Regional studies have found significant agglomeration effects of education development on economic growth. Regional favouritism is potentially closely related to public investment in education, further impacting regional growth. This paper provides significant empirical evidence on the potential impact of favouritism on education development in the Chinese context. Using data for 282 Chinese cities from 1996 to 2016 with treatment for endogeneity (Lewbel two-stage least squares estimator), the results provide evidence that Chinese provincial political leaders favour their birthplaces’ education resource development, and that the effect is larger for within-provincial impact and higher tier cities ranked by income.
Truths of the Riverscape refer to the use of geomorphological principles to inform sustainable approaches to nature-based river management. Across much of the world a command-and-control philosophy continues to assert human authority over rivers. Tasked to treat rivers as stable and predictable entities, engineers have ‘fixed rivers in place’ and ‘locked them in time’. Unsustainable outcomes ensue. Legacy effects and path dependencies of silenced and strangled (zombified) rivers are difficult and increasingly expensive to address. Nature fights back, and eventually it wins, with disastrous consequences for the environment, society, culture and the economy. The failure to meet the transformative potential of nature-based applications is expressed here as a disregard for ‘Truths of the Riverscape’. The first truth emphasises the imperative to respect diversity , protecting and/or enhancing the distinctive values and attributes of each and every river. A cross-scalar (nested hierarchical) lens underpins practices that ‘know your catchment’. The second truth envisages management practices that work with processes , interpreting the behaviour of each river. This recognises that erosion and deposition are intrinsic functions of a healthy living river—in appropriate places, at appropriate rates. This premise underpins the third truth, assess river condition , highlighting the importance of what to measure and what to measure against in approaches that address the causes rather than the symptoms of unexpected river adjustment. The fourth truth interprets evolutionary trajectory to determine what is realistically achievable in the management of a given river system. Analysis of whether the river sits on a degradation or recovery pathway (i.e., condition is deteriorating or improving), alongside assessment of catchment-specific recovery potential, is used to foresight river futures. Viewed collectively, Truths of the Riverscape provide a coherent platform to develop and apply proactive and precautionary catchment management plans that address concerns for biodiversity loss and climate change adaptation.
The sea anemone, Exaiptasia diaphana , is a model of coral-dinoflagellate (Symbiodiniaceae) symbiosis. However, little is known of its potential to form symbiosis with Cladocopium —a key Indo-Pacific algal symbiont of scleractinian corals, nor the host nutritional consequences of such an association. Aposymbiotic anemones were inoculated with homologous algal symbionts, Breviolum minutum , and seven heterologous strains of Cladocopium C1 acro (wild-type and heat-evolved) under ambient conditions. Despite lower initial algal cell density, Cladocopium C1 acro -anemeones achieved similar cell densities as B. minutum -anemones by week 77. Wild-type and heat-evolved Cladocopium C1 acro showed similar colonization patterns. Targeted LC-MS-based metabolomics revealed that almost all significantly different metabolites in the host and Symbiodiniaceae fractions were due to differences between Cladocopium C1 acro and B. minutum , with little difference between heat-evolved and wild-type Cladocopium C1 acro at week 9. The algal fraction of Cladocopium C1 acro -anemones was enriched in metabolites related to nitrogen storage, while the host fraction of B. minutum -anemones was enriched in sugar-related metabolites. Compared to B. minutum , Cladocopium C1 acro is likely slightly less nutritionally beneficial to the host under ambient conditions, but more capable of maintaining its own growth when host nitrogen supply is limited. Our findings demonstrate the value of E. diaphana to study experimentally evolved Cladocopium .
