Sustainable Production of Biomass-Derived Graphite and Graphene Conductive Inks from Biochar.

Graphite is a commonly used raw material across many industries and the demand for high-quality graphite has been increasing in recent years, especially as a primary component for lithium-ion batteries. However, graphite production is currently limited by production shortages, uneven geographical distribution, and significant environmental impacts incurred from conventional processing. Here, an efficient method of synthesizing biomass-derived graphite from biochar is presented as a sustainable alternative to natural and synthetic graphite. The resulting bio-graphite equals or exceeds quantitative quality metrics of spheroidized natural graphite, achieving a Raman ID/IG ratio of 0.051 and crystallite size parallel to the graphene layers (La) of 2.08 µm. This bio-graphite is directly applied as a raw input to liquid-phase exfoliation of graphene for the scalable production of conductive inks. The spin-coated films from the bio-graphene ink exhibit the highest conductivity among all biomass-derived graphene or carbon materials, reaching 3.58 ± 0.16 × 104 S m-1. Life cycle assessment demonstrates that this bio-graphite requires less fossil fuel and produces reduced greenhouse gas emissions compared to incumbent methods for natural, synthesized, and other bio-derived graphitic materials. This work thus offers a sustainable, locally adaptable solution for producing state-of-the-art graphite that is suitable for bio-graphene and other high-value products.

Bayesian Optimization of Environmentally Sustainable Graphene Inks Produced by Wet Jet Milling.

Liquid phase exfoliation (LPE) of graphene is a potentially scalable method to produce conductive graphene inks for printed electronic applications. Among LPE methods, wet jet milling (WJM) is an emerging approach that uses high-speed, turbulent flow to exfoliate graphene nanoplatelets from graphite in a continuous flow manner. Unlike prior WJM work based on toxic, high-boiling-point solvents such as n-methyl-2-pyrollidone (NMP), this study uses the environmentally friendly solvent ethanol and the polymer stabilizer ethyl cellulose (EC). Bayesian optimization and iterative batch sampling are employed to guide the exploration of the experimental phase space (namely, concentrations of graphite and EC in ethanol) in order to identify the Pareto frontier that simultaneously optimizes three performance criteria (graphene yield, conversion rate, and film conductivity). This data-driven strategy identifies vastly different optimal WJM conditions compared to literature precedent, including an optimal loading of 15 wt% graphite in ethanol compared to 1 wt% graphite in NMP. These WJM conditions provide superlative graphene production rates of 3.2 g hr-1 with the resulting graphene nanoplatelets being suitable for screen-printed micro-supercapacitors. Finally, life cycle assessment reveals that ethanol-based WJM graphene exfoliation presents distinct environmental sustainability advantages for greenhouse gas emissions, fossil fuel consumption, and toxicity.

Technical, Environmental, and Economic Analysis Comparing Low-Carbon Industrial Process Heat Options in U.S. Poly(vinyl chloride) and Ethylene Manufacturing Facilities.

Electrification and clean hydrogen are promising low-carbon options for decarbonizing industrial process heat, which is an essential target for reducing sector-wide emissions. However, industrial processes with heat demand vary significantly across industries in terms of temperature requirements, capacities, and equipment, making it challenging to determine applications for low-carbon technologies that are technically and economically feasible. In this analysis, we develop a framework for evaluating life cycle emissions, water use, and cost impacts of electric and clean hydrogen process heat technologies and apply it in several case studies for plastics and petrochemical manufacturing industries in the United States. Our results show that industrial heat pumps could reduce emissions by 12-17% in a typical poly(vinyl chloride) (PVC) facility in certain locations currently, compared to conventional natural gas combustion, and that other electric technologies in PVC and ethylene production could reduce emissions by nearly 90% with a sufficiently decarbonized electric grid. Life cycle water use increases significantly in all low-carbon technology cases. The levelized cost of heat of viable low-carbon technologies ranges from 15 to 100% higher than conventional heating systems, primarily due to energy costs. We discuss results in the context of relevant policies that could be useful to manufacturing facilities and policymakers for aiding the transition to low-carbon process heat technologies.

Relationships between vestibular issues, noise sensitivity, anxiety and prolonged recovery from mild traumatic brain injury among adults: a scoping review.

