Staff Working Life and Older Persons' Satisfaction With Care: A Multilevel, Correlational Design.

BACKGROUND: The importance of staff working life for staff well-being has been demonstrated in several studies; less research has focused on staff working life and older persons' satisfaction with care. PURPOSE: The study aim was to study relationships between 1) staff assessments of their structural conditions/empowerment in elderly care, psychological empowerment, and job satisfaction and (2) older persons' satisfaction with care. METHODS: A multilevel, cross-sectional, and correlational design was applied using questionnaire data on working life (1021 staff members) and unit-level data (40 elderly care units) on older persons' satisfaction with care. RESULTS: Statistically significant relationships were found between all 3 working life variables and older persons' satisfaction with care. Furthermore, the results revealed an indirect/mediating effect of job satisfaction between structural empowerment and satisfaction with care, but not for psychological empowerment. CONCLUSIONS: Staff structural empowerment, psychological empowerment, and job satisfaction are linked to older persons' satisfaction with care.

Psychometric properties of an instrument measuring communication within and between the professional groups licensed practical nurses and registered nurses in anaesthetic clinics.

BACKGROUND: The most common cause of clinical incidents and adverse events in relation to surgery is communication error. There is a shortage of studies on communication between registered nurses and licenced practical nurses as well as of instruments to measure their perception of communication within and between the professional groups. The aim of the present study was to evaluate the psychometric properties of the Swedish version of the adapted ICU Nurse-Physician Questionnaire, designed to also measure communication within and between two professional groups: licensed practical nurses and registered nurses. Specifically, the aim was to examine the instrument's construct validity using confirmatory factor analysis and its internal consistency using Cronbach's Alpha. METHODS: A cross-sectional and correlational design was used. The setting was anaesthetic clinics in two Swedish hospitals. A total of 316 questionnaires were delivered during spring 2011, of which 195 were analysed to evaluate the psychometric properties of the questionnaire. Construct validity was assessed using confirmatory factor analysis and internal consistency using Cronbach's Alpha. To assess items with missing values, we conducted a sensitivity analysis of two sets of data, and to assess the assumption of normally distributed data, we used Bayesian estimation. RESULTS: The results support the construct validity and internal consistency of the adapted ICU Nurse-Physician Questionnaire. Model fit indices for the confirmative factor analysis were acceptable, and estimated factor loadings were reasonable. There were no large differences between the estimated factor loadings when comparing the two samples, suggesting that items with missing values did not alter the findings. The estimated factor loadings from Bayesian estimation were very similar to the maximum likelihood results. This indicates that confirmative factor analysis using maximum likelihood produced reliable factor loadings. Regarding internal consistency, alpha values ranged from 0.72 to 0.82. CONCLUSIONS: The tests of the adapted ICU Nurse-Physician Questionnaire indicate acceptable construct validity and internal consistency, both of which need to be further tested in new settings and samples. TRIAL REGISTRATION: Current controlled trials http://www.controlled-trials.com Communication and patient safety in anaesthesia and intensive care. Does implementation of SBAR make any differences? Identifier: ISRCTN37251313, retrospectively registered (assigned 08/11/2012).

Staff perception of Lean, care-giving, thriving and exhaustion: a longitudinal study in primary care.

BACKGROUND: Lean is commonly adopted in healthcare to increase quality of care and efficiency. Few studies of Lean involve staff-related outcomes, and few have a longitudinal design. Thus, the aim was to examine the extent to which changes over time in Lean maturity are associated with changes over time in care-giving, thriving and exhaustion, as perceived by staff, with a particular emphasis on the extent to which job demands and job resources, as perceived by staff, have a moderated mediation effect. METHOD: A longitudinal study with a correlational design was used. In total, 260 staff at 46 primary care units responded to a web survey in 2015 and 2016. All variables in the study were measured using staff ratings. Ratings of Lean maturity reflect participants' judgements regarding the entire unit; ratings of care-giving, thriving, exhaustion and job demands and resources reflect participants' judgements regarding their own situation. RESULTS: First, over time, increased Lean maturity was associated with increased staff satisfaction with their care-giving and increased thriving, mediated by increased job resources. Second, over time, increased Lean maturity was associated with decreased staff exhaustion, mediated by decreased job demands. No evidence was found showing that job demands and job resources had a moderated mediation effect. CONCLUSION: The results indicate that primary care staff may benefit from working in organizations characterized by high levels of Lean maturity and that caregiving may also be improved as perceived by staff.

