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The authors compare pretend play and executive function both in preschool children with an acquired brain injury and in neurotypical preschool children. They find the ability to produce logical, sequenced pretend play actions and object substitutions in play correlates strongly with executive function ability in both groups, and working memory emerges in their study as the most reliable predictor of pretend play in both groups of children. Their investigation highlights the need to include pretend play in rehabilitating children with brain injuries and the importance of pretend play for developing executive function in all children.

This paper aims to explore the impacts of a Learn to Play programme in specialist schools for children with multiple developmental issues. Specialist schools are schools dedicated to children with IQs below 70 and who may also have other developmental issues. The Learn to Play programme focusses on facilitating children's enjoyment and ability to self-initiate pretend play. Staff views were sought on the importance of pretend play for children with developmental delay and disability within a special school, and their views on the impacts of the Learn to Play programme and its implementation in specialist schools. Participants included 14 staff members across four schools for children with developmental disabilities and delay located across Victoria, Australia. The 14 staff members included six teachers, one assistant principal, two speech pathologists, one occupational therapist and four integration aide staff members. Data were collected through focus groups and Thematic Analysis was used to analyse the data. Five themes emerged which included: 'schools create successful programs', 'Learn to Play has created shifts in children's development', 'assessing pretend play is really important', 'structuring Learn to Play to allow for the challenge of play with children with developmental delay and disability' and 'communicating with parents about play'.

Strong oral language skills are foundational for literacy development and begin before a child enters formal schooling. Oral language development has been related to pretend play abilities in children. Children, particularly those from disadvantaged areas, who enter school with low pretend play levels and oral language abilities, are at risk for learning. This quantitative study investigated the pretend play and oral language abilities of a group of 30 children from a disadvantaged area in Victoria, Australia, in their first year of school. Standardised play and language assessments were administered by researchers independent of each other. Results showed that, as a group, the children were entering school with play and oral language abilities below expected range for their age. Object substitution, the ability to symbolise and use an object as something else, was found to be a predictor of a child's expressive and receptive language ability. Applying a socio-cultural lens enabled further exploration of the findings in relation to children's lives. Implications for practice that are mindful of the policy context in which teachers work are noted.

Considerably modified and enlarged compared to the 1879 print, the second edition of Primo Vere, the work of Gabriele d’Annunzio’s poetic debut, was published in 1880. This contribution focuses on it, which aims to offer an overview of the representation of nature in its chromatic, musical and olfactory aspects. Portrayed from life or fruit of the imagination, the landscape triumphs in its colouristic value and with its symphonic strength in the alternation of acute, hoarse, powerful or delicate sounds, which sometimes give way to the enchantments of silence or intertwine with the inebriation of fragrances and scents that cloak the atmosphere.

The choice of the values of the friction parameters may strongly influence the numerical modeling of the interaction between waves and porous media. Here, an assessment of such an influence is carried out using the OpenFOAM solver IhFoamV1 to simulate the response of the Catania harbor breakwater under extreme wave attack. The numerical model was validated by comparison with an experimental dataset, and a sensitivity analysis of the overtopping discharge estimate to van Gent parameter β was carried out testing values suggested by previous studies. A discussion on the importance of a careful estimate of such a parameter when dealing with the numerical modeling of porous coastal structures is presented. Indeed, variations in the non-dimensional overtopping discharge higher than 150% were observed as a consequence of a small variation (10–20%) in the absolute value of β.

The effects of climate change on coastal areas are expected to significantly influence the risk for port operations. In the present work, a novel methodology for the quantitative assessment of the performances of upgraded rubble-mound breakwaters under a changing climate is proposed. For each considered upgrading option, the failure probability related to a certain limit state is calculated through the implementation of Monte Carlo (MC) simulations, using the factor of change (FoC) method to include the projected future climate. Three indexes are defined for the immediate and intuitive interpretation of the results: i) the ratio between the calculated and the maximum acceptable failure probability during lifetime (r); ii) the rate of the growth of the failure probability during lifetime (s); iii) the coefficient of variation of the failure probability due to both the intrinsic uncertainty of the MC simulation and the variability of future climate (v). The methodology was applied to the case study of the Catania harbor breakwater, considering the failure of different upgrading solutions due to the collapse of the outer armor layer and to excessive mean overtopping discharge. The results revealed the acceptability of the structural and hydraulic performances of all the tested configurations, under both present and future climate. Moreover, a high climate-related variability of the future failure probability was found. The usefulness of the proposed indexes for designer and decision-makers was also demonstrated. In particular, r gives direct information about the acceptability of the structure performances, enabling the immediate comparison between different configurations and climate scenarios. The index s is fundamental to calculate the appropriate times to implement repair interventions during the structure lifetime. Finally, v allows the identification of those situations which requires the design of highly flexible maintenance plans, able to adapt to a very variable climate avoiding excessive costs.

