Browse Articles

Developing a rehabilitation intervention difficulty index: A mixed-methods study using NASA-TLX and Borg RPE in a tertiary clinical setting

Background Rehabilitation difficulty varies substantially across clinical areas and intervention types, yet few brief, standardised measures exist to quantify difficulty from the therapist’s perspective. Understanding rehabilitation difficulty is important for workforce planning, resource allocation, and identifying contexts where therapist support is most needed. Objective To develop and preliminarily evaluate the Rehabilitation Intervention Difficulty Index (RIDI), a mixed-methods measure combining cognitive/affective and physiological dimensions of rehabilitation difficulty, and to identify contextual factors associated with high difficulty. Methods Quantitative component: 441 rehabilitation sessions from 28 therapists across 12 clinical areas were assessed using the NASA Task Load Index (NASA-TLX; four items: mental demand, temporal demand, effort, frustration) and Borg Rating of Perceived Exertion (RPE). The RIDI was constructed as the mean of the NASA composite score and normalised Borg RPE (0–10 scale). Psychometric properties were evaluated using Cronbach’s alpha and exploratory factor analysis. Descriptive statistics, one-way ANOVA, Pearson correlations, and intervention-level summaries were performed. Qualitative component: Semi-structured interviews and focus groups with 20 therapists (10 individual interviews, 10 focus-group participants; 11 physiotherapists, 9 occupational therapists) were conducted across selected clinical areas in the same hospital. Thematic analysis identified key sources of rehabilitation difficulty. Qualitative and quantitative findings were integrated through joint display analysis. Results Quantitative findings: RIDI showed good internal consistency for the NASA items (α = 0.80, 95% CI [0.77, 0.83]) and acceptable consistency for the five-item set (α = 0.75, 95% CI [0.72, 0.78]), with a unidimensional factor structure explaining 52% of the variance. RIDI scores differed significantly across clinical areas (F = 9.18, p < 0.001, η² = 0.19), with higher scores in neurorehabilitation and acute neuro settings (both 5.80) and lower scores in outpatient physical therapy (3.63). Among frequently used interventions (n ≥ 5), transfer training and splinting had the highest RIDI scores (6.78 and 6.71), while passive range of motion had the lowest (2.68). RIDI was moderately correlated with session duration (r = 0.28, p < 0.001) but not with therapist experience (r = 0.01, p = 0.78). Qualitative findings: Six themes described sources of difficulty: time demands (78 coded segments, 18 participants), cognitive demands (72, 18), physical demands (65, 17), patient-related factors (57, 16), environmental constraints (44, 15), and coping strategies (33, 14). No substantially new themes were identified after approximately 70% of the data, suggesting thematic saturation. Mixed-methods integration: High RIDI scores in neuro and acute inpatient areas converged with qualitative descriptions of heavy time, cognitive, and physical demands. Coping strategies were discussed much less often in high-RIDI areas (8 segments) than in lower-RIDI areas (23 segments), suggesting that in the most demanding contexts therapists may have fewer opportunities to apply deliberate coping strategies. Conclusions RIDI showed acceptable reliability and preliminary evidence of construct validity as a therapist-reported measure of rehabilitation difficulty that captures both cognitive/affective and physiological aspects of workload. Variation in RIDI scores across clinical areas and interventions was consistent with meaningful differences in perceived difficulty. The under-representation of coping strategies in high-RIDI contexts suggests that high rehabilitation difficulty may require structural and organisational responses—such as staffing, workflow redesign, and environmental modifications—rather than relying primarily on individual coping. RIDI may provide a practical tool for identifying high-demand areas, informing workforce planning, and targeting support where it is most needed.

Daily briefing: The neural circuit that can make it hard to start a difficult task

Same-sex sexual behaviour can help primates to survive — and reproduce

US scientists push back as Trump eyes Greenland

The old pea model in a new light: power of auxin over photoassimilates

Comparison of apparent and three-dimensional pupillary diameter measurements in cataract patients and their impact on multifocal intraocular lens selection

Myeloid cell-specific HMGB1 deficiency exaggerates mucoinflammatory responses but promotes bacterial clearance in mucoinflammatory lung disease

Global RNA expression analysis of patient samples identified potential diagnostic biomarkers specific for peritoneal, ovarian and deep endometriosis

Dark and camouflaged genomic regions remain challenging in CHM13

Development of a global screening system for detecting protein–protein interactions by luminescence complementation in fission yeast

Study on CO2/CH4 displacement process in shale microscale models with adsorption/desorption behavior by lattice Boltzmann method

Interpretations of reproducibility crisis in medical education research: a qualitative study

Histological and genetic changes induced by extracorporeal shockwave therapy after rotator cuff repair in a rat model with tears

A quantitative study of cytotoxic compounds using graph based descriptors and machine learning

Experimental study on fracture and fragmentation characteristics of laminated rocks under impact loading

Abstract Laminated rock bodies are prevalent in engineering applications, making the investigation of their damage characteristics and evolution patterns under impact loading critical for ensuring engineering safety. Despite this importance, the relationship between energy dissipation and the crushing mode of laminated rock bodies remains underexplored, particularly regarding the influence of lamination orientation on their dynamic response. To bridge this scientific gap, this study conducts rock impact tests in the presence of various lamination angles (0°, 30°, 60°, and 90°) and employs digital image correlation (DIC) technology alongside acoustic emission (AE) monitoring and fracture sieve analysis to systematically examine how lamination orientation affects energy dissipation patterns, crack propagation behavior, and fragmentation characteristics in rocks. The results indicate that the lamination angle has a significant influence on the energy dissipation characteristics of rocks. When the lamination orientation is parallel or perpendicular to the direction of shock wave propagation, the rocks exhibit a low intensity of energy dissipation, a singular crushing mode, restricted crack propagation, and a relatively stable fragmentation process. Conversely, laminated rocks with oblique intersections demonstrate complex damage modes due to the combined effects of shear and tension, wherein significant large-scale crack propagation occurs, exacerbating structural instability. Analysis of AE b -values corroborates these observations, revealing that the development of microcracks in rocks with diagonally interbedded laminations along the impact direction is more prone to result in large-scale destabilization and damage. This study elucidates the damage mechanisms and directional characteristics of laminated rocks subjected to impact loading, thereby providing a vital theoretical foundation and technical support for the safe design of engineering structures and related construction practices.

