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Development and evaluation of a behaviour change intervention to increase general practitioner REferral of people with hip and knee osteoarthritis to community-based First-linE caRe (REFER): a mixed methods study
No full textBACKGROUND: Globally osteoarthritis is a leading cause of pain and disability. General practitioners (GPs) have a critical role in the management of osteoarthritis in primary care, yet they also face numerous barriers to referral of people with osteoarthritis to osteoarthritis management programs that provide evidence based first line care (exercise, education, and weight management.) Thus, the aim of this project was to co-develop and evaluate the feasibility of a multi-faceted, theory-based behaviour change intervention to increase GP REferral of people with hip and knee osteoarthritis to community-based First-linE caRe (REFER). METHODS: This project involved a mixed-methods modified exploratory sequential design. Registered GPs or GP registrars with a case load including patients with hip or knee osteoarthritis were recruited in Victoria, Australia. Phase 1: REFER was initially designed by mapping GP-specific referral barriers to the behaviour change wheel. Registered GPs or GP registrars engaged in online, one-on-one semi-structured interviews to explore their learning preferences and refine REFER. Interviews were recorded, transcribed verbatim, and managed in NVIVO. Analyses involved an inductive, thematic approach. Phase 2: REFER was evaluated with a sample of GPs using the Reach, Effectiveness, Adoption, Implementation, and Maintenance Qualitative Evaluation for Systematic Translation (RE-AIM QuEST) framework. RESULTS: Phase 1: 25 GP interviews identified diverse learning preferences and barriers, including time, cost, and lack of enticing opportunities. Learning facilitators included quick and easily accessible options and earning professional development points. Almost all GPs agreed on including an online, interdisciplinary workshop with additional components (electronic medical record template, web-based toolkit, posters and flyers, booster follow-up session). Phase 2: 27 GPs participated in REFER, with 13 engaging in process evaluation interviews. REFER had high acceptability among GPs who participated and was associated with improved knowledge and confidence in OA guidelines and referral options, with a sub-set of GPs self-reporting increased referral behaviours to community-based osteoarthritis care. CONCLUSIONS: Improved GP knowledge and confidence in guidelines and referral options, alongside increased self-reported referral to first-line care indicates REFER has the potential to improve community-based osteoarthritis management. However, prior to scale-up, work is needed to improve reach and engagement with GPs, and to further refine the intervention. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12875-025-02968-x
Seating-related adaptation and deformation of components of removable partial denture frameworks fabricated by different workflows
No full textSTATEMENT OF PROBLEM: Removable partial denture (RPD) frameworks have traditionally been produced by conventional impression making and casting. Due to the popularity of intraoral scanning (IOS) and digital manufacturing, RPD frameworks can be produced by alternative workflows. PURPOSE: The purpose of this in vitro study was to assess the seating-related adaptation and deformation of components of RPD frameworks fabricated by different workflows. MATERIALS AND METHODS: A partially edentulous mandibular arch was used as the master model. Three RPD framework manufacturing workflows were evaluated: the conventional impression making and casting (Imp-Cast) group, conventional impression making and digital fabrication by selective laser melting (Imp-SLM) group, and IOS and digital fabrication (IOS-SLM) group. According to each workflow, 10 frameworks were produced. The virtual superimposition of seated and unseated frameworks was executed to determine component adaptation (retentive arm, reciprocating arm, and occlusal rest) and component deformation (retentive arm and framework body). The 1-way analysis of variance (ANOVA) test was used to determine the differences among the groups (α=.05). RESULTS: No difference in component adaptation was observed for Imp-Cast and Imp-SLM (P>.05), and both were better than IOS-SLM (P<.001). The least retentive arm deformation was observed for Imp-SLM. Imp-Cast and Imp-SLM showed no difference in framework body deformation (P=.92), and both were better than IOS-SLM (P<.05). The IOS-SLM frameworks appeared narrower than the master model. CONCLUSIONS: Frameworks fabricated from conventional casts exhibited comparable adaptation of components. In some comparisons, SLM fabrication was associated with less deformation than casting. Frameworks fabricated from IOS had the greatest adaptation error and deformation. As all the frameworks were seated on the master model without adjustment, the clinical relevance of this study's finding is yet to be determined
