlated (self-report 15.7 (5.6) GPS 14.4 (5.8) (r = 0.94)). Significant correlations between both the number of trips taken from home, with social interactions (r = 0.62) and the minutes of moderate to vigorous physical activity (MVPA) (r = 0.43) were observed. Daily MVPA was higher in participants who visited local walk/greenspaces (r = 0.48). CONCLUSION: Participants performed more activities with social interactions out of home and visited commercial locations most frequently. The combination of GPS, accelerometry and self-report methods provided a detailed picture of community participation for older adults. Further research is required with older adults of varying health status to generalise the relationships between community participation, location and physical activity. TRIAL REGISTRATION: Ethical approval was gained from the Flinders University Social and Behavioural Research Ethics Committee (protocol no. 8176).

Morphological Errors in Spanish-Speaking Bilingual Children With and Without Developmental Language Disorders.

Purpose The purpose of this study was to find morphological markers with good diagnostic accuracy to identify developmental language disorders (DLD) in Spanish-English bilingual children. Method The participants in this study included 66 Spanish-English bilingual children between the ages of 4;0 and 6;11 (years;months) with (n = 33) and without DLD (n = 33). We employed a comprehensive production task in Spanish to elicit morphological structures that have been previously found to be problematic for Spanish-speaking children with DLD. These structures included elements of nominal morphology (articles, direct object pronouns, adjectives, and plurals) and verbal morphology (verbs and the subjunctive mood). Logistic regression was used in this study to find a set of grammatical structures that most accurately predicted group membership. Results Spanish-English bilingual children with and without DLD significantly differed from each other in their accurate production of articles, clitics, adjectives, verbs, and the subjunctive mood. Clitics, verbs, and the subjunctive mood in isolation had adequate diagnostic accuracy. A combination of verb and subjective mood accuracy best predicted group membership in this study (sensitivity of 85% and specificity of 91%). Conclusion In addition to clitics, verbs, and the subjunctive mood, both elements of verbal morphology should be considered grammatical markers of DLD in Spanish-English bilingual children. Supplemental Material https://doi.org/10.23641/asha.13641320.

The role of grain boundary character in solute segregation and thermal stability of nanocrystalline Pt-Au.

Nanocrystalline (NC) metals suffer from an intrinsic thermal instability; their crystalline grains undergo rapid coarsening during processing treatments or under service conditions. Grain boundary (GB) solute segregation has been proposed to mitigate grain growth and thermally stabilize the grain structures of NC metals. However, the role of GB character in solute segregation and thermal stability of NC metals remains poorly understood. Herein, we employ high resolution microscopy techniques, atomistic simulations, and theoretical analysis to investigate and characterize the impact of GB character on segregation behavior and thermal stability in a model NC Pt-Au alloy. High resolution electron microscopy along with X-ray energy dispersive spectroscopy and automated crystallographic orientation mapping is used to obtain spatially correlated Pt crystal orientation, GB misorientation, and Au solute concentration data. Atomistic simulations of polycrystalline Pt-Au systems are used to reveal the plethora of GB segregation profiles as a function of GB misorientation and the corresponding impact on grain growth processes. With the aid of theoretical models of interface segregation, the experimental data for GB concentration profiles are used to extract GB segregation energies, which are then used to elucidate the impact of GB character on solute drag effects. Our results highlight the paramount role of GB character in solute segregation behavior. In broad terms, our approach provides future avenues to employ GB segregation as a microstructure design strategy to develop NC metallic alloys with tailored microstructures.

Patient functional independence and occupational therapist time-use in inpatient services: Patient demographic and clinical correlates.

INTRODUCTION: Health care expenditure has rapidly increased in Australia. Effective management of occupational therapy services is required to meet clinical demand. Improving our understanding of factors which influence occupational therapy service delivery is a vital step to manage workload distribution and optimise service efficiency. This study aims to examine the influence of patient sociodemographic characteristics, diagnosis and functional independence on the utilisation of occupational therapy resources in hospital inpatients over 18 years old. METHODS: Prospective, cross-sectional, observational cohort study of 4549 inpatients from three hospital sites in Melbourne, Australia. Data extracted from organisational databases and included in this study were: patient demographics, diagnosis, functional level assessed using the SMAF (Functional Autonomy Measurement System) and occupational therapy time-use. Data were analysed using univariable and multivariable modelling. RESULTS: Occupational therapy time-use was significantly associated with all variables included in analysis (p < 0.05). For each variable the amount and direction of effect differed between hospital sites. The SMAF was the only variable consistently associated with occupational therapy time-use. Higher occupational therapy time-use was associated with lower functional independence (leading to a 3.5 min increase in median occupational therapy time for every unit decrease in SMAF score). CONCLUSIONS: Management of resources within busy hospitals require knowledge of factors associated with occupational therapist time-use. This study identified that time-use could in part be predicted by functional independence, diagnosis and sociodemographic characteristics. Occupational therapy managers can use this information to support decision making while acknowledging other patient and therapist level factors also influence time-use.