BACKGROUND: We investigated the extent of literature and findings on relationships between vestibular issues, noise sensitivity (NS), and anxiety. We were interested in how relationships among these factors impacted adults' recovery three months or more after mild traumatic brain injury (mTBI). METHODS: We conducted a scoping review to evaluate the extent of evidence linking relationships between vestibular issues, NS and anxiety with recovery after mTBI. Data relating to study characteristics and key findings were extracted and used to inform a critical narrative synthesis of findings. RESULTS: After screening and full-text review, we included two studies. Both studies considered the combination of vestibular issues, NS and anxiety and mTBI recovery. Vestibular issues, NS and anxiety were all significantly associated with one another and their presence was the strongest indicator that symptoms would extend beyond three-months after mTBI. CONCLUSION: Few studies have focused on the relationships that vestibular issues, NS and anxiety have with one another and recovery after mTBI. Given the apparent strong relationships between these factors and prolonged recovery, we highlight this as an area warranting further investigation.

Vestibular issues, noise sensitivity and anxiety all appear to impact on recovery from mild traumatic brain injury.There appear to be quite strong relationships between vestibular, noise sensitivity and anxiety symptoms following mild traumatic brain injury.More work exploring these key symptoms and how they impact recovery from mild traumatic brain injury using a wide range of study methods and approaches are needed to advance the field.

Comparison of multidirectional upper limb strength for non-disabled individuals and individuals with C4-C7 spinal cord injury in a seated position.

This study investigates the multidirectional upper limb strength of individuals with a C4-C7 spinal cord injury (SCI) and non-disabled individuals in a seated position by measuring multidirectional force at the hand. Current literature lacks quantitative strength data to evaluate strength requirements for people who have reduced upper limb function due to a cervical SCI. Seated multidirectional force measurements were recorded for eleven non-disabled and ten males with a C4-C7 SCI. Collected data was displayed using detailed force polar plots. The resulting plots revealed a clear difference in polar plot shape for non-disabled participants and participants with a C4-C7 SCI. Namely that SCI participants had more elliptical polar plots due to reductions in circumferential strength compared to non-disabled participants. However, the polar plots for higher SCIs tended to have an increasingly more circular shape. The results provide insight into the differences in strength between people with cervical SCI and no disability.

This paper presents seated multidirectional arm strength data from 21 SCI and non-disabled participants. Force polar plots display the applied force magnitudes and directions for reachable points which can be used to evaluate the force requirements based on SCI level. Results highlighted strength reductions for people with higher SCIs.

Graphite Flows in the U.S.: Insights into a Key Ingredient of Energy Transition.

Demand for graphite will grow with expanding use of lithium-ion batteries in the United States. Much graphite is imported, raising supply chain risks. It is therefore imperative to characterize graphite's sources and sinks. Accordingly, we present the first material flow analysis for natural and synthetic graphite in the U.S. The analysis (for 2018) begins with processed graphite trade and includes graphite production, graphite product trade, manufacturing of end products, end product use, and waste management. It considers 11 end-use applications for graphite, two waste management stages, and three recycling pathways. In 2018, 354 thousand tonnes (kt) of processed graphite were consumed in the U.S., including 60 kt natural graphite and 294 kt synthetic graphite. 145 kt of graphite were traded. Refractories and foundries consumed 56% of natural graphite; 42% of synthetic graphite went into making graphite electrodes. Batteries accounted for 10 and 5% of natural and synthetic graphite consumption, respectively; 78% of total graphite used dissipated into the environment; 22% reached the waste disposal stage of which 71% was landfilled and 29% was recycled; and 59 kt of graphite accumulated in in-use stocks. Recycling more graphite and producing graphite from lignin would favorably influence today's supply chain.

Experiences of diagnosis and treatment for upper limb Complex Regional Pain Syndrome: a qualitative analysis.

INTRODUCTION: Complex Regional Pain Syndrome (CRPS) most frequently affects the upper limb, with high associated disability. Delays to diagnosis and appropriate treatment can adversely impact prognosis and quality of life, but little is known about the healthcare experiences of people with CRPS. This study aimed to explore lived experiences of diagnosis and treatment for people with upper limb CRPS. METHODS: Participants were recruited through online support groups and multiple public and private healthcare settings in the Greater Wellington Region, New Zealand. Semi-structured interviews were conducted with participants who had experienced upper limb CRPS for more than three months and less than three years. Interviews were transcribed verbatim and analysed using reflexive thematic analysis. RESULTS: Thirteen participants (11 female, 2 male) aged between 43 and 68 years were interviewed. Duration of CRPS ranged from 7 months to 2.5 years. Five themes were identified. Participants initially engaged in healthcare out of a desire to return to being the person they were before having CRPS. Three interacting experiences epitomised the overall healthcare experience: (1) not knowing what is going on, (2) not being taken seriously, and (3) healthcare as adding another layer of load. Meanwhile, participants used multiple approaches in an attempt to not let CRPS stop them from continuing to live their lives. CONCLUSIONS: Participants in this study felt that credible information, validation, and simplification from healthcare providers and systems would support their process of navigating towards a meaningful life and self-concept in the presence of CRPS.