Background It is unclear if the use of imaging for low back pain (LBP) is impacted by patient beliefs. This study aimed to: (1) describe beliefs about the importance of imaging and whether patients wanted imaging when presenting for chiropractic care for LBP; (2) describe associations between baseline patient characteristics and imaging beliefs and whether patients wanted imaging; and (3) determine whether patients who believed imaging to be important in the management of LBP, or who wanted to receive imaging, were more likely to receive an imaging referral. Methods Cross-sectional observational data was collected between November 2016 to December 2019 from 10 primary care chiropractic clinics in Denmark. Consecutive patients aged 18 or older and presenting with a new episode of LBP were included (N = 2818). Beliefs about the importance of imaging (two questions) and whether imaging was wanted (one question) were collected at the initial visit, together with baseline participant characteristics and whether an imaging referral was provided. Associations between imaging beliefs/desire to receive imaging and participant characteristics were explored using multivariable logistic regression analysis. The relationships between imaging beliefs and desire to receive imaging with subsequent imaging referral were assessed using multivariable logistic regression analysis adjusted for pre-selected confounder variables. Results Approximately one third of participants believed imaging to be important for the management of LBP (29.5% (95%CI 27.8, 31.3) or 41.5% (95%CI 39.6, 43.3) depending on the two imaging beliefs questions). Approximately one quarter (26.1%, 95%CI 24.5, 27.7) of participants wanted to receive an imaging referral. Participants were more likely to believe in the importance of imaging or want an imaging referral if they had a longer duration of LBP, history of previous imaging for LBP, or a lower completed education level. Participants who wanted imaging at the initial consult were more likely to receive an imaging referral (Odds ratio; 95%CI 1.6; 1.2, 2.1). Conclusions Approximately one third of patients presenting for chiropractic care in Denmark believed imaging to be important in the management of LBP. One quarter wanted imaging at the initial consult. Patients’ desire for imaging appeared to impact the use of diagnostic imaging.
Background Practice-based guidelines recommend patient education and exercise as first-line care for low back pain (LBP); however, these recommendations are not routinely delivered in practice. GLA:D® Back, developed in Denmark to assist clinicians to implement guideline recommendations, offers a structured education and supervised exercise program for people with LBP in addition to a clinical registry to evaluate patient outcomes. In this study we evaluated the feasibility of implementing the GLA:D® Back program in Australia. We considered clinician and patient recruitment and retention, program fidelity, exploring clinicians’ and patients’ experiences with the program, and participant outcome data collection. Methods Clinicians (chiropractors and physiotherapists) were recruited and participated in a 2-day GLA:D® Back training course. Patients were eligible to participate if they had persistent or recurrent LBP. Feasibility domains included the ability to: (1) recruit clinicians to undergo training; (2) recruit and retain patients in the program; (3) observe program fidelity; and (4) perceive barriers and facilitators for GLA:D® Back implementation. We also collected data related to: (5) clinician confidence, attitudes, and behaviour; and (6) patient self-reported outcomes related to pain, disability, and performance tests. Results Twenty clinicians (8 chiropractors, 12 physiotherapists) participated in the training, with 55% (11/20) offering GLA:D® Back to their patients. Fifty-seven patients were enrolled in the program, with 67% (38/57) attending the final follow-up assessment. Loss to follow up was mainly due to the effects of the COVID-19 pandemic. We observed program fidelity, with clinicians generally delivering the program as intended. Interviews revealed two clinician themes related to: (i) intervention acceptability; and (ii) barriers and facilitators to implementation. Patient interviews revealed themes related to: (i) intervention acceptability; and (ii) program efficacy. At 3 months follow-up, clinicians demonstrated high treatment confidence and biomedical orientation. Patient outcomes trended towards improvement. Conclusion GLA:D® Back implementation in Australia appears feasible based on clinician recruitment, program acceptability and potential benefits for patient outcomes from the small sample of participating clinicians and patients. However, COVID-19 impacted patient recruitment, retention, and data collection. To scale-up GLA:D® Back in private and public settings, further work is warranted to address associated barriers, and to leverage facilitators.