Empowerment and performance of managers and subordinates in elderly care: A longitudinal and multilevel study.

AIM: To investigate relationships between first-line managers' ratings of structural and psychological empowerment, and the subordinates' ratings of structural empowerment, as well as their ratings of the managers' leadership-management performance. BACKGROUND: Work situations in elderly care are complex. To date, few studies have used a longitudinal, correlational and multilevel design to study the working life of subordinates and managers. METHOD: In five Swedish municipalities, questionnaires were answered twice during 2010-12 by 56 first-line managers and 769 subordinates working in nursing homes or home-help services. RESULTS: First-line managers' empowerment at Time 1 partially predicted subordinate's structural empowerment and ratings of their managers' leadership-management performance at Time 2. Changes over time partially revealed that the more access managers had to structural empowerment, i.e. increase over time, the higher the ratings were for structural empowerment and managerial leadership-management performance among subordinates. CONCLUSIONS: Findings strengthen research and theoretical suggestions linking first-line managers' structural empowerment to their subordinates' structural empowerment and ratings of their manager's leadership-management performance. IMPLICATIONS FOR NURSING MANAGEMENT: Managers with high access to structural empowerment are more likely to provide subordinates access to structural empowerment.

Lung cancer among native and foreign-born Swedes: histopathology, treatment, and survival.

BACKGROUND: Lung cancer (LC) is the leading cause of cancer-related death worldwide, including Sweden. Several studies have shown that socioeconomic status affects the risk, treatment, and survival of LC. Due to immigration after Second World War, foreign-born people constitute 12.5% of the Swedish population. We wanted to investigate if there were any differences in LC management, treatment and survival among the foreign-born Swedes (FBS) compared to the native Swedish population (NatS) in Stockholm. MATERIAL AND METHODS: A retrospective analysis of all patients diagnosed with non-small cell lung cancer (NSCLC) at the Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Solna from 1 January 2003 to 31 December 2008 was made. In all, 2041 cases of LC were diagnosed, thereof 1803 with NSCLC. Of these, 211 (11.7%) were FBS. RESULTS: The mean age of NatS and FBS patients was 69.9 years, median 70 (range 26-96) and 66.0 years, median 66 (range 38-94), respectively (p < 0.001). In all, 89.8% of NatS and 90.0% of FBS were either smokers or former smokers. Adenocarcinoma was the most common subtype in both groups (NatS 54.7%, FBS 48.3%). In 140 (8.8%) of the NatS and 17 (8.1%) of the FBS the diagnosis was clinical only. There were no significant differences in stage at diagnosis, nor in performance status (PS) or different therapies between the groups. The median overall survival time for the NatS was 272 days and for FBS 328 days, again no significant difference. However, the median overall survival time for female NatS was 318 days and for female FBS 681 days (p = 0.002). CONCLUSION: FBS patients were significantly younger than NatS at diagnosis, and female FBS lived longer than female NatS, but otherwise there were no significant differences between NatS and FBS patients with LC regarding diagnosis, treatment, and survival.

Implementing situation-background-assessment-recommendation in an anaesthetic clinic and subsequent information retention among receivers: A prospective interventional study of postoperative handovers.