The Critical Role of Retailers in Leveraging Sustainability of a Global Supply Chain
No full textABSTRACT
Shade‐grown coffee farming supports biodiversity and generates additional sustainability outcomes, though the drivers of this approach are poorly understood. Previous research on coffee sustainability has focused on producers or consumers, potentially overlooking the role of retailers in commodity supply chains. We conducted semi‐structured interviews with 19 coffee traders, roasters and retailers in Melbourne, Australia to understand their coffee purchasing decisions, sustainability initiatives and their underlying motivations. Our findings indicate that retailers occupy a critical point in a supply chain from which to leverage sustainability transformations: they can support sustainable approaches at origin, in partnership with farmers and other actors, whilst also undertaking initiatives at the consumer end of the supply chain, thereby exerting bidirectional influence in supply chains. Place‐based environmental initiatives were especially likely to be implemented by large multinational traders and independent roasters operating with purpose‐driven business models that aim to deliver positive environmental, social and economic outcomes for all stakeholders. Behaviour change interventions should target retailers in global supply chains to support sustainability outcomes
Understanding the possibilities of Reflective Parent-Infant Songwriting: A Grounded theory and therapeutic songwriting model to support parents to process the experience of their baby's hospital admission after birth
No full text© 2025 Amy Rebecca HowdenThis qualitative research project explores the ways in which a novel Reflective Parent-Infant Songwriting model supported parents to reflect on the experience of having a baby in the Neonatal Intensive Care Unit (NICU) or paediatric hospital after birth. Having a premature or unwell baby and subsequent hospital admission is known to be an emotional and complex experience for parents. During hospital admission and after discharge home, parents may experience disruptions to their identity and parental role, the quality of their relationship with their baby, and with others (McLean, 2016; Shah et al., 2011). Music therapy and songwriting approaches tailored to parent-infant bonding and parent wellbeing in the NICU context have been documented (Ettenberger & Beltran Ardila, 2018; Haslbeck, 2017), yet little is known about whether similar methods might support these families after discharge.
This research spans two studies. Firstly, a pilot study was conducted with two mother-infant dyads who had experienced a NICU admission with their infant. Mother-infant dyads participated in individual, home-based musical experiences and therapeutic songwriting to create a personally meaningful song which they could use and incorporate into their lives at home. The Microanalysis in Music Therapy Framework (McFerran & Grocke, 2007) based on Descriptive Phenomenology (Giorgi, 2012) guided the analysis, resulting in four shared themes. I was particularly curious about shared theme 3: the women were proud of developing lyrics which represented what they wanted to remember about their journey with their baby. This theme informed the more narrowed focus on parent reflection for the subsequent study.
In-depth documentation of my therapeutic songwriting facilitation in the pilot study resulted in articulating Reflective Lullaby Writing (Howden et al., 2022) as a novel approach. However, during the reflexive planning phase for the second study (the main study) I reconsidered whether limiting the songwriting genre to a lullaby was necessary. This reconceptualisation led me to incorporate a broader perspective of parent-infant experiences, musical styles and inspirations, resulting in the identification of Reflective Parent-Infant Songwriting as a distinct therapeutic songwriting model.
The main study further explores this new approach to therapeutic songwriting. Eligibility criteria were expanded to include NICU or other types of admission after an infant’s birth. 12 parents (including three couples) and their infants wrote nine songs comprising of original and song parodies. Constructivist Grounded Theory (Charmaz, 2006, 2014) guided data collection and analysis of two rounds of parent interviews. Findings from a substantive grounded theory highlights that parents’ active engagement in therapeutic songwriting supported them to look back on, integrate, and make sense of their experiences. By engaging with their song personally, with their baby, and with others, parents gained insight, perspective and fostered rich connections. Several song-sharing considerations were identified, indicating that parents navigate a range of personal factors and motivations prior to using their song with their baby, or sharing it with others. This finding suggests the need for supportive discussions facilitated by a music therapist regarding parents’ emotional experience of using their song, particularly to consider whether they might like to invite reflections from a song-sharing partner afterwards or not.