Introduction The World Health Organization describes chiropractic as a health profession that treats the musculoskeletal system and the effects of that system on the function of the nervous system and general health. Notwithstanding such descriptions, scope of practice remains a contentious issue in Australia chiropractic with various authors defining it differently. To date, the peak governing body, the Chiropractic Board of Australia, has focused on title protection rather than defining a scope of practice for the profession. A well-defined scope of practice is important, as it helps to identify what is acceptable in the profession and the role chiropractic has in the broader healthcare system. Objective The objective of this scoping review was to explore the literature on the factors that influence scope of practice of chiropractic in Australia. Methods This study employed scoping review methodology to document the current state of the literature on factors that influence scope of practice of the chiropractic profession in Australia. Results A total of 1270 articles were identified from the literature search. Six studies fulfilled the inclusion criteria and were included in the final analysis. Four factors that influence scope of practice were identified: education, professional identity, patient safety, and organisational structure. Conclusion The results of this study will inform future discussions around establishing a framework for a more comprehensive scope of practice for the chiropractic profession in Australia. Such a framework has the potential to benefit patient safety, professional identity, public perception, education, and regulation of the profession.
Background To report the national prevalence, years lived with disability (YLDs) and attributable risk factors for all musculoskeletal conditions and separately for low back pain (LBP), as well as compare the disability burden related to musculoskeletal with other health conditions in Australia in 2019. Methods Global Burden of Disease (GBD) 2019 study meta-data on all musculoskeletal conditions and LBP specifically were accessed and aggregated. Counts and age-standardised rates, for both sexes and across all ages, for prevalence, YLDs and attributable risk factors are reported. Results In 2019, musculoskeletal conditions were estimated to be the leading cause of YLDs in Australia (20.1%). There were 7,219,894.5 (95% UI: 6,847,113–7,616,567) prevalent cases of musculoskeletal conditions and 685,363 (95% UI: 487,722–921,471) YLDs due to musculoskeletal conditions. There were 2,676,192 (95% UI: 2,339,327–3,061,066) prevalent cases of LBP and 298,624 (95% UI: 209,364–402,395) YLDs due to LBP. LBP was attributed to 44% of YLDs due to musculoskeletal conditions. In 2019, 22.3% and 39.8% of YLDs due to musculoskeletal conditions and LBP, respectively, were attributed to modifiable GBD risk factors. Conclusions The ongoing high burden due to musculoskeletal conditions impacts Australians across the life course, and in particular females and older Australians. Strategies for integrative and organisational interventions in the Australian healthcare system should support high-value care and address key modifiable risk factors for disability such as smoking, occupational ergonomic factors and obesity.
Background The inappropriate use of lumbar spine imaging remains common in primary care despite recommendations from evidence-based clinical practice guidelines to avoid imaging in the absence of red flags. This study aimed to explore factors influencing ordering behaviours and adherence to radiographic guidelines for low back pain (LBP) in chiropractors in Newfoundland and Labrador (NL), Canada. Methods We conducted two focus groups in December 2018 with chiropractors in different regions of NL (eastern, n = 8; western, n = 4). An interview guide based on the Theoretical Domains Framework (TDF) served to identify perceived barriers to, and enablers of, target behaviours of guideline adherence and managing LBP without X-rays. We conducted thematic analysis of chiropractors’ statements into relevant theoretical domains, followed by grouping of similar statements into specific beliefs. Domains key to changing radiographic guideline adherence, LBP imaging behaviours, and/or informing intervention design were identified by noting conflicting beliefs and their reported influence on the target behaviours. Results Six of the 14 TDF domains were perceived to be important for adherence to radiographic guidelines and managing non-specific LBP without imaging. Participating chiropractors reported varying levels of knowledge and awareness of guidelines for LBP imaging ( Knowledge ). Many chiropractors based their decision for imaging on clinical presentation, but some relied on “gut feeling” ( Memory, attention, and decision processes ). While chiropractors thought it was their role to manage LBP without imaging, others believed ordering imaging was the responsibility of other healthcare providers ( Social/professional role and identity ). Contrasting views were found regarding the negative consequences of imaging or not imaging LBP patients ( Beliefs about consequences ). Communication was identified as a skill required to manage LBP without imaging ( Skills ) and a strategy to enable appropriate imaging ordering behaviours ( Behavioural regulation ). Chiropractors suggested that access to patients’ previous imaging and a system that facilitated better interprofessional communication would likely improve their LBP imaging behaviours ( Behavioural regulation ). Conclusion We identified potential influences, in six theoretical domains, on participating chiropractors’ LBP imaging behaviours and adherence to radiographic guidelines. These beliefs may be targets for theory-informed behaviour change interventions aimed at improving these target behaviours for chiropractors in NL.