BACKGROUND: Communication errors cause clinical incidents and adverse events in relation to surgery. To ensure proper postoperative patient care, it is essential that personnel remember and recall information given during the handover from the operating theatre to the postanaesthesia care unit. Formalizing the handover may improve communication and aid memory, but research in this area is lacking. OBJECTIVE: The objective of this study was to evaluate whether implementing the communication tool Situation-Background-Assessment-Recommendation (SBAR) affects receivers' information retention after postoperative handover. DESIGN: A prospective intervention study with an intervention group and comparison nonintervention group, with assessments before and after the intervention. SETTING: The postanaesthesia care units of two hospitals in Sweden during 2011 and 2012. PARTICIPANTS: Staff involved in the handover between the operating theatre and the postanaesthesia care units within each hospital. INTERVENTION: Implementation of the communication tool SBAR in one hospital. MAIN OUTCOME MEASURES: The main outcome was the percentage of recalled information sequences among receivers after the handover. Data were collected using both audio-recordings and observations recorded on a study-specific protocol form. RESULTS: Preintervention, 73 handovers were observed (intervention group, n = 40; comparison group, n = 33) involving 72 personnel (intervention group, n = 40; comparison group, n = 32). Postintervention, 91 handovers were observed (intervention group, n = 44; comparison group, n = 47) involving 57 personnel (intervention group, n = 31; comparison group, n = 26). In the intervention group, the percentage of recalled information sequences by the receivers increased from 43.4% preintervention to 52.6% postintervention (P = 0.004) and the SBAR structure improved significantly (P = 0.028). In the comparison group, the corresponding figures were 51.3 and 52.6% (P = 0.725) with no difference in SBAR structure. When a linear regression generalised estimating equation model was used to account for confounding influences, we were unable to show a significant difference in the information recalled between the intervention group and the nonintervention group over time. CONCLUSION: Compared with the comparison group with no intervention, when SBAR was implemented in an anaesthetic clinic, we were unable to show any improvement in recalled information among receivers following postoperative handover. TRIAL REGISTRATION: Current controlled trials http://www.controlled-trials.com Identifier: ISRCTN37251313.

Garden greenery and the health of older people in residential care facilities: a multi-level cross-sectional study.

AIMS: To test the relationship between greenery in gardens at residential facilities for older people and the self-perceived health of residents, mediated by experiences of being away and fascination when in the garden and the frequency of visitation there. To examine how these indirect effects vary with the number of physical barriers to visiting the garden. BACKGROUND: Many older people in residential facilities suffer from complex health problems. Access to a green outdoor environment may enable psychological distance, engage effortless attention, encourage more frequent visitation and promote resident health. DESIGN: A multi-level, cross-sectional, correlational design. METHODS: Questionnaires were administered June-August, 2011 to convenience samples of residents at 72 facilities for older people with complex healthcare needs. One to 10 eligible residents were sampled during self-motivated garden visits at each facility (n = 290). They reported on their garden experiences and health. Facility staff reported on objective garden characteristics and barriers to access. A serial mediation model was tested with multiple linear regression analysis. RESULTS: The total indirect effect of greenery on self-perceived health was positive and significant. Garden greenery appears to affect health by enhancing a sense of being away, affording possibilities to experience the outdoor environment as interesting and encouraging visitation. Among residents in homes with multiple barriers, only fascination mediated the relationship between greenery and self-perceived health. CONCLUSION: Ample greenery in outdoor space at residential facilities for older people appears to promote experiences of being away and fascination, more frequent visitation and better health.

A longitudinal study of working life among first-line managers in the care of older adults.