Investigation of changes observed in the statistical characteristics of Lake Tana’s water levels after damming the outflow, Ethiopia

Incidence rates of tendinopathies and non-traumatic tendon ruptures in Hong Kong: a 25-year epidemiological study using big data from public hospitals

Abstract Tendinopathy affects a substantial proportion of individuals and imposes a notable burden on healthcare systems. Its management poses considerable challenges, largely due to the limited availability of effective treatments, some of which may eventually lead to tendon tears. Despite its clinical importance, epidemiological research on tendinopathic conditions remains sparse and somewhat contentious. Consequently, there is an urgent need for comprehensive data to inform prevention strategies and optimize resource allocation. This study investigated the incidence of tendinopathy and non-traumatic tendon rupture in the Hong Kong population, using medical records from public hospitals. Data were sourced from the Clinical Data Analysis and Reporting System (CDARS). Patients with tendinopathy or non-traumatic tendon rupture were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) from 2000 to 2024. The overall, age-standardized, and sex-standardized annual incidence rates, as well as the age-specific and sex-specific annual incidence rates, were presented. Our study involved 36,970 patients across 47 public hospitals. The total annual incidence rate for the 17 tendinopathies and non-traumatic tendon ruptures included was 21.05 ± 7.08 cases per 100,000 persons. Incidence rate for the 10 tendinopathies was 15.48 ± 6.33, whereas for the 7 non-traumatic tendon ruptures was 5.57 ± 0.93. Tendinopathy had the highest overall incidence among cases of lateral epicondylitis, at 8.84 ± 3.31 cases per 100,000 persons, followed by Achilles tendinopathy at 3.09 ± 1.59. Regarding non-traumatic tendon rupture, rotator cuff tendon rupture had the highest average incidence at 1.90 ± 0.87 cases per 100,000 persons, followed by Achilles tendon rupture at 1.73 ± 0.37. Older individuals (aged 40–59) showed higher rates of most tendinopathies, except for patellar and Achilles tendinopathies predominantly affected in youngsters. Females had higher rates of several tendinopathies, while males had higher rates of patellar tendinopathy and various tendon ruptures. Our findings highlight several key tendon conditions for targeted prevention, with a focus on middle-aged adults and especially females for tendinopathies and males for non-traumatic tendon ruptures. Primary care providers are encouraged to facilitate earlier referrals for lateral epicondylitis and Achilles tendinopathy, while orthopaedic surgeons are advised to consider earlier interventions for these conditions. Additionally, emergency staff may consider additional training in the management of commonly encountered tendon conditions, such as rotator cuff tears and Achilles tendon ruptures.

Short-term nitrogen enrichment alters microbial phosphorous limitation in Pinus taiwanensis forest soils

An efficient three-tier defense mechanism for mitigation of DDoS attack with port connection analysis in SDN

Abstract This study presents a novel three-tier defense mechanism at the software-defined networking (SDN) control plane to improve DDoS attack detection and mitigation using real-time flow table data from OpenFlow switches. The proposed method combines adaptive statistical detection, event-based activation of the ML classifier, and targeted port-level mitigation to increase accuracy and lower controller load, in contrast to current solutions that rely on static thresholds, full attack-path tracing, or continuously running machine learning models. The proposed model employs an improvised cumulative sum algorithm at the first tier with adaptive threshold and an event-based activation of decision tree classifier at second tier to swiftly and accurately detect DDoS traffic with sub-second latency without adding extra load on SDN controller. The third tier uses port connection analysis by utilizing link-layer discovery protocol (LLDP) that distinguishes direct and indirect port sources involved during attack without tracing the complete attack path. Results demonstrate that this integrated mechanism offers faster, more precise, and more resource-efficient DDoS mitigation compared with existing solutions. It outperforms traditional methods by achieving accuracy of 99.99%, reducing computational load and false positive rate by 87%, and achieve a more targeted response by reducing unnecessary mitigation actions by 94% with 0% packet loss.

Utility of fluorescamine for spectrofluorimetric quantitation of berotralstat hydrochloride in spiked human plasma and content uniformity test and evaluation of method greenness

Abstract A novel, simple and highly sensitive spectrofluorimetric approach has been developed and validated for the first time for determination of berotralstat through derivatization reaction using fluorescamine as a fluorescent probe. The reaction was carried out in buffered medium at pH 7.5, using a borate buffer. After being illuminated at 390 nm, the fluorescence intensity of the resulting product was measured at 480 nm. The proposed approach demonstrated linearity within the concentration range of 100 to 1000 ng mL − 1 . LOD and LOQ are 6.98 and 26.36 ng mL − 1 , respectively. Pharmaceutical capsules of berotralstat were successfully evaluated in addition to spiked biological fluid. The statistical data has been validated in accordance with ICH criteria. Additionally, it was applied to examine the content uniformity in accordance with US Pharmacopeia requirements. Furthermore, the results of the ecology scale scores indicated that the analytical process involved was green.