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Background: Patient Reported Outcome Measures (PROMs) have been shown to be valid and reliable indicators of health status and treatment outcomes, however, the current knowledge, understanding, and utilisation of PROMs within the Australian Chiropractic profession is limited. This study used the New World Kirkpatrick Model (NWKM) to evaluate whether an online PROM education package could improve knowledge, confidence, attitude, and utilisation of PROMs by chiropractors in Australia., Methods: A longitudinal cohort interventional study of chiropractors in Australia. The recruitment phase and data collection period occurred from November 2020 - May 2021. Participants completed three online surveys two weeks before, four weeks after, and 12 weeks after receiving an online education package that included ten evidence-based region-specific modules on PROMs. Survey questions were grouped into five subthemes for analysis according to the NWKM levels: (1) Reaction; (2) Learning - knowledge; (3) Learning - confidence; (4) Behaviour - attitude; (5) and Behaviour - utilisation)., Results: Of the 116 participants that enrolled in the study, 43 completed all three survey and were included in the analysis. There was very positive reaction to the education package with mean response scores (1-5 Likert scale) for the reaction questions ranging from 3.75 to 4.43. There was a small, but significant, increase in knowledge (out of 32) at four weeks (24.3 ± 6.1) and 12 weeks after receiving the education package (27.2 ± 5.5), compared to baseline (27.4 ± 5.1). There was no effect of the intervention on clinician confidence or attitude towards PROMs. Utilisation of function- and pain-related PROMs did not change after the intervention. There was a small and significant (p < 0.05) increase in utilisation of health-related PROMs 12 weeks after the intervention., Conclusion: Despite modest improvements in knowledge, which were retained 12 weeks after the educational package was provided, there was no evidence that participant confidence, attitude, or utilisation of PROMs changed because of the intervention. While the respondents' have positive attitudes and beliefs regarding PROMs use, further education surrounding the clinical translation process into clinical practice is required. Caution is advised when interpreting these findings due to the low participant response and completion rate with the potential for selection bias and the inability to generalise the results., (© 2022. The Author(s).)

Background: Factors that influence utilisation rates of patient reported outcome measures (PROMs) for low back pain (LBP) within the chiropractic profession of Australia are currently unknown. This study aimed to examine whether factors, including age, sex, experience level, clinical title (principal vs associate), or a clinicians' perceived value of PROMs, are predictive of the frequency and/or type of PROMs used by chiropractors in the management of LBP., Methods: A cross sectional online survey was distributed to members of the Chiropractic Association of Australia (CAA now known as Australian Chiropractors Association-ACA) and Chiropractic Australia (CA). 3,014 CAA members and 930 CA members were invited to participate totaling 3,944, only respondents that were using PROMs were included in the analysis (n = 370). Ordinal logistic regression was used to examine associations between clinician demographics and perceived value of PROMs, and the frequency of pain, health, and functional patient reported outcome measure (PROM) usage by chiropractors., Results: Principal chiropractors were more likely (Wald = 4.101, p = 0.04, OR = 1.4 (1.0-2.1)) than associate chiropractors to frequently use pain-related PROMs for the management of patients with LBP. The remaining demographic factors (age, sex, and experience level) were not associated with the frequency of PROM usage; nor were the perceived value clinicians place on PROMs in clinical practice., Conclusion: Principal chiropractors were more likely to frequently use pain-related PROMs for the management of patients with LBP when compared to associate chiropractors. Demographic factors, appear to have little influence on PROM usage. While chiropractors place high value on PROMs, these beliefs are not associated with increased frequency of PROM usage for the management of LBP., (© 2021. The Author(s).)