AIM: To study whether the number of subordinates plays a role in first-line managers' and subordinates' ratings of empowerment, stress symptoms, and leadership-management performance. The aim was also to study relationships between managers' empowerment and stress symptoms and leadership-management performance. METHODS: A longitudinal and correlational design was used. All first-line managers (n=98) and their subordinates (n=2085) working in the care of older adults in five municipalities were approached. RESULTS: With fewer (≤30) subordinates per manager, there were higher ratings of structural empowerment among managers and subordinates and lower stress symptoms among subordinates, than with ≥31 subordinates. Furthermore, structural empowerment was related to the managers' stress symptoms and leadership-management performance, mediated through psychological empowerment. Moreover, structural empowerment can control/adjust for large numbers of subordinates in relation to stress symptoms. CONCLUSION: The higher FLMs rated their access to empowerment, the lower stress symptoms and higher leadership-management performance they rated over time.

On the origin of epitaxial rhombohedral-B4C growth by CVD on 4H-SiC.

Rhombohedral boron carbide, often referred to as r-B4C, is a potential material for applications in optoelectronic and thermoelectric devices. From fundamental thin film growth and characterization, we investigate the film-substrate interface between the r-B4C films grown on 4H-SiC (0001̄) (C-face) and 4H-SiC (0001) (Si-face) during chemical vapor deposition (CVD) to find the origin for epitaxial growth solely observed on the C-face. We used high-resolution (scanning) transmission electron microscopy and electron energy loss spectroscopy to show that there is no surface roughness or additional carbon-based interlayer formation for either substrate. Based on Raman spectroscopy analysis, we also argue that carbon accumulation on the surface hinders the growth of continued epitaxial r-B4C in CVD.

An explorative and confirmative factor analysis of the Leadership and Management Inventory-II among staff working in elderly care.

PURPOSE: The Purpose of the study was to investigate the construct validity and internal consistency of the LaMI among staff in the context of elderly care in Sweden. DESIGN/METHODOLOGY/APPROACH: Questionnaire data from a longitudinal study of staff working in elderly care were used. Data were collected using the Leadership and Management Inventory. First data collection was for explorative factor analysis (n = 1,149), and the second collection, one year later, was for confirmatory factor analysis (n = 1,061). FINDINGS: The explorative factor analysis resulted in a two-factor solution that explained 70.2% of the total variance. Different models were tested in the confirmatory factor analysis. The final model, a two-factor solution where three items were omitted, showed acceptable results. ORIGINALITY/VALUE: The instrument measures both leadership and management performance and can be used to continually measure managers' performances as perceived by staff to identify areas for development.

Associations between lean maturity in primary care and musculoskeletal complaints among staff: a longitudinal study.

OBJECTIVE: This study had two aims: (1) to determine the prevalence of musculoskeletal complaints among staff in primary care and (2) to determine to what extent lean maturity of the primary care unit can predict musculoskeletal complaints 1 year later. DESIGN: Descriptive, correlational and longitudinal design. SETTING: Primary care units in mid-Sweden. PARTICIPANTS: In 2015, staff members responded to a web survey addressing lean maturity and musculoskeletal complaints. The survey was completed by 481 staff members (response rate 46%) at 48 units; 260 staff members at 46 units also completed the survey in 2016. OUTCOME MEASURES: Associations with musculoskeletal complaints were determined both for lean maturity in total and for four Lean domains entered separately in a multivariate model, that is, philosophy, processes, people and partners, and problem solving. RESULTS: The shoulders (12-month prevalence: 58%), neck (54%) and low back (50%) were the most common sites of 12-month retrospective musculoskeletal complaints at baseline. Shoulders, neck and low back also showed the most complaints for the preceding 7 days (37%, 33% and 25%, respectively). The prevalence of complaints was similar at the 1-year follow-up. Total lean maturity in 2015 was not associated with musculoskeletal complaints, neither cross-sectionally nor 1 year later, for shoulders (1 year ß: -0.002, 95% CI -0.03 to 0.02), neck (ß: 0.006, 95% CI -0.01 to 0.03), low back (ß: 0.004, 95% CI -0.02 to 0.03) and upper back (ß: 0.002, 95% CI -0.02 to 0.02). CONCLUSION: The prevalence of musculoskeletal complaints among primary care staff was high and did not change within a year. The extent of lean maturity at the care unit was not associated with complaints among staff, neither in cross-sectional analyses nor in a 1-year predictive analysis.