This study highlights that Reflective Parent-Infant Songwriting honours the individual experiences and therapeutic preferences of parents with a recently discharged infant, for example, reflective processes and musical or song-based choices. Future research adopting this songwriting model would further enhance the theory’s relevance and applicability with a broader range of parent and infant experiences
Resilience pathways through community- based forest management for navigating the triple planetary crisis
No full textRural communities and ecosystems are interlinked parts of social ecological systems. However, these relationships are witnessing changes because of biodiversity loss, pollution and climate change. Ecosystems and the human communities that rely on them are both sensitive and resilient to change. There is a need to understand the autonomous processes involved in complex change, including resilience and adaptive capacity in response to external shocks. Taking Community Based Forest Management (CBFM) as a case, in this study we reviewed empirical research with the dual aims of understanding the state of literature about resilience in CBFM and synthesizing findings about how CBFM produces social, economic, ecological and disaster resilience. The review process involved systematic selection and screening of articles based on clear criteria and a defined review protocol. The 51 selected articles were analysed for changing themes over time, geographical coverage and pathways to resilience. This study demonstrates how CBFM fosters resilience through diverse social, economic, ecological, and disaster resilience pathways that are intertwined and enabled by the close coupling of people and nature in CBFM. The local activity in CBFM contributes to achieving broader global goals of sustainable forest management and adaptation to climate change. The study concludes that CBFM needs to be viewed from the perspective that it enables resilience for communities and ecosystems in changing contexts. Despite many external factors that hinder its implementation, CBFM remains one of the best strategies for enabling the adaptive capacity of forest dependent communities. This contribution of CBFM should be better recognized and should be supported by building on existing resilience processes and attending to social justice
The mid-Cretaceous Hohonu Batholith (South Island, New Zealand): Identifying magmatic sources and processes during onset of crustal extension
No full textThe Hohonu Batholith is an aggregation of mostly mid-Cretaceous granitoid plutons on the West Coast of the South Island of New Zealand emplaced during a transitional period between subduction-related compression and continental lithospheric extension. This study reports an integrated dataset, comprising in-situ U-Pb, O and Hf isotope compositions and REE, Ti and other trace and major elements (Zr-Hf, Th-U) for zircons extracted from four representative plutons within the batholith. Our results provide detailed insight into the protracted thermal, chronological and geochemical histories. LA-ICPMS U-Pb zircon ages indicate a primary episode of magma genesis and emplacement from 107 to 113 Ma, confirming published SIMS dating. However, a younger previously unrecognized age population of ∼91–96 Ma is identified, primarily (although not exclusively) in zircon rims. This younger age event coincides with the timing of protracted lithospheric extension and crustal thinning of the Zealandia continent. The cryptic younger zircon ages suggest that Hohonu granitoids experienced a partial thermal overprint (accompanied by Pb loss) mostly recorded in rims. Differences in bulk rock geochemistry between plutons are inferred to reflect variable conditions of partial melting controlled by source mineralogy and H2O content. Isotope and trace element compositions, along with Ti-thermometry, measured on the same micro-volume of CL-imaged zircons, are used to test if source characteristics were imparted from melt to minerals in zircon-saturated silicic systems. Similarities are revealed in the zircon record of the selected plutonic rocks, confirming their broadly consanguineous relationship and the fundamental role of open-system behaviour, involving hybridization or assimilation between mantle-derived (or juvenile mafic) and crustal-derived components, as previously inferred from whole rock Nd-Sr isotope systematics. However, intra-sample decoupling of zircon O-Hf isotope systematics may also be linked to residual source unmixing. This possibility, in addition to mafic recharge, may have obscured melt source compositional characteristics, and hence zircon REE appear as unsuitable fingerprints of source(s) and conditions of partial melting in this granitoid system. Simple compositional and thermal magma evolution trends appear punctuated by episodes of mafic recharge, presumably during lithospheric thinning
Establishing normative scores of affect, safety, and comfort for bicycling infrastructure and traffic conditions