Background: Australia is one of the leading countries resettling people from refugee-like backgrounds. Catch-up immunisation is a key priority in this cohort. However, few studies have included asylum seekers and the adult age group in their study sample. In addition, Electronic Health Records (EHR) has recently been recognised as a vital tool in big data analysis with the capacity to contribute to informed strategic decision making. As such, the main aim of this study is to explore EHR routinely used in a specialised refugee clinic in South East Queensland to estimate the extent of catch-up immunisation and assess the factors associated with under-immunisation among refugees and asylum seekers., Methods: A quantitative study involving a secondary data analysis on a pre-existing dataset was undertaken. Relevant data was extracted from the EHR in the clinic. SPSS was used to perform Statistical data analysis., Results: The majority of clients originated from Papua New Guinea, followed by Iran and Afghanistan. When assessing the uptake of catch-up immunisations among refugees and asylum seekers, MMR (Measles-Mumps-Rubella), Polio and DTP (Diphtheria-Tetanus-Pertussis) had the highest uptake, while HPV (Human Papilloma Virus), Pneumococcal and Hib (Haemophilus influenza type b) immunisations had the lowest uptake. Binary logistic regression revealed that the younger patients, the refugees (compared to asylum seekers) and those with a longer residential duration in Australia are at a higher risk of being under-immunised., Conclusion: This study indicates that the broader group of immigrants, and in particular refugees and asylum seekers, do not represent a homogenous group in terms of immunisation coverage, and that each cohort should be carefully considered during immunisation interventions and strategies. This will be particularly important during targeted health promotions and future immunisation programs in this cohort., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

In increasingly constrained health and aged care services, strategies are needed to improve quality and translate evidence into practice. In dementia care, recent failures in quality and safety have led the WHO to prioritise the translation of known evidence into practice. While quality improvement collaboratives have been widely used in healthcare, there are few examples in dementia care.We describe a recent quality improvement collaborative to improve dementia care across Australia and assess the implementation outcomes of acceptability and feasibility of this strategy to translate known evidence into practice. A realist-informed process evaluation was used to analyse how, why and under what circumstances a quality improvement collaborative built knowledge and skills in clinicians working in dementia care.This realist-informed process evaluation developed, tested and refined the programme theory of a quality improvement collaborative. Data were collected pre-intervention and post-intervention using surveys and interviews with participants (n=28). A combined inductive and deductive data analysis process integrated three frameworks to examine the context and mechanisms of knowledge and skill building in participant clinicians.A refined program theory showed how and why clinicians built knowledge and skills in quality improvement in dementia care. Six mechanisms were identified: motivation, accountability, identity, collective learning, credibility and reflective practice. These mechanisms, in combination, operated to overcome constraints, role boundaries and pessimism about improved practice in dementia care.A quality improvement collaborative designed for clinicians in different contexts and roles was acceptable and feasible in building knowledge, skills and confidence of clinicians to improve dementia care. Supportive reflective practice and a credible, flexible and collaborative process optimised quality improvement knowledge and skills in clinicians working with people with dementia. Trial registration number ACTRN12618000268246., Competing Interests: Competing interests: MCa has been employed in the last 5 years to assist with data collection for Alzheimer’s disease drug trials funded by Janssen and Merck., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: In increasingly constrained healthcare budgets worldwide, efforts to improve quality and reduce costs are vital. Quality Improvement Collaboratives (QICs) are often used in healthcare settings to implement proven clinical interventions within local and national programs. The cost of this method of implementation, however, is cited as a barrier to use. This systematic review aims to identify and describe studies reporting on costs and cost-effectiveness of QICs when used to implement clinical guidelines in healthcare., Methods: Multiple databases (CINAHL, MEDLINE, PsycINFO, EMBASE, EconLit and ProQuest) were searched for economic evaluations or cost studies of QICs in healthcare. Studies were included if they reported on economic evaluations or costs of QICs. Two authors independently reviewed citations and full text papers. Key characteristics of eligible studies were extracted, and their quality assessed against the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). Evers CHEC-List was used for full economic evaluations. Cost-effectiveness findings were interpreted through the Johanna Briggs Institute 'three by three dominance matrix tool' to guide conclusions. Currencies were converted to United States dollars for 2018 using OECD and World Bank databases., Results: Few studies reported on costs or economic evaluations of QICs despite their use in healthcare. Eight studies across multiple healthcare settings in acute and long-term care, community addiction treatment and chronic disease management were included. Five were considered good quality and favoured the establishment of QICs as cost-effective implementation methods. The cost savings to the healthcare setting identified in these studies outweighed the cost of the collaborative itself., Conclusions: Potential cost savings to the health care system in both acute and chronic conditions may be possible by applying QICs at scale. However, variations in effectiveness, costs and elements of the method within studies, indicated that caution is needed. Consistent identification of costs and description of the elements applied in QICs would better inform decisions for their use and may reduce perceived barriers. Lack of studies with negative findings may have been due to publication bias. Future research should include economic evaluations with societal perspectives of costs and savings and the cost-effectiveness of elements of QICs., Trial Registration: PROSPERO registration number: CRD42018107417.