Texture evolution in rhombohedral boron carbide films grown on 4H-SiC(0001̄) and 4H-SiC(0001) substrates by chemical vapor deposition.

Boron carbide in its rhombohedral form (r-BxC), commonly denoted B4C or B13C2, is a well-known hard material, but it is also a potential semiconductor material. We deposited r-BxC by chemical vapor deposition between 1100 °C and 1500 °C from triethylboron in H2 on 4H-SiC(0001) and 4H-SiC(0001̄). We show, using ToF-ERDA, that pure B4C was grown at 1300 °C, furthermore, using XRD that graphite forms above 1400 °C. The films deposited above 1300 °C on 4H-SiC(0001̄) were found to be epitaxial, with the epitaxial relationships B4C(0001)[101̄0]‖4H-SiC(0001̄)[101̄0] obtained from pole figure measurements. In contrast, the films deposited on 4H-SiC(0001) were polycrystalline. We suggest that the difference in growth mode is explained by the difference in the ability of the different surfaces of 4H-SiC to act as carbon sources in the initial stages of the film growth.

Sex Pheromone of the Introduced Pine Sawfly, Diprion similis, Revisited to Define a Useful Monitoring Lure: Deviating Chiral Composition and Behavioural Responses Compared to Earlier Reports.

Extracts of Diprion similis females contained about 15 ng of the sex pheromone precursor 3,7-dimethylpentadecan-2-ol per female. After derivatisation with (S)-2-acetoxypropanoyl chloride, we found that the major stereoisomer in the extract was (2S,3R,7R)-3,7-dimethylpentadecan-2-ol. Small amounts of other stereoisomers of 3,7-dimethylpentadecan-2-ol were also identified in the extract, namely 1% of (2R,3S,7S), 0.3% (2R,3R,7R) and 0.4% of (2R,3R,7S). An unknown fifth substance showed a very similar spectrum to 3,7-dimethylpentadecan-2-ol, both in SIM and full scan mode. None of the earlier suggested behavioural synergistic isomers ((2S,3S,7S), (2S,3S,7R) and (2S,3R,7S)) were detected in the extracts. In field tests in Ontario, Canada, the earlier identified main pheromone component, viz. the propanoate of (2S,3R,7R)-3,7-dimethylpentadecan-2-ol, was tested alone and in combination with other stereoisomers, earlier reported to be synergistic. No synergistic effects were detected and the threo four-isomer blend was as attractive as the pure main compound. Thus, one of the few examples of a diprionid sawfly using more than one substance in its sex pheromone could not be confirmed. The results also suggest that monitoring programs can use the more easily synthesized threo-blend without losing efficiency. Furthermore, the study suggests that other diprionid pheromones may benefit from a reinvestigation, to clarify possible synergistic effects of stereoisomers.

Field response of male pine sawflies, Neodiprion sertifer (Diprionidae), to sex pheromone analogs in Japan and Sweden.

The pine sawfly Neodiprion sertifer (Geoffroy) uses the acetate or propionate of (2S,3S,7S)-3,7-dimethyl-2-pentadecanol (diprionol) as pheromone components, with the (2S,3R,7R)-isomer being antagonistic, synergistic, or inactive according to the population tested. In this study, we tested the attraction of males to the acetates of three analogs of diprionol, each missing one methyl group, viz. (2S,7S)-7-methyl-2-pentadecanol, (2S,6S)-2,6-dimethyl-1-tetradecanol, and (2S,3S)-3-methyl-2-pentadecanol. None of the analogs alone, or in combination with diprionol acetate, was attractive in Sweden, even at 100 times the amount of diprionol acetate attractive to N. sertifer. In Japan, the acetate of (2S,3S)-3-methyl-2-pentadecanol attracted males when tested in amounts 10-20 times higher than the acetate pheromone component. The acetate esters of the (2S,3R)-analog and the (2S,3R,7R)-isomer of diprionol also were tested in combination with the pheromone compound (acetate ester). Both compounds caused an almost total trap-catch reduction in Sweden, whereas in Japan they appear to have relatively little effect on trap capture when added to diprionol acetate. Butyrate and iso-butyrate esters of diprionol were unattractive to N. sertifer in Sweden. In summary, there exists geographic variation in N. sertifer in responses to both diprionyl acetate and some of its analogs.

