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Simple process models are applied to predict microstructural changes due to the thermal cycle imposed in friction stir welding. A softening model developed for heat-treatable aluminium alloys of the 6000 series is applied to the aerospace alloy 2014 in the peak-aged (T6) condition. It is found that the model is not readily applicable to alloy 2024 in the naturally aged (T3) temper, but the softening behaviour can still be described semi-empirically. Both analytical and numerical (finite element) thermal models are used to predict the thermal histories in trial welds. These are coupled to the microstructural model to investigate: (a) the hardness profile across the welded plate; (b) alloy softening ahead of the approaching welding tool. By incorporating the softening model applied to 6082-T6 alloy, the hardness profile of friction stir welds in dissimilar alloys is also predicted.

ObjectivesTo systematically review the evidence base for a systems approach to healthcare design, delivery or improvement.DesignSystematic review with meta-analyses.MethodsIncluded were studies in any patients, in any healthcare setting where a systems approach was compared with usual care which reported quantitative results for any outcomes for both groups. We searched Medline, Embase, HMIC, Health Business Elite, Web of Science, Scopus, PsycINFO and CINAHL from inception to 28 May 2019 for relevant studies. These were screened, and data extracted independently and in duplicate. Study outcomes were stratified by study design and whether they reported patient and/or service outcomes. Meta-analysis was conducted with Revman software V.5.3 using ORs—heterogeneity was assessed using I2 statistics.ResultsOf 11 405 records 35 studies were included, of which 28 (80%) were before-and-after design only, five were both before-and-after and concurrent design, and two were randomised controlled trials (RCTs). There was heterogeneity of interventions and wide variation in reported outcome types. Almost all results showed health improvement where systems approaches were used. Study quality varied widely. Exploratory meta-analysis of these suggested favourable effects on both patient outcomes (n=14, OR=0.52 (95% CI 0.38 to 0.71) I2=91%), and service outcomes (n=18, OR=0.40 (95% CI 0.31 to 0.52) I2=97%).ConclusionsThis study suggests that a systems approaches to healthcare design and delivery results in a statistically significant improvement to both patient and service outcomes. However, better quality studies, particularly RCTs are needed.PROSPERO registration numberCRD42017065920.