Microfluidic devices have shown promising applications in the bioprocessing industry. However, the lack of modularity and high cost of testing and error limit their implementation in the industry. Advances in 3D printing technologies have facilitated the conversion of microfluidic devices from research output to applicable industrial systems. Here, for the first time, we presented a 3D printed modular microfluidic system consisting of two micromixers, one spiral microfluidic separator, and one microfluidic concentrator. We showed that this system can detach and separate mesenchymal stem cells (MSCs) from microcarriers (MCs) in a short time while maintaining the cell’s viability and functionality. The system can be multiplexed and scaled up to process large volumes of the industry. Importantly, this system is a closed system with no human intervention and is promising for current good manufacturing practices. Graphical Abstract
As a natural flavone, apigenin is abundantly present in vegetables, fruits, oregano, tea, chamomile, wheat sprout and is regarded as a major component of the Mediterranean diet. Apigenin is known to inhibit proliferation in different cancer cell lines by inducing G 2 /M arrest, but it is unclear whether this action is predominantly imposed on G 2 or M phases. In this study, we demonstrate that apigenin arrests prostate cancer cells at G 2 phase by flow cytometric analysis of prostate cancer cells co-stained for phospho-Histone H3 and DNA. Concurrently, apigenin also reduces the mRNA and protein levels of the key regulators that govern G 2 -M transition. Further analysis using chromatin immunoprecipitation (ChIP) confirmed the diminished transcriptional activities of the genes coding for these regulators. Unravelling the inhibitory effect of apigenin on G 2 -M transition in cancer cells provides the mechanistic understanding of its action and supports the potential for apigenin as an anti-cancer agent. Graphical Abstract
Academic resilience refers to academic success despite chronic socio-educational adversity. Given increases in immigration across the world in the past decade (including in Europe), there have been calls to identify factors (e.g., engagement) that can better support immigrant students’ academic resilience. With a sample of N = 17,241 immigrant students from 18 European countries, the present investigation employed multi-level probit regression to determine the extent to which cognitive, behavioral, and social-emotional engagement predict academic resilience status at both the student- and school-level. Findings revealed that cognitive engagement and behavioral engagement, at both the student- and school-level, are positively associated with academic resilience (yielding moderate and large effect sizes), while the findings regarding social-emotional engagement were more equivocal.
The Zeno effect occurs in quantum systems when a very strong measurement is applied, which can alter the dynamics in non-trivial ways. Despite being dissipative, the dynamics stay coherent within any degenerate subspaces of the measurement. Here we show that such a measurement can turn a single-qubit operation into a two- or multi-qubit entangling gate, even in a non-interacting system. We demonstrate this gate between two effectively non-interacting transmon qubits. Our Zeno gate works by imparting a geometric phase on the system, conditioned on it lying within a particular non-local subspace. These results show how universality can be generated not only by coherent interactions as is typically employed in quantum information platforms, but also by Zeno measurements.