Investigating the Probability of Response Bias in Owner-Perceived Pain Assessment in Dogs With Osteoarthritis.

Owners' ability to recognize signs of chronic pain in dogs undergoing pharmacologic and nonpharmacologic pain interventions during a period of physical rehabilitation is not known. This study aimed to compare dogs with and without chronic pain, and to assess the relationship between explanatory factors, including the probability of owners' response bias induced by pharmacologic and nonpharmacologic pain intervention, and chronic pain in dogs with osteoarthritis (OA). Seventy-one dogs with OA were included in this observational study. Owner-perceived pain interference was measured by Canine Brief Pain Inventory (CBPI) and owner-perceived pain behavior was assessed using Helsinki Chronic Pain Index. A dichotomous variable of Helsinki Chronic Pain Index was used in regression analysis to investigate the association between chronic pain and explanatory factors (body condition, anti-inflammatory medication, animal physiotherapy consultation once or more and owners' perception of pain interfering). Seventy-five percent of the dogs had ongoing anti-inflammatory medication, 51% of were overweight and 45% had a physiotherapy consultation. Higher levels of overt pain behaviors were reported in items addressing activities. Body condition, physiotherapy consultation and medication were not associated with chronic pain. Odds ratio (OR) and 95% confidence intervals of OR for the CBPI were 1.74 (1.23-2.47) and significantly associated with chronic pain. The adjusted OR of the CBPI did not differ from the crude OR. Owner-perceived pain behavior was not confounded by the dogs' medication. Results indicated that CBPI was not mediated by the medication. The CBPI pain interference score was not associated with response bias and may be used as clinical outcome measure of chronic pain and pain-related disability in dogs with OA along a period of physical rehabilitation comprising pharmacologic and nonpharmacologic pain interventions.

The Effect of N, C, Cr, and Nb Content on Silicon Nitride Coatings for Joint Applications.

Ceramic coatings deposited on orthopedic implants are an alternative to achieve and maintain high wear resistance of the metallic device, and simultaneously allow for a reduction in metal ion release. Silicon nitride based (SiNx) coatings deposited by high power impulse magnetron sputtering (HiPIMS) have shown potential for use in joint replacements, as a result of an improved chemical stability in combination with a good adhesion. This study investigated the effect of N, C, Cr, and Nb content on the tribocorrosive performance of 3.7 to 8.8 µm thick SiNx coatings deposited by HiPIMS onto CoCrMo discs. The coating composition was assessed from X-ray photoelectron spectroscopy and the surface roughness by vertical scanning interferometry. Hardness and Young's modulus were measured by nanoindentation and coating adhesion was investigated by scratch tests. Multidirectional wear tests against ultrahigh molecular weight polyethylene pins were performed for 2 million cycles in bovine serum solution (25%) at 37 °C, at an estimated contact pressure of 2.1 MPa. Coatings with a relatively low hardness tended to fail earlier in the wear test, due to chemical reactions and eventually dissolution, accelerated by the tribological contact. In fact, while no definite correlation could be observed between coating composition (N: 42.6-55.5 at %, C: 0-25.7 at %, Cr: 0 or 12.8 at %, and Nb: 0-24.5 at %) and wear performance, it was apparent that high-purity and/or -density coatings (i.e., low oxygen content and high nitrogen content) were desirable to prevent coating and/or counter surface wear or failure. Coatings deposited with a higher energy fulfilled the target profile in terms of low surface roughness (Ra < 20 nm), adequate adhesion (Lc2 > 30 N), chemical stability over time in the tribocorrosive environment, as well as low polymer wear, presenting potential for a future application in joint bearings.