Introduction: Successful implementation and embedding of new health care practices relies on co-ordinated, collective behaviour of individuals working within the constraints of health care settings. Normalization Process Theory (NPT) provides a theory of implementation that emphasises collective action in explaining, and shaping, the embedding of new practices. To extend the practical utility of NPT for improving implementation success, an instrument (NoMAD) was developed and validated., Methods: Descriptive analysis and psychometric testing of an instrument developed by the authors, through an iterative process that included item generation, consensus methods, item appraisal, and cognitive testing. A 46 item questionnaire was tested in 6 sites implementing health related interventions, using paper and online completion. Participants were staff directly involved in working with the interventions. Descriptive analysis and consensus methods were used to remove redundancy, reducing the final tool to 23 items. Data were subject to confirmatory factor analysis which sought to confirm the theoretical structure within the sample., Results: We obtained 831 completed questionnaires, an average response rate of 39% (range: 22-77%). Full completion of items was 50% (n = 413). The confirmatory factor analysis showed the model achieved acceptable fit (CFI = 0.95, TLI = 0.93, RMSEA = 0.08, SRMR = 0.03). Construct validity of the four theoretical constructs of NPT was supported, and internal consistency (Cronbach's alpha) were as follows: Coherence (4 items, α = 0.71); Collective Action (7 items, α = 0.78); Cognitive Participation (4 items, α = 0.81); Reflexive Monitoring (5 items, α = 0.65). The normalisation scale overall, was highly reliable (20 items, α = 0.89)., Conclusions: The NoMAD instrument has good face validity, construct validity and internal consistency, for assessing staff perceptions of factors relevant to embedding interventions that change their work practices. Uses in evaluating and guiding implementation are proposed.

Background: This paper uses Normalization Process Theory (NPT) to examine staff impressions of Montessori-based program training and implementation at Veterans Affairs Community Living Centers (VA CLCs; nursing homes). Methods: We conducted a mixed-methods evaluation of Montessori Approaches to Person-Centered Care (MAP-VA) at eight VA CLCs. Trainings were conducted as either a live virtual course or a pre-recorded asynchronous class. Two NPT constructs, coherence building and cognitive participation, informed qualitative interview questions, surveys, and analyses focused on staff movement from knowledge to action during initial implementation. Data collection included staff-completed standardized post-training exams (N = 906), post-training evaluations (N = 761), and optional validated surveys on perceptions of Montessori training (N = 307). Champions (peer-leaders) from each CLC completed semi-structured qualitative interviews post-training (N = 22). Findings: The majority of staff (83%–90%) passed all courses. Staff evaluated the training highly (80%+ agreement) on learning relevant new knowledge and confidence applying new skills. On average, staff felt MAP-VA would become a normal part of their work (7.68/10 scale), and reported increased familiarity with Montessori approaches after training (p =.002). Qualitative interview data from staff trained in Montessori supported three themes concordant with the NPT dimensions of coherence building and cognitive participation. (1) Coherence regarding Montessori: staff demonstrated an understanding of the program and mentioned the benefits of Montessori compared to their previous usual routines. Cognitive participation or engagement with Montessori: (2) staff had positive feelings about Montessori principles/applications and demonstrated a willingness to try the Montessori approach, and (3) staff made sense of the new intervention through early rehearsal of Montessori principles/practices and recognized opportunities for using Montessori in future interactions. Conclusions: Montessori virtual training resulted in high levels of coherence and cognitive participation among multidisciplinary staff, evidenced by high knowledge, self-efficacy, and readiness to act. The asynchronous and synchronous trainings were accessible, relevant, and supported diverse learners. [ABSTRACT FROM AUTHOR]