It is important for assessments used by occupational therapists to have documented evidence of their validity. This adds to the knowledge about what specific factors assessments measure and inform their utility for use in clinical practice by occupational therapists. The convergent validity between the Children's Assessment of Participation and Enjoyment & Preferences for Activities of Children (CAPE/PAC), Kid Play Profile (KiPP), and Pediatric Activity Card Sort (PACS) was investigated. This will address gaps in the current body of psychometric evidence related to these three participation-focused, child self-reported measures of children's play and activity interests. Fifty Australian children without disabilities ([x-bar] age 8.54 ± 2.04 years; 64% female) completed the CAPE/PAC, KiPP, and PACS. Data were analyzed using Spearman Rho correlations with bootstrapping. Several significant low to moderate level correlations (r[subscript s] = 0.280, p < 0.05 to r[subscript s] = 0.552, p < 0.01) were found between the scale domains of the CAPE, PAC, KiPP, and PACS. Evidence of the convergent validity between the CAPE/PAC, KiPP, and PACS was established. This indicates that the three measures appear to measure several similar play and activity interest factors. Given the differences between the CAPE/PAC, KiPP, and PACS in the mode of administration, time needed to complete, purchase costs and profile of score results obtained, the convergent evidence provides additional information for occupational therapists toward making informed decisions about the most appropriate assessment(s) to potentially use. Further validity research is recommended.

In Australia, children with developmental delay and disability, who have an IQ less than 70, are eligible to attend a specialist school. These schools are called special schools or special developmental schools. Teachers, occupational therapists, and speech pathologists work in these schools together with integration aids. Children with developmental delay and disability require support when they enter school due to difficulties in play, language and social interaction. Play is important to a child's functioning with pretend play strongly linked to language acquisition and social competence. In many specialist schools in Victoria Australia, occupational therapists have implemented play programs. This study aimed to explore staff experiences of play-based programs within specialist schools in order to inform occupational therapy practice for children with developmental delay and disability in a specialist school setting. There were 20 participants. Of these, 11 were teachers, 4 were therapists, 3 were integration aides, and two were assistant principals. Data were collected through focus groups. Thematic Analysis was used to analyze the qualitative (focus group) data. Five themes emerged from the data. These were: 'We value play', 'Child led play is a challenge', 'Confidence to be a co-player with children with diverse play skills', 'We need parents to understand' and 'Barriers to play programs'. Staff valued play in the curriculum for these children, as staff understood play was a foundational ability. Staff described the challenges of play programs within a school in terms of a change in their role, being a co-player, balancing structure with child-initiated play, resources, and assessment of play. Schools that had access to an occupational therapist were more confident in play assessment, selection of play activities for the program, and encouraging self-initiated play. The findings of the study inform the role of occupational therapy in specialist schools.

Participation is a multidimensional concept that has evolved from the International Classification of Functioning, Disability and Health as one's engagement in life. This study investigated the impact that personal and environmental factors have on typically developing children's activity participation (n = 18). Children and parents/caregivers completed self-report questionnaires. Children completed the Children's Assessment of Participation and Enjoyment & Preferences for Activities of Children (CAPE/PAC) and the Children's Leisure Assessment Scale (CLASS) while parents completed the Children Participation Questionnaire (school-aged) (CPQS), Performance Skill Questionnaire (school-aged) (PSQS), and Environmental Restriction Questionnaire (school-aged) (ERQS). Pearson correlations were performed to determine whether there were correlations between the independent variables (PSQS and ERQS) and dependent variables (CAPE, PAC, CLASS, CPQS), total scores and subscale scores. The Pearson r correlation analyses were also bootstrapped. Linear regressions analyses were used to determine whether the positive correlations identified between the variables were predictive. Personal factors (which included the child's motor, process, and communication skills) were predictive of five out of the six dimensions of participation, diversity (40.8% variance accounted for in the dependent variables), intensity (32% variance), where (54.3% variance), with whom (30% variance), and enjoyment (54% variance). Environmental factors that include the child's community, educational, and home environment were predictive of all six dimensions of participation. Diversity (32.4% variance accounted for in the dependent variables), intensity (32.8% variance), where (22.4% variance), with whom (25.3% variance), enjoyment (44.9% variance), and preference (49.1% variance). The results indicated that motor, process, and communication skills were significantly predictive of a child's diversity and intensity of participation, with whom and where they completed activities, their enjoyment and parental satisfaction. Community and education environments were also found to be predictive of these elements of participation, while the home was predictive of a child's activity preference.