Psychometric testing of a short-form questionnaire for the measurement of health experiences among people with musculoskeletal disorders undergoing multimodal rehabilitation.

AIM: The aim of the present study was to assess if a previously suggested short-form questionnaire tested among women with non-specific neck-shoulder pain is suitable also for use among men and women with non-specific musculoskeletal disorders in any part of the body, by testing its construct validity by a confirmatory factor analysis. If not, the secondary aim was to investigate the evolving factor structure when performing an explorative factor analysis of data in the expanded sample. METHODS: Questionnaire data were collected in three different contexts, in primary care via eight different multimodal rehabilitation teams and in specialised care via two different specialist care centres. The sample consisted of 116 men (n=29) and women (n=87) with non-specific musculoskeletal disorders.Data were analysed using confirmatory and exploratory factor analysis and a visual comparison between the result of the principal component analysis in the present study and the results attained in a previous study with a similar aim and design. RESULTS: The confirmatory factor analyses did not end up in a model with acceptable measures for validity. Three models were tested, none of them met the criterion for an acceptable model, and the goodness-of-fit statistics were not fully acceptable. The exploratory factor analysis had only partly comparable result compared with previous study. CONCLUSION: The results of the present study did not prove the suggested short-form questionnaire to be suitable for evaluation of symptoms among men and women with non-specific musculoskeletal disorders in any part of the body. Further studies including larger samples are recommended. TRIAL REGISTRATION NUMBER: 92199001.

The Effect of Coating Density on Functional Properties of SiNx Coated Implants.

Ceramic coatings may be applied onto metallic components of joint replacements for improved wear and corrosion resistance as well as enhanced biocompatibility, especially for metal-sensitive patients. Silicon nitride (SiNx) coatings have recently been developed for this purpose. To achieve a high coating density, necessary to secure a long-term performance, is however challenging, especially for sputter deposited SiNx coatings, since these coatings are insulating. This study investigates the time-dependent performance of sputter-deposited SiNx based coatings for joint applications. SiNx coatings with a thickness in the range of 4.3-6.0 µm were deposited by reactive high power impulse magnetron sputtering onto flat discs as well as hip heads made of CoCrMo. SiNx compositional analysis by X-ray photoelectron spectroscopy showed N/Si ratios between 0.8 and 1.0. Immersion of the flat disks in fetal bovine serum solution over time as well as short-term wear tests against ultra-high molecular weight polyethylene (UHMWPE) discs showed that a high coating density is required to inhibit tribocorrosion. Coatings that performed best in terms of chemical stability were deposited using a higher target power and process heating.

Participation in everyday occupations in a late phase of recovery after brain injury.

The aim of this study was to describe to what extent individuals of working age, in a late phase after an acquired brain injury, participate in everyday occupations related to home maintenance, work, and leisure. The aim was also to evaluate if participation in different occupations influences their life satisfaction. A sample of 157 people consecutively admitted to a rehabilitation clinic between June 1995 and December 2000 answered a mailed questionnaire. The subjects who were of working age had had a brain injury on average 6 years before this study. The perceived participation was reported using the Reintegration to Normal Living Index (RNL) and life satisfaction according to an expanded version of the LiSat 11. This study showed that in this late phase of recovery after brain injury the subjects still experienced many restrictions in participation in everyday occupations. The area with the lowest reported participation was work activity while most comfort with the situation was reported for self-care. The RNL subscales showed a significant connection with satisfaction with life as a whole. Furthermore an interaction was found between the two subscales "Daily living" and "Perception of self". This study showed restrictions in participation in the community even several years after brain injury, which underlines the need for rehabilitation services long after injury.