A causal mechanism for the Volgian Isotopic Carbon Excursion (VOICE) remains enigmatic. Elemental geochemical profiles of the Deer Bay Formation, Sverdrup Basin, Arctic Canada that record the VOICE and contemporaneous strata are herein examined to provide insight into depositional environments during Late Jurassic‐Early Cretaceous time. Silver (Ag) and Cadmium (Cd) are enriched across the VOICE at localities on Axel Heiberg Island, and in Tithonian (∼Volgian) strata of Ellef Ringnes Island. Other redox‐sensitive trace elements do not exhibit spatially or temporally consistent patterns and indicate oxic conditions. A lack of relationship across the VOICE between Ag and the quality, quantity, and isotopic composition of organic matter suggests that the negative isotope excursion and interval of Ag enrichment are not merely functions of changes in organic matter source or amount, while a lack of spatially consistent change in geochemical indices of weathering similarly excludes climate change and/or sediment provenance as a driver. Therefore, in a ventilated setting and without marked changes in organic matter content, Ag enrichment may be due to hydrothermal activity. Contemporaneous Ag enrichment in strata from Svalbard suggests that a source of hot fluid sufficient to produce Ag‐rich seawater may have been related to rifting in the adjacent proto‐Amerasia Basin. Hydrothermal activity may also have been a widespread source of isotopically depleted carbon. This work develops new geochemical fingerprints that may be used to trace the spatial extent of hydrothermal events that do not leave an extinction pattern but may nonetheless have a far‐reaching influence on biogeochemical systems. Plain Language Summary: Silver (Ag) is enriched in marine sedimentary strata of Tithonian age, and in particular, across the Volgian Isotopic Carbon Excursion in Arctic Canada. However, other redox‐sensitive trace elements do not exhibit spatially or temporally consistent patterns, and collectively suggest oxygenated conditions near the seafloor during this time. Contemporaneous Ag enrichment in strata from Svalbard suggests that a source of hot fluid sufficient to produce Ag‐rich seawater may have been related to rifting in the adjacent proto‐Amerasia Basin. Hydrothermal activity may also have been a widespread source of isotopically depleted carbon. This work develops new geochemical fingerprints that may be used to trace the spatial extent of hydrothermal events that do not leave an extinction pattern but may nonetheless have a far‐reaching influence on biogeochemical systems. Key Points: Silver is enriched across the Volgian Isotopic Carbon Excursion (VOICE) in the Canadian ArcticOther redox‐sensitive trace elements do not exhibit spatially or temporally consistent patterns and indicate oxic conditionsRifting in the proto‐Amerasia Basin may have resulted in hydrothermal activity that caused the silver enrichment [ABSTRACT FROM AUTHOR]