No full textPerceptions of safety and comfort are key components of bicyclist user experiences and influence bicycling uptake. Existing video-based surveys show that environments with greater separation of bicycle and motor traffic are associated with greater subjective safety and comfort. However, these studies have not compared on-road and off-road bicycling infrastructure, the relationship between subjective safety/comfort and measures of emotion, nor established normative scores of safety and comfort with representative samples. This survey study aimed to establish normative scores of affect (defined as perceived safety, comfort, valence and arousal) for video clips depicting first-person riding in different infrastructure and traffic environments in an age and gender representative sample of Australian adults aged 18 to 80 years (N = 1737). Results showed that off-road shared paths and separated bike lanes provided the subjectively safest and most comfortable riding environments, while there was significant overlap in affect scores for painted bike lane and mixed traffic environments in low traffic levels. Linear multilevel models revealed gender, bicycling confidence, and Geller typology differences in affect scores. Scores of valence, arousal, safety, and comfort were highly correlated. These results highlight the individuality of subjective perceptions across demographic sub-groups and the need for representative samples in research. They also reinforce the need for planners to prioritise off-road shared paths and separated bike lanes, which offer the most positive biking experiences. Finally, designing infrastructure with user experiences in mind (i.e., to foster positive emotions and safety) may make biking more attractive, encouraging more people to ride
Identifying diabetes in hospital inpatients: A systematic review of diabetes digital phenotyping methods and applications
No full textTectonically-induced neptunian dykes and breccias of the Paleoproterozoic Teena Dolomite: Significance to stratiform zinc deposits in the McArthur Basin, Australia
No full textA widespread system of breccias and neptunian dykes is present within the Paleoproterozoic Teena Dolomite of the McArthur Basin. Most breccia types within the unit are infilled by early fibrous marine cements and dark grey sediments. We interpret the dominant breccia types as in-situ synsedimentary fracture systems (neptunian dykes) while some matrix-supported breccias are likely to be mass flow deposits. Fibrous marine cements filling the neptunian dykes have several different textures and all now consist of dolomite. Petrographic evidence indicates the cements were likely precipitated as calcite and dolomitized during early diagenesis. The trace and rare earth element chemistry of the marine cements is typical of Paleoproterozoic marine cements and indicate relatively anoxic marine conditions. The breccias in the Teena Dolomite appear to be the result of a basin-wide tectonic event that occurred during Teena Dolomite to early Barney Creek time at ∼1640 Ma. Early marine-cemented neptunian dykes likely formed by tectonic fracturing and gravitational collapse on tectonic highs. Many large stratiform Zn-Pb deposits in northern Australia (HYC, Teena, Lady Loretta, Mt Isa) are hosted by shales that are coeval with this tectonic event, suggesting a genetic link between tectonism and mineralization. We suggest that this ∼1640 Ma tectonic event is responsible for both the release of mineralization fluids (via faulting and/or dewatering), and the deposition of deeper water organic-rich fine-grained sediments that host the mineralization (via tectonic subsidence). This tectonic event appears to be an important component of the sedimentary exhalative mineral system in the Carpentaria Zinc Belt of northern Australia
Incidence and Clinical Outcomes of Multiple Viral Infections After Allogeneic Hematopoietic Cell Transplantation
No full textBackground. Recipients of allogeneic hematopoietic cell transplantation (alloHCT) are at risk of multiple viral infections. However, our knowledge about the clinical impact of viruses following alloHCT is predominantly focused on outcomes of a single viral infection such as cytomegalovirus (CMV). This retrospective cohort study aimed to evaluate the incidence, risk factors, and clinical outcomes of multiple viral infections in the first year following alloHCT. Methods. All microbiologically confirmed viral infection of CMV, Epstein-Barr virus (EBV), BK polyomavirus (BKV), varicella zoster virus, human herpesvirus 6, herpes simplex virus, and various respiratory viruses were reviewed up to 12 months post-alloHCT. Results. Among 430 alloHCT recipients, 744 viral infections were observed within the first year posttransplantation, predominantly CMV (55%), followed by EBV (51%) and BKV (21%). Eighty-five percent of patients had at least 1 viral infection, of which 34% had 2 and 24% had ≥3 viruses. Independent risk factors of multiple viral infections included CMV serostatus (R+/D−: hazard ratio [HR], 2.59 [95% confidence interval {CI}, 2.03–3.30]; R−/D+: HR, 2.25 [95% CI, 1.66–3.05]), haploidentical donor (HR, 1.56 [95% CI, 1.18–2.06]), T-cell depletion use (HR, 1.44 [95% CI, 1.11–1.88]), and grade III–IV acute graft-versus-host disease (HR, 1.44 [95% CI, 1.15–1.80]). Patients experiencing multiple viral infections (≥3 vs 2 vs 1) had an earlier time to onset of first infection (median, 18 vs 25 vs 40 days), were hospitalized for an increased number of days (median, 53 vs 40 vs 37 days), and had lower survival probability at day 270 following infusion (P = .044). Conclusions. Multiple viral infections were frequently observed, with a significant impact on morbidity and mortality following alloHCT