"'Oh gosh, why go?' cause they are going to look at me and not hire": intersectional experiences of black women navigating employment during pregnancy and parenting.

BACKGROUND: Workplace legal protections are important for perinatal health outcomes. Black birthing people are disproportionally affected by pregnancy discrimination and bias in the employment context and lack of family-friendly workplace policies, which may hinder their participation in the labor force and lead to gender and racial inequities in income and health. We aimed to explore Black pregnant women's experiences of pregnancy discrimination and bias when looking for work, working while pregnant, and returning to work postpartum. Additionally, we explored Black pregnant women's perspectives on how these experiences may influence their health. METHODS: Using an intersectional framework, where oppression is based on intersecting social identities such as race, gender, pregnancy, and socioeconomic status, we conducted an analysis of qualitative data collected for a study exploring the lived experience of pregnancy among Black pregnant women in New Haven, Connecticut, United States. Twenty-four women participated in semi-structured interviews (January 2017-August 2018). Interview transcripts were analyzed using grounded theory techniques. RESULTS: Participants expressed their desire to provide a financially secure future for their family. However, many described how pregnancy discrimination and bias made it difficult to find or keep a job during pregnancy. The following three themes were identified: 1) "You're a liability"; difficulty seeking employment during pregnancy; 2) "This is not working"; experiences on the job and navigating leave and accommodations while pregnant and parenting; and 3) "It's really depressing. I wanna work"; the stressors of experiencing pregnancy discrimination and bias. CONCLUSION: Black pregnant women in this study anticipated and experienced pregnancy discrimination and bias, which influenced financial burden and stress. We used an intersectional framework in this study which allowed us to more fully examine how racism and economic marginalization contribute to the lived experience of Black birthing people. Promoting health equity and gender parity means addressing pregnancy discrimination and bias and the lack of family-friendly workplace policies and the harm they cause to individuals, families, and communities, particularly those of color, throughout the United States.

Grasp and Release Test for Tetraplegic Hand Assessment: an update of the Grasp and Release Test.

The Grasp and Release Test (GRT) was originally developed to measure effectiveness of an implanted neuroprosthesis in people with tetraplegia. Its ease of use and lack of floor and ceiling effects culminated in recommendations for inclusion in a battery of tests to measure outcome following upper limb reconstructive surgery. However, the length of time taken to administer the GRT in a clinical setting, lack of instructions of accepted grasp patterns in the upper limb reconstructive surgery population and scoring procedures lead to differences in reporting outcomes using this measure. In order to ensure clinical utility for the upper limb reconstructive surgery population, revisions of the original test instructions have been made and are reported in this article. Further testing of the psychometric properties of the new measure are currently underway.

Difficulties capturing co-occurring traumatic brain injury among people with traumatic spinal cord injury: a population-based study.

STUDY DESIGN: This is a population-based prospective cohort study. OBJECTIVES: Traumatic brain injury (TBI) is common among people with traumatic spinal cord injury (TSCI), but rates vary across studies associated with variable approaches to diagnosis. We aimed to determine if a published diagnostic algorithm could be consistently applied to capture co-occurring TBI among persons sustaining TSCI. SETTING: One of two spinal centres in New Zealand (NZ), the Burwood Spinal Unit (BSU) captures approximately 45% of NZ TSCI admissions. METHODS: Adults (age 16+) with TSCI admitted to the BSU between 1 January 2021 and 31 August 2021 (n = 51) were included. Clinical notes were audited prospectively to identify co-occurring TBI. RESULTS: We identified co-occurring TBI in 39% of TSCI cases with a small number of additional suspected TBI cases where TBI could not be confidently ruled in or out. Including all TBI cases, suspected or otherwise resulted in up to 55% of the sample having sustained co-occurring TBI. There were difficulties applying the published algorithm, associated with inconsistent documentation of TBI indicators from acute to rehabilitation contexts. CONCLUSIONS: In this study, the feasibility of a TBI diagnostic algorithm for the TSCI population was low. Alternative approaches to screening for TBI among people sustaining TSCI are needed. Greater consistency in documenting TBI across the continuum of care will ensure TBI if present, is included in treatment planning.