Social play and social interactions are essential occupations for children, but can be challenging for children with Autism Spectrum Disorders (ASD). This systematic review investigates cortisol responsivity in children with ASD during naturalistic social play and social interactions. Methodology: Six control and comparison studies of moderate quality were identified. Findings revealed that some children with ASD experience heightened stress (cortisol responsivity) during naturalistic social play and social interactions; however, this response is highly variable between individuals. These findings emphasize the importance of individualized approaches for children with ASD, to facilitate their engagement in these essential occupations.

Importance: Play is the primary occupation in childhood and fundamental to occupational therapy practice. Objective: To evaluate a play intervention in special school settings. Design: Pre- and postinvolvement of a 7-mo play program. Setting: Four special schools in Victoria, Australia, for children with IQs < 70. Participants: Thirty-eight children with diagnoses including intellectual disability, autism, and global developmental delay, 7 teachers, 2 speech pathologists, and 2 occupational therapists. Intervention: Learn to Play Therapy for 1 hr per week over a 7-mo period. Outcomes and Measures: Pre–post outcome measures included children's pretend play skills, language, social skills, emotional regulation, and academic competence. Results: Mean age of 38 children (15 girls and 23 boys) at baseline was 5 yr 7 mo (SD = 0.46 yr). Results showed significant changes in children's pretend play (p =.03), ability to recall sentences (p =.02), social skills (p =.022), and academic competence (p =.012). Learn to Play had a large effect on children's narrative skills (d = 2.72). At follow-up, object substitution at baseline influenced expressive language (p <.001), narrative mean language utterance (MLU; p =.015), social skills (p <.001), and academic competence (p <.001); elaborate play at baseline plus time influenced social skills (p <.001); and elaborate play at baseline influenced narrative MLU (p =. 016), sentence recall (p =.009), and academic competence (p =.001). Conclusions and Relevance: Embedding pretend play within practice positively influenced children's language, narrative, social, and academic skills. Plain-Language Summary: This study adds to the limited research on play-based therapy programs in special school settings for children with an IQ of less than 70. Children participated in Learn to Play Therapy, during which an occupational therapist, who has observed and assessed the child's play and understands the child's play abilities, played beside the child. Learn to Play Therapy is a child-centered therapy that is used to increase a child's ability to self-initiate and enjoy pretend play. The positive impacts of supporting the children's pretend play ability were highlighted by increases in their pretend play, language, social skills, academic competence, and narrative language after participating in Learn to Play Therapy in their special schools. This study adds to the limited research on play-based therapy programs in special school settings for children with an IQ of less than 70. [ABSTRACT FROM AUTHOR]

Children learn, communicate, and connect with others through play. This study investigated how the 'Stay at Home' public health directives impacted the play of autistic children and is supported by research indicating how play is vital for child development. In addition, autistic children may have challenges in their play development that typically require therapeutic intervention, and environmental and social changes, such as the COVID-19 pandemic, add further stress. Parents of autistic children aged 18 months to five years and residing in Australia during 2020 participated in an online survey. As a sub-sample from a larger survey, responses from 27 participants who completed COVID-19 specific, open-ended questions, were analysed using qualitative reflexive thematic analysis. Survey responses showed how parents managed the COVID-19 circumstances through self-initiated efforts to be actively involved and create play opportunities for their children. This highlights the importance of parent involvement in interventions and several target areas to consider in supporting play development in autistic children. [ABSTRACT FROM AUTHOR]