Unlabelled: CONTEXTS: An evidence base for complementary and alternative medicine (CAM) consumption within general populations is emerging. However, research data on CAM use for headache disorders remain poorly documented. This paper, constituting the first critical review of literature on this topic, provides a synopsis and evaluation of the research findings on CAM use among patients with headache and migraine., Methods: A comprehensive search of literature from 2000 to 2011 in CINAHL, MEDLINE, AMED, and Health Sources was conducted. The search was confined to peer-reviewed articles published in English reporting empirical research findings of CAM use among people with primary headache or migraine., Results: The review highlights a substantial level of CAM use among people with headache and migraine. There is also evidence of many headache and migraine sufferers using CAM concurrent to their conventional medicine use. Overall, the existing studies have been methodologically weak and there is a need for further rigorous research employing mixed method designs and utilizing large national samples., Discussion: The critical review highlights the substantial prevalence of CAM use among people with headache and migraine as a significant health care delivery issue, and health care professionals should be prepared to inquire and discuss possible CAM use with their patients during consultations. Health care providers should also pay attention to the possible adverse effects of CAM or interactions between CAM and conventional medical treatments among headache and migraine patients., (© 2012 American Headache Society.)

Particle systems and their efficient and precise separation are becoming increasingly complex. Therefore, instead of focusing on a single separation feature, a multidimensional approach is needed where more than one particle property is considered. This, however, requires the precise characterization of the particle system, which is especially challenging for fine particles with sizes below 10 µm. This paper discusses the benefits and limitations of different characterization techniques, including optical contour analysis, inverse gas chromatography, flow cytometry, and SEM-based image analysis. The separation of ultrafine particles was investigated for a binary system using froth flotation, where a novel developed flotation apparatus is used. A special focus was placed on the multidimensional evaluation of the separation according to the particle properties of size, shape, and wettability, which was addressed via multivariate Tromp and entropy functions. The results emphasize the intricacy of the flotation process and the complex interaction of the individual particle properties and process parameters. The investigations contribute to the understanding of the characterization of particulate properties as well as the separation behavior of ultrafine particles via froth flotation, especially in the case of a multidimensional approach. [ABSTRACT FROM AUTHOR]

The sulfidization-amine flotation method is commonly used for the beneficiation of zinc oxide ores. Lanping zinc oxide ores contains 8.40% zinc, with the main mineral being smithsonite; additionally, they have a high mud content. Conventional sulfidization–ammonium flotation presents a low flotation index and unsatisfactory flotation froth. A new open-circuit technology is employed to treat Lanping zinc oxide ores, where Na2S, KG-248, and dodecyl amine + sodium isoamyl xanthate + ammonium dibutyl dithiophosphate are used as the regulator, depressant, and ternary collector, respectively. Consequently, the flotation indices for the zinc grade and recovery are 28.71% and 86.24%, respectively, and the flotation froth becomes more stable. Subsequently, the flotation behavior and adsorption mechanism of smithsonite with a ternary collector are investigated. The flotation recovery of smithsonite increases to 94.40% after treatment with the ternary collector. Surface-analysis results indicate that the ternary collector can synergistically adsorb onto the sulfidized smithsonite surface to enhance its hydrophobicity, thus increasing the floatability of smithsonite. Meanwhile, the total consumption of the collector in the ternary-collector system is lower than that in the binary- or unitary-collector system. [ABSTRACT FROM AUTHOR]

Long outpatient waiting times pose a significant global challenge in healthcare, impacting children and families with implications for health outcomes. This paper presents the eHealth system called eADVICE (electronic Advice and Diagnosis Via the Internet following Computerised Evaluation) that is designed to address waiting list challenges for paediatricians. Initially designed for children's incontinence, the system's success in terms of health goals and user experience led to its adaptation for paediatric sleep problems. This paper focuses on user experiences and the development of a working alliance with the virtual doctor, alongside health outcomes based on a randomised controlled trial (N = 239) for incontinence. When reengineering eADVICE to sleep disorders, the promising results regarding the reciprocal relationship between user experience and building a working alliance encouraged a focus on the further development of the embodied conversational agent (ECA) component. This involved tailoring the ECA discussion to patient cognition (i.e., beliefs and goals) to further improve engagement and outcomes. The proposed eADVICE framework facilitates adaptation across paediatric conditions, offering a scalable model to enhance access and self-efficacy during care delays. [ABSTRACT FROM AUTHOR]