Objective To assess whether the capacity to utilize cues amongst emergency physicians is associated with differences in the capacity to recover performance following an interruption. Background Interruptions are implicated in errors in emergency medicine due to the cognitive load that they impose on working memory, resulting in a loss of performance on the primary task. The utilization of cues is associated with a reduction in cognitive load during the performance of a task, thereby enabling the allocation of residual resources that mitigates the loss of performance following interruptions. Method Thirty-nine emergency physicians, recruited at a medical conference, completed an assessment of cue utilization (EXPERTise 2.0) and an online simulation (Septris) that involved the management of patients presenting with sepsis. During the simulation, physicians were interrupted and asked to check a medication order. Task performance was assessed using scores on Septris, with points awarded for the accurate management of patients. Results Emergency physicians with higher cue utilization recorded significantly higher scores on the simulation task following the interruption, compared to physicians with lower cue utilization (p = .028). Conclusion The results confirm a relationship between cue utilization and the recovery of performance following an interruption. This is likely due to the advantages afforded by associated reductions in cognitive load. Application Assessments of cue utilization may assist in the development of interventions to support clinicians in interruptive environments.
Objectives Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) has emerged as a promising imaging tool in prostate cancer diagnosis. PSMA PET/CT radiotracers are produced in-house (gallium-68, eg, ⁶⁸Ga-PSMA-11) or provided by commercial entities (fluorine-18, eg, ¹⁸F-DCFPyL). Nevertheless, the cost per procedure is not well established given that current estimates have several limitations. This study aimed to establish the cost of PSMA PET/CT in Australia. Methods Hospitals and diagnostic facilities currently conducting PSMA PET/CT in Australia in metropolitan and regional areas completed a survey of PSMA PET/CT throughput, radiotracers involved, and the cost of assets, departmental staffing, consumables, and occupancy. Total costs were estimated using a top-down microcosting approach, involving identifying all relevant cost components and valuing each component for the average patient, and a gross costing approach, involving apportioning cost components at an aggregated level. Results Data were collected from 8 facilities. The most common radiotracer used was ¹⁸F-DCFPyL (7 facilities, 87%), followed by ⁶⁸Ga-PSMA-11 (4 facilities, 50%). The average cost of PSMA PET/CT was A$1554.77 and A$1306.00 based on the microcosting and gross costing approaches, respectively. Conclusions This study provides a detailed and accurate estimation of the cost of PSMA PET/CT in Australia. These costs can be used as a benchmark to identify potential efficiencies and help policy makers set the appropriate reimbursement rate for this procedure. The use of data from facilities using different radiotracers in metropolitan and regional areas and with different throughput increases the generalizability of the results, especially in countries with similar health systems.
Evidence regarding the impact of product line breadth (PLB) on brand performance remains fragmented; the current research proposes an influential effect of product equity in determining PLB success. To test these predictions, Study 1 first identifies heterogeneous effects of PLB on brand performance according to the levels of product equity. Specifically, PLB hinders (improves) the performance of low (high) product equity brands. Then Study 2 identifies two drivers of PLB effectiveness, product attribute differences and competitive intensity, that have contrasting influences for brands with high versus low product equity. These influences exert long-term, cumulative effects (i.e., over 104 weeks). To ensure the generalizability and applicability of the findings, this research effort spans a vast consumer scanner data set, involving 268 brand panels, 14 product categories, and three retailers. Based on this collected evidence, the authors propose a matrix of managerial actions that practitioners can adopt to increase their PLB effectiveness.
Can we trust our eyes? Until recently, we rarely had to question whether what we see is indeed what exists, but this is changing. Artificial neural networks can now generate realistic images that challenge our perception of what is real. This new reality can have significant implications for cybersecurity, counterfeiting, fake news, and border security. We investigated how the human brain encodes and interprets realistic artificially generated images using behaviour and brain imaging. We found that we could reliably decode AI generated faces using people's neural activity. However, while at a group level people performed near chance classifying real and realistic fakes, participants tended to interchange the labels, classifying real faces as realistic fakes and vice versa. Understanding this difference between brain and behavioural responses may be key in determining the 'real' in our new reality. Stimuli, code, and data for this study can be found at https://osf.io/n2z73/.
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