Developing spinal cord injury physiotherapy clinical practice guidelines: a qualitative study to determine how physiotherapists and people living with spinal cord injury use evidence.

STUDY DESIGN: Generic qualitative design. OBJECTIVES: Australian and New Zealand SCI physiotherapists are developing clinical practice guidelines for the physiotherapy management of people living with spinal cord injury. To guide the development of the guidelines it was important to understand how physiotherapists and people living with spinal cord injury use evidence to choose interventions and the potential barriers and facilitators to the uptake of the clinical practice guidelines. SETTING: Spinal Cord Injury Centres in Sydney, Australia and New Zealand. METHODS: Focus groups and interviews with physiotherapists and people living with spinal cord injury were recorded, transcribed, and subjected to thematic analysis. RESULTS: A total of 75 participants took part in the study, 45 physiotherapists and 30 people living with spinal cord injury. Three main themes were identified from the data: (1) Types and sources of evidence that influence treatment choices, (2) the many factors determining treatment choices, and (3) ways in which clinical practice guidelines could influence treatment. CONCLUSIONS: Clinical practice guidelines have the potential to reduce the barriers identified by physiotherapists in accessing and interpreting research evidence on interventions for people living with spinal cord injury. Supported implementation of guidelines is required to demonstrate their benefit and encourage physiotherapists to factor in evidence when balancing the multiple factors influencing choice of physiotherapy intervention.

Developing A Conceptual Framework for Early Intervention Vocational Rehabilitation for People Following Spinal Cord Injury.

PURPOSE: Early intervention vocational rehabilitation (EIVR) can improve return to work (RTW) outcomes for people with spinal cord injury (SCI). However, mechanisms explaining how and why EIVR works are not well understood. This study aims to develop a conceptual framework describing key mechanisms of EIVR intervention effect following SCI. METHODS: We synthesised data from a realist literature review with data from interviews of people with SCI (n = 30), a survey of people with SCI who had received EIVR (n = 37), a focus group of EIVR providers and a focus group of community vocational providers. We first synthesised the literature review and interviews to develop an initial programme theory describing the contexts in which mechanisms are activated to produce EIVR outcomes. Then we used data from the survey and focus groups to further refine the EIVR programme theory. Finally, a conceptual framework was developed to support knowledge dissemination. RESULTS: By ensuring consistent messaging across the multi-disciplinary team, EIVR programmes establish and maintain hope that work is possible following injury. Conversations about work allow individuals to determine the priority of work following injury. These conversations can also improve self-efficacy by providing individualized support to envisage pathways toward RTW goals and maintain worker identity. The synthesised study findings highlight the contexts and resources required to trigger activation of these mechanisms. CONCLUSIONS: EIVR key mechanisms of effect are not specific to SCI as a health condition, therefore enabling this framework to be applied to other populations who face similar impairments and return to work barriers.

Reproducibility, Construct Validity, and Responsiveness of the Tetraplegia Upper Limb Activities Questionnaire, TUAQ. Part 2.

OBJECTIVE: To test reliability, construct validity and responsiveness of the Tetraplegia Upper Limb Activities Questionnaire (TUAQ), a patient-reported outcome measure that assesses perceived performance and satisfaction with 10 standardized activities. DESIGN: Outcome measure psychometric evaluation. SETTING: Spinal cord injury units in 2 countries. PARTICIPANTS: Reproducibility: 47 individuals with tetraplegia. Construct validity and responsiveness: 33 individuals with tetraplegia undergoing surgery to restore hand function (N=80). INTERVENTIONS: Reproducibility: The TUAQ was completed on 2 occasions, 2 weeks apart. Construct validity and responsiveness: Participants completed the TUAQ prior to surgery and 3-12 months after hand reconstruction surgery. Internal consistency was examined using Cronbach α. Two agreement parameters were examined: the SEM and minimal detectable change with 90% confidence interval (MDC90). Construct validity was evaluated using Pearson product moment correlation against a priori hypotheses. Responsiveness was assessed using paired t tests and effect size. RESULTS: Test-retest reliability and internal consistency was high (intraclass correlation coefficient of 0.89 for performance scale and 0.88 for satisfaction, Cronbach α of 0.92 and 0.90, respectively). For agreement the SEM scores were 4.7 and 3.5, with MDC90 of 10.9 and 8.2, respectively. Responsiveness and construct validity showed sound results with no ceiling or floor effects and with large effect size (>1.05). CONCLUSIONS: The TUAQ demonstrates good psychometric properties for reliability and agreement for persons with tetraplegia and responsiveness and construct validity for surgical reconstruction of hand function for persons with tetraplegia. The TUAQ appears appropriate to be used as a patient-reported outcome measure for clinical and research purposes in this population.

Development, Internal Construct, and Unidimensionality of the Tetraplegia Upper Limb Activities Questionnaire, TUAQ. Part 1.

OBJECTIVE: This study aims to develop a patient-reported outcome measure that focuses on relevant daily activities relying on upper extremity for individuals with tetraplegia. DESIGN: Cross-sectional study. SETTING: Spinal cord injury units in 2 countries. PARTICIPANTS: Ninety-nine individuals (N=99) with C2-C8, American Spinal Injury Association Impairment Scale A-D tetraplegia, mean age 46 years, 1- 43 years post injury. INTERVENTIONS: Thirteen items included in the initial testing were chosen from 708 activity limitations identified by individuals with tetraplegia. Items were pilot tested for wording, response options, and relevance for both performance and satisfaction. Items were analyzed and reselected using exploratory factor analysis and Rasch analysis for local dependency, dimensionality, differential item functioning (DIF), threshold response, and targeting. MAIN OUTCOME MEASURES: Not applicable. RESULTS: Exploratory factor analysis supported a 2-factor solution for both performance and satisfaction. While data fit the Rasch model, there was evidence of local dependency and multiple disordered thresholds. Three items were removed because of high interitem correlation and DIF and the scale rescored to 5 response options. The remaining 10 items demonstrated fit to the Rasch model, with no local dependency, no multidimensionality, no item or person misfit, and minimal disordered thresholds. CONCLUSIONS: Results support the internal construct validity and unidimensionality of the Tetraplegia Upper Limb Activities Questionnaire (TUAQ), a 10-item, 5-response patient-reported outcome measure assessing performance and satisfaction with activities targeted to the upper extremity for individuals with tetraplegia. Further testing is required and ongoing to evaluate reliability and responsiveness of the TUAQ.

Material Flows of Polyurethane in the United States.

Today, polyurethanes are effectively not recycled and are made principally from nonrenewable, fossil-fuel-derived resources. This study provides the first high-resolution material flow analysis of polyurethane flows through the U.S. economy, tracking back to fossil fuels and covering polyurethane-relevant raw materials, trade, production, manufacturing, uses, historical stocks, and waste management. According to our analysis, in 2016, 2900 thousand tonnes (kt) of polyurethane were produced in the United States and 920 kt were imported for consumption, 2000 kt entered the postconsumer waste streams, and 390 kt were recycled and returned to the market in the form of carpet underlayment. The domestic production of polyurethane consumed 1100 kt of crude oil and 1100 kt of natural gas. With the developed polyurethane flow map, we point out the limitation of the existing mechanical recycling methods and identify that glycolysis, a chemical recycling method, can be used to recycle the main components of postconsumer polyurethane waste. We also explore how targeting biobased pathways could influence the supply chain and downstream markets of polyurethane and reduce the consumption of fossil fuels and the exposure to toxic precursors in polyurethane production.

Associations between comorbidity and quality of life outcomes after total joint replacement.

PURPOSE: We examined associations between self-reported and clinician-assessed comorbidity and quality of life (QOL) outcomes after hip and knee replacement. METHODS: This is a cross-sectional, questionnaire-based national survey. Participants aged 45 years or older (n = 409) were recruited from the New Zealand Joint Registry six months after a total hip (THR), total knee (TKR) or unicompartmental knee replacement (UKR). The main outcome QOL was measured using an 8-item short form of the World Health Organisation Quality of Life (WHOQOL-Bref) questionnaire six months following joint replacement surgery. The WHOQOL is a generic and non-health condition specific measure of QOL. RESULTS: Participants were on average 68 years of age, with more men (54%) than women (46%). Number of coexisting conditions and body mass index were correlated with age, pain and function scores, and QOL (p < 0.01), but not with each other. Linear regression analyses showed that comorbidities such as number of comorbid conditions and BMI had moderate associations with QOL outcomes. CONCLUSION: This study showed that general QOL outcomes following hip and knee joint replacement, while generally high, were associated with comorbidity burden and BMI. Future prospective research examining change in QOL before and following surgery would help to advance understandings of the various factors that contribute to patient satisfaction with their joint replacement.

Collection and Reporting of Patient-reported Outcome Measures in Arthroplasty Registries: Multinational Survey and Recommendations.

BACKGROUND: Patient-reported outcome measures (PROMs) are validated questionnaires that are completed by patients. Arthroplasty registries vary in PROM collection and use. Current information about registry collection and use of PROMs is important to help improve methods of PROM data analysis, reporting, comparison, and use toward improving clinical practice. QUESTIONS/PURPOSES: To characterize PROM collection and use by registries, we asked: (1) What is the current practice of PROM collection by arthroplasty registries that are current or former members of the International Society of Arthroplasty Registries, and are there sufficient similarities in PROM collection between registries to enable useful international comparisons that could inform the improvement of arthroplasty care? (2) How do registries differ in PROM administration and demographic, clinical, and comorbidity index variables collected for case-mix adjustment in data analysis and reporting? (3) What quality assurance methods are used for PROMs, and how are PROM results reported and used by registries? (4) What recommendations to arthroplasty registries may improve PROM reporting and facilitate international comparisons? METHODS: An electronic survey was developed with questions about registry structure and collection, analysis, reporting, and use of PROM data and distributed to directors or senior administrators of 39 arthroplasty registries that were current or former members of the International Society of Arthroplasty Registries. In all, 64% (25 of 39) of registries responded and completed the survey. Missing responses from incomplete surveys were captured by contacting the registries, and up to three reminder emails were sent to nonresponding registries. Recommendations about PROM collection were drafted, revised, and approved by the International Society of Arthroplasty Registries PROMs Working Group members. RESULTS: Of the 25 registries that completed the survey, 15 collected generic PROMs, most frequently the EuroQol-5 Dimension survey; 16 collected joint-specific PROMs, most frequently the Knee Injury and Osteoarthritis Outcome Score and Hip Disability and Osteoarthritis Outcome Score; and 11 registries collected a satisfaction item. Most registries administered PROM questionnaires within 3 months before and 1 year after surgery. All 16 registries that collected PROM data collected patient age, sex or gender, BMI, indication for the primary arthroplasty, reason for revision arthroplasty, and a comorbidity index, most often the American Society of Anesthesiologists classification. All 16 registries performed regular auditing and reporting of data quality, and most registries reported PROM results to hospitals and linked PROM data to other data sets such as hospital, medication, billing, and emergency care databases. Recommendations for transparent reporting of PROMs were grouped into four categories: demographic and clinical, survey administration, data analysis, and results. CONCLUSION: Although registries differed in PROM collection and use, there were sufficient similarities that may enable useful data comparisons. The International Society of Arthroplasty Registries PROMs Working Group recommendations identify issues that may be important to most registries such as the need to make decisions about survey times and collection methods, as well as how to select generic and joint-specific surveys, handle missing data and attrition, report data, and ensure representativeness of the sample. CLINICAL RELEVANCE: By collecting PROMs, registries can provide patient-centered data to surgeons, hospitals, and national entities to improve arthroplasty care.

Development of a Programme Theory for Early Intervention Vocational Rehabilitation: A Realist Literature Review.

Purpose Little is currently known about how early intervention vocational rehabilitation (EIVR) works for people with newly acquired neurological conditions such as traumatic brain injury, acquired brain injury and spinal cord injury. This study aims, from a realist framework, to identify relevant literature and develop an initial programme theory to understand how EIVR might work for people experiencing acquired neurological disability. Realist reviews are ideally placed to address the identified knowledge gap as they assist in gaining a deeper understanding of how the intervention works, for whom it works best, and the contexts that promote the activation of desired outcomes. Methods We used a seven-step iterative process to synthesise literature using a realist approach. The steps included: development of initial programme theory, literature search, article selection, extracting and data organising, synthesis of evidence and programme theory refinement. We performed a literature search using the following databases: Cinahl, Embase, EMcare, Medline, PsychInfo and Scopus. Articles were selected if they contributed to the knowledge describing what is EIVR and how it works in newly acquired neurological conditions. Data were extracted and synthesised to develop a programme theory for EIVR. Results Following screening of 448 references, 37 documents were eligible for data extraction. We developed a refined programme theory of EIVR consisting of three contexts (prioritisation of exploring work options, return to work discussed as an option, and workplace support), nine mechanisms (ensuring rehabilitation teams' culture, fostering hope, exploring options, optimising self-efficacy, maintaining worker identity, staying connected, setting goals, engaging employer, and flexing roles) and three outcomes (confidence in ability to work, psychological adjustment, and engagement in solution focussed options). Conclusions This appears to be the first paper to explore how EIVR works, for whom and in what situations. We have produced a programme theory that may provide an initial understanding of EIVR following acquired neurological conditions.

Co-optimization of Heavy-Duty Fuels and Engines: Cost Benefit Analysis and Implications.

Heavy-duty vehicles require expensive aftertreatment systems for control of emissions such as particulate matter (PM) and nitrogen oxides (NOx) to comply with stringent emission standards. Reduced engine-out emissions could potentially alleviate the emission control burden, and thus bring about reductions in the cost associated with aftertreatment systems, which translates into savings in vehicle ownership. This study evaluates potential reductions in manufacturing and operating costs of redesigned emission aftertreatment systems of line-haul heavy-duty diesel vehicles (HDDVs) with reduced engine-out emissions brought about by co-optimized fuel and engine technologies. Three emissions reduction cases representing conservative, medium, and optimistic engine-out emission reduction benefits are analyzed, compared to a reference case: the total costs of aftertreatment systems (TCA) of the three cases are reduced to $11,400(1.63 ¢/km), $9,100 (1.30 ¢/km), and $8,800 (1.26 ¢/km), respectively, compared to $12,000 (1.71 ¢/km) for the reference case. The largest potential reductions result from reduced diesel exhaust fluid (DEF) usage due to lower NOx emissions. Downsizing aftertreatment devices is not likely, because the sizes of devices are dependent on not only engine-out emissions, but also other factors such as engine displacement. Sensitivity analysis indicates that the price and usage of DEF have the largest impacts on TCA reduction.

Occupational stressors and desired changes for wellness amongst employees at a Canadian animal welfare organization.

While occupational stressors in human caregiving environments have been well-explored, little is known about these stressors in the animal caregiving professions. To address this, a cross-sectional survey was conducted (June and July, 2016) with employees at a Canadian animal welfare organization to explore perceived occupational stressors and desired wellness resources. Responses to open-ended questions were analyzed via thematic network analysis. Themes related to employee stress included: inability to provide desired level of animal care, poor team environment, overwork, challenges working with the public, and personal safety and vulnerability. Desired resource themes were: reduce overwork and address staffing issues, team building, creation of a wellness culture, and mental health training. These results shed light on occupational stressors facing animal welfare employees at a Canadian animal welfare organization. Recommendations to promote positive mental health and wellness within this, and potentially similar, organizations are discussed.

Facteurs de stress au travail et changements souhaités pour le bien-être parmi les employés d'une organisation canadienne de bien-être animal. Même si les facteurs de stress au travail dans les milieux de prestation de soins aux humains ont été bien explorés, on en sait encore peu dans les professions de prestation de soins aux animaux. Pour aborder cette situation, une enquête transversale a été réalisée (en juin et en juillet 2016) auprès d'employés dans une organisation canadienne de bien-être animal afin d'explorer les facteurs de stress au travail perçus et les ressources de bien-être souhaitées. Les réponses à des questions ouvertes ont été analysées à l'aide d'une analyse de réseaux thématiques. Les thèmes reliés au stress des employés mentionnés incluaient notamment : incapacité de fournir le niveau souhaité de soins aux animaux, mauvais environnement d'équipe, surcharge de travail, difficultés de travail avec le public ainsi que sécurité personnelle et vulnérabilité. Les thèmes de ressources souhaitées étaient : réduction de la surcharge de travail et gestion des problèmes de dotation en personnel, consolidation d'équipe, création d'une culture de bien-être et formation en santé mentale. Ces résultats mettent en lumière les facteurs de stress au travail auxquels font face les employés dans une organisation canadienne de bien-être animal. Les recommandations afin de promouvoir une santé mentale et un bien-être positifs dans cette organisation et des organismes semblables sont discutées.(Traduit par Isabelle Vallières).