Abstract Background In 2014, a large metropolitan mental health service in Australia developed a senior role (Lead Research Occupational Therapist) to address an identified need for greater research and knowledge translation, and associated capacity building. The aim of this study was to evaluate the impact, in the first 2.5 years, of this role across a range of variables. Methods Multiple methods were used to gather a comprehensive range of data. Workforce surveys were completed both online and in hard copy in early 2014 (n = 42) and late 2016 (n = 44). Research key performance indicators (academic, research production and cultural) were also identified for measurement over time. The data from these surveys were analysed using descriptive and inductive analysis, and also with social network analysis. Results This role has demonstrated positive outcomes across a range of variables. There was a medium effect on the quantity of participation in quality assurance and knowledge translation activities by the workforce. Most knowledge translation behaviours were occurring regularly, although several were absent. An improving trend in attitudes towards evidence-based practice was recorded, and perceptions of the knowledge translation role were generally positive. The Lead Research Occupational Therapist moved from the periphery to the centre of the evidence based practice social network. Improved awareness of other clinicians deploying evidence based practice was observed, and the frequency of interaction between clinicians increased. The role has met all key performance indicators, across the academic, research production and cultural domains. Conclusions The shift in focus of this role from research to knowledge translation has produced tangible outcomes for the occupational therapy workforce. These achievements have had a positive impact on the sustainability of the role, which will be continued for at least another two years. An ongoing challenge is to directly measure the impact of this role on outcomes for people with mental illness and their carers.

Abstract Background Organisational performance measurement is a recognised business management tool and essential for survival and success. There is a paucity of methodological studies of organisational performance measurement relating to non-acute healthcare charities and this study is the first to suggest a set of evidence-informed organisational performance measures for the sector. Methods This study was designed using a two-staged approach. A systematic review of peer-reviewed journal literature between 2003 and 2016 was conducted according to the twenty-seven (27) point checklist of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) complemented by a thematic analysis of eligible data using a cutting and sorting technique to generate a set of common measures of organisational performance for non-acute health charities. Results Not one study was found relating to organisational performance of non-acute healthcare charities however four records met eligibility criteria relating to non-acute or primary healthcare services with charitable fundraising capability. Three were case studies of specific organisations that related their approach to organisational performance measurement, while the fourth compared a case study organisation to a public service. Three different organisational performance frameworks and 20 organisational performance measures were used across the four studies. Conclusions The study concluded that (1) demonstration of organisational performance is relevant to non-acute health charities; (2) organisational performance measurement is feasible in this sector; (3) an evidence-based organisational performance measurement framework for the sector has not yet been developed nor has an existing organisational performance measurement framework been adapted for the sector, although the Balanced Scorecard is likely to be an effective option and (4) five leading measures – Quality of Service; Finance; Stakeholders (Customers and Clients); People and Culture; and Governance and Business Management; could be used to determine organisational performance in these sectors. Finally, ‘Mission and Purpose’ could be explored as a potential measure. Further research to understand why there is such limited published organisational performance evidence for the sector could be useful. Case studies of organisational measurement strategies of successful non-acute healthcare charities and research into important factors for organisational performance implementation in the sector may contribute to greater uptake and knowledge dissemination.

Abstract Background A wide variety of hemostats are available as adjunctive measures to improve hemostasis during surgical procedures if residual bleeding persists despite correct application of conventional methods for hemorrhage control. Some are considered active agents, since they contain fibrinogen and thrombin and actively participate at the end of the coagulation cascade to form a fibrin clot, whereas others to be effective require an intact coagulation system. The aim of this study is to provide an evidence-based approach to correctly select the available agents to help physicians to use the most appropriate hemostat according to the clinical setting, surgical problem and patient’s coagulation status. Methods The literature from 2000 to 2016 was systematically screened according to PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-Analyses] protocol. Sixty-six articles were reviewed by a panel of experts to assign grade of recommendation (GoR) and level of evidence (LoE) using the GRADE [Grading of Recommendations Assessment, Development and Evaluation] system, and a national meeting was held. Results Fibrin adhesives, in liquid form (fibrin glues) or with stiff collagen fleece (fibrin patch) are effective in the presence of spontaneous or drug-induced coagulation disorders. Mechanical hemostats should be preferred in patients who have an intact coagulation system. Sealants are effective, irrespective of patient’s coagulation status, to improve control of residual oozing. Hemostatic dressings represent a valuable option in case of external hemorrhage at junctional sites or when tourniquets are impractical or ineffective. Conclusions Local hemostatic agents are dissimilar products with different indications. A knowledge of the properties of each single agent should be in the armamentarium of acute care surgeons in order to select the appropriate product in different clinical conditions.