It is not that simple nor compelling! Comment on "Translating evidence into healthcare policy and practice: single versus multi-faceted implementation strategies - is there a simple answer to a complex question?"

Healthcare decisions are often made under pressure, with varying levels of information in a changing clinical context. With limited resources and a focus on improving patient outcomes, healthcare managers and health professionals strive to implement both clinical and cost-effective care. However, the gap between research evidence and health policy/clinical practice persists despite our best efforts. In an attempt to close the gap through behaviour change interventions, there has been a strong held belief that 'more is better,' without understanding the mechanisms and circumstances of knowledge translation (KT). We argue that even a single intervention or strategy in translating evidence into healthcare policy or practice is rarely simple to implement. Nor is the evidence compelling on the best approach. As Harvey and Kitson argued, designing and evaluating KT interventions requires flexibility and responsiveness. If we are to move forward in translation science then we need to use rigorous designs such as randomised controlled trials to test effectiveness of interventions or strategies with embedded process evaluations to understand the reason interventions do or do not work!

Efficacy of a workplace osteoporosis prevention intervention: a cluster randomized trial

BACKGROUND: Osteoporosis is a debilitating disease. Adequate calcium consumption and physical activity are the two major modifiable risk factors. This paper describes the major outcomes and efficacy of a workplace-based targeted behaviour change intervention to improve the dietary and physical activity behaviours of working women in sedentary occupations in Singapore.

METHODS: A cluster-randomized design was used, comparing the efficacy of a tailored intervention to standard care. Workplaces were the units of randomization and intervention. Sixteen workplaces were recruited from a pool of 97, and randomly assigned to intervention and control arms (eight workplaces in each). Women meeting specified inclusion criteria were then recruited to participate. Workplaces in the intervention arm received three participatory workshops and organization-wide educational activities. Workplaces in the control/standard care arm received print resources. Outcome measures were calcium intake (milligrams/day) and physical activity level (duration: minutes/week), measured at baseline, 4 weeks and 6 months post intervention. Adjusted cluster-level analyses were conducted comparing changes in intervention versus control groups, following intention-to-treat principles and CONSORT guidelines.

RESULTS: Workplaces in the intervention group reported a significantly greater increase in calcium intake and duration of load-bearing moderate to vigorous physical activity (MVPA) compared with the standard care control group. Four weeks after intervention, the difference in adjusted mean calcium intake was 343.2 mg/day (95 % CI = 337.4 to 349.0, p < .0005) and the difference in adjusted mean load-bearing MVPA was 55.6 min/week (95 % CI = 54.5 to 56.6, p < .0005). Six months post intervention, the mean differences attenuated slightly to 290.5 mg/day (95 % CI = 285.3 to 295.7, p < .0005) and 50.9 min/week (95 % CI =49.3 to 52.6, p < .0005) respectively.

CONCLUSION: This workplace-based intervention substantially improved calcium intake and load-bearing moderate to vigorous physical activity 6 months after the intervention began. TRIAL REGISTRATION: Australia New Zealand Clinical Trial Registry ACTRN12616000079448 . Registered 25 January 2016 (retrospectively registered).

Refreshed…reinforced…reflective: a qualitative exploration of interprofessional education facilitators' own interprofessional learning and collaborative practice

While there is extensive research examining the outcomes of interprofessional education (IPE) for students, minimal research has investigated how facilitating student learning influences the facilitators themselves. This exploratory case study aimed to explore whether and how facilitating IPE influences facilitators' own collaborative practice attitudes, knowledge, and workplace behaviours. Sixteen facilitators of an online pre-licensure IPE unit for an Australian university participated in semi-structured telephone interviews. Inductive thematic analysis revealed three emergent themes and associated subthemes characterising participants' reflexivity as IPE facilitators: interprofessional learning; professional behaviour change; and collaborative practice expertise. Participants experienced interprofessional learning in their role as facilitators, improving their understanding of other professionals' roles, theoretical and empirical knowledge underlying collaborative practice, and the use and value of online communication. Participants also reported having changed several professional behaviours, including improved interprofessional collaboration with colleagues, a change in care plan focus, a less didactic approach to supervising students and staff, and greater enthusiasm impressing the value of collaborative practice on placement students. Participants reported having acquired their prior interprofessional collaboration expertise via professional experience rather than formal learning opportunities and believed access to formal IPE as learners would aid their continuing professional development. Overall, the outcomes of the IPE experience extended past the intended audience of the student learners and positively impacted on the facilitators as well.

Trial for reducing weight retention in new mums: a randomised controlled trial evaluating a low intensity, postpartum weight management programme

BACKGROUND: Failure to return to pregnancy weight by 6 months postpartum is associated with long-term obesity, as well as adverse health outcomes. This research evaluated a postpartum weight management programme for women with a body mass index (BMI) > 25 kg m(-2) that combined behaviour change principles and a low-intensity delivery format with postpartum nutrition information. METHODS: Women were randomised at 24-28 weeks to control (supported care; SC) or intervention (enhanced care; EC) groups, stratified by BMI cohort. At 36 weeks of gestation, SC women received a 'nutrition for breastfeeding' resource and EC women received a nutrition assessment and goal-setting session about post-natal nutrition, plus a 6-month correspondence intervention requiring return of self-monitoring sheets. Weight change, anthropometry, diet, physical activity, breastfeeding, fasting glucose and insulin measures were assessed at 6 weeks and 6 months postpartum. RESULTS: Seventy-seven percent (40 EC and 41 SC) of the 105 women approached were recruited; 36 EC and 35 SC women received a programme and 66.7% and 48.6% completed the study, respectively. No significant differences were observed between any outcomes. Median [interquartile range (IQR)] weight change was EC: -1.1 (9.5) kg versus SC: -1.1 (7.5) kg (6 weeks to 6 months) and EC: +1.0 (8.7) kg versus SC: +2.3 (9) kg (prepregnancy to 6 months). Intervention women breastfed for half a month longer than control women (180 versus 164 days; P = 0.10). An average of 2.3 out of six activity sheets per participant was returned. CONCLUSIONS: Despite low intervention engagement, the high retention rate suggests this remains an area of interest to women. Future strategies must facilitate women's engagement, be individually tailored, and include features that support behaviour change to decrease women's risk of chronic health issues.

Reinforcement sensitivity theory (RST) and body change behaviour in males

According to the unrevised Reinforcement Sensitivity Theory two motivational systems shape personality: a behavioural approach system (BAS) that determines sensitivity to rewards, and a behavioural inhibition system (BIS) that determines sensitivity to punishments. The role of reinforcement sensitivity in body change behaviour in males was explored with a non-clinical sample of 120 men aged 18–40 years. Self-reported symptoms of unhealthy weight loss (weight preoccupation, fasting, bingeing/purging) and body development (muscle/size preoccupation, obligatory exercise, use of chemical supplements) were regressed on measures of BAS and BIS sensitivity. Significant relationships were observed between BAS sensitivity and body development, and between BIS sensitivity and weight loss. These relationships were mediated by internalization of the athletic/muscular ideal, body comparisons, the importance of achieving one’s ideal or ‘best possible’ body (in the case of BAS but not BIS), and body dissatisfaction (in the case of BIS but not BAS). These results support the proposition that body development in males is influenced by sensitivity to rewards associated with achieving a certain body shape, and that weight loss is influenced by sensitivity to punishments associated with possessing an unsatisfactory body shape.

Knowledge enhancement in the change process : social marketing and attitude change leading to improved environmental behaviour

The complexity of relationships between social change and natural resource management has generated interest in the identification of indicators that might provide more streamlined means of monitoring and planning control programmes. This case study highlights the marketing paradigms of benchmarking and social marketing in a not-for-profit governmental environment. Publicly funded programs that require individual and community participation need to be marketed with a view to optimising involvement and commitment of the various stakeholders. A mail survey with a representative sample of 608 respondents was conducted to evaluate the effectiveness of a social marketing program. This study highlights the use of social marketing in a program to overcome an environmental issue by a governmental agency. Changing attitudes and beliefs takes time and often the target audience may not even know they have a problem that needs fixing. This process influences the focus of the social marketing effort which might be organised into three phases: • Raise awareness and knowledge.   •Change attitudes.  • Encourage action. The research conducted in this study illustrates how the various stages in the social marketing process were achieved through knowledge enhancement in an environmental management case study.

Readiness to change a problem behaviour : a conceptual framework

The thesis study aims to develop a model of readiness to enter treatment to change problem behaviour by addressing the limitations of previous models. The research shows that a model consisting of personal and social factors, mediated by problem recognition and desire for help accurately assesses readiness to enter treatment. The portfolio examines the broad framework of the Multifactor Offender Readiness Model (MORM) which assesses an offender's readiness to engage in treatment. Four case studies are presented.

Screening and intervention for mental health problems in alcohol and other drug settings: Can training change practitioner behaviour?

Aims: The comorbidity of substance use and mental health problems poses a significant challenge for alcohol and other drug (AOD) treatment services. In many cases, AOD practitioners do not have experience or training in identifying or managing mental health conditions. Methods: This project examined the implementation of screening and intervention practices for mental health disorders among AOD clients. Training and supervision was provided to 20 AOD practitioners across five sites in four agencies with a focus on enhancing skills in detection of, and intervention for, mental health conditions among their clients. A package developed for this purpose, known as PsyCheck, was used. A random file audit was undertaken to examine changes in detection of mental health conditions. Findings: There were significant improvements in detection after training and supervision, with detection rates almost doubling in this time. Conclusions: Training and supervision using the PsyCheck package appears to have the potential to improve mental health detection and intervention in AOD services. This study shows promise for the implementation of mental health intervention in AOD services.

Petal diagrams: a new technique for mapping historical change in the film industry

As the study of cinema has increasingly turned to the examination of economic ebbs and industrial flows, rather than focussing its attention solely on the critical evaluation of the films themselves, new analytic techniques and tools have been adopted (and adapted) by film scholars. Key amongst these is the use of innovative visualization techniques that can assist in the understanding of the spatial and temporal features of film industry practices. However, like the cinema itself, visualization carries its own spatial and temporal dimension. This article explores some of the benefits and limitations that derive from the use of spatial visualization technologies in the field of cinema studies. In particular, this research presents a new holistic multivariate approach to spatio-temporal visualization for point based historical data. This method has been developed through extending the spatial presence in timeline graphics and through meaningful spatial classification and representation.

Qualitative assessment of bubble behaviour for central and asymmetric injection in 2D gas-solid fluidized bed using image analysis technique and CFD modelling

Bubble characteristics such as shape, size, and trajectory control the hydrodynamics and therefore heat transfer in fluidized bed reactors. Thus understanding these characteristics is very important for the design and scaleup of fluidized beds. An earlier developed Eulerian-Eulerian two-fluid model for simulating dense gas–solid two-phase flow has been used to compare the experimental data in a pseudo-two-dimensional (2-D) bed. Bubbles are injected asymmetrically by locating the nozzle at proximity to the wall, thus presenting the effect wall has on asymmetrical injection as compared to symmetrical injection. In this work, a digital image analysis technique was developed to study the bubble behaviour in a two-dimensional bubbling bed. The high-speed photography reveals an asymmetric wake formation during detachment indicating an early onset of mixing process. The wall forces acts tangentially on thebubble and has a significant impact on the bubble shape, neck formation during detachment and its trajectory through the bed. Larger bubbles drifting away from the centre with longer paths are observed. This qualitative behaviour is well predicted by CFD modelling. Asymmetric injection can significantly influence the heat and mass transfer characteristics.

Change in dielectric properties in the microwave frequency region of polypyrrole-coated textiles during aging

Complex permittivity of conducting polypyrrole (PPy)-coated Nylon-Lycra textiles ismeasured using a free space transmission measurement technique over the frequency range of1–18 GHz. The aging of microwave dielectric properties and reflection, transmission and absorptionfor a period of 18 months is demonstrated. PPy-coated fabrics are shown to be lossy over thefull frequency range. The levels of absorption are shown to be higher than reflection in the testedsamples. This is attributed to the relatively high resistivity of the PPy-coated fabrics. Both the dopantconcentration and polymerisation time affect the total shielding effectiveness and microwave agingbehaviour. Distinguishing either of these two factors as being exclusively the dominant mechanismof shielding effectiveness is shown to be difficult. It is observed that the PPy-coated Nylon-Lycrasamples with a p-toluene sulfonic acid (pTSA) concentration of 0.015 M and polymerisation times of60 min and 180 min have 37% and 26% decrease in total transmission loss, respectively, upon agingfor 72 weeks at room temperature (20 C, 65% Relative humidity (RH)). The concentration of thedopant also influences the microwave aging behaviour of the PPy-coated fabrics. The samples with ahigher dopant concentration of 0.027 mol/L pTSA are shown to have a transmission loss of 32.6% and16.5% for short and long polymerisation times, respectively, when aged for 72 weeks. The microwaveproperties exhibit better stability with high dopant concentration and/or longer polymerization times.High pTSA dopant concentrations and/or longer polymerisation times result in high microwaveinsertion loss and are more effective in reducing the transmission and also increasing the longevity ofthe electrical properties.

A public health intervention to change knowledge, attitudes and behaviour regarding alcohol consumption in pregnancy

Aim. To evaluate the effectiveness of a public health intervention aimed at changing knowledge, attitudes and behaviour. Methods. A non-blinded parallel group randomised controlled trial of pregnant women over 18 years of age. Women were recruited in the second trimester and assigned to one of two treatment groups. Both groups completed an initial questionnaire assessing knowledge, attitudes, and practices relating to alcohol consumption during pregnancy. The intervention group then received a mocktail recipe booklet and participants were asked to share the information with their partner. The control group received standard antenatal care. A follow-up questionnaire was conducted four weeks post birth. Primary outcome measures were a knowledge score of the health risks associated with alcohol consumption during pregnancy and an attitude score toward drinking during pregnancy. Secondary outcome measures included whether or not the woman and her partner abstained from drinking. Ethical approval was granted by the Women’s and Children’s Health Network and the University of South Australia. Results. A total of 161 participants were recruited at baseline (intervention = 82, control = 79) and 96 participants completed the trial (intervention = 49, control = 47). The findings suggest that the mocktail booklet was effective at improving knowledge (p<0.001; effect size 0.80) and improving attitudes towards drinking during pregnancy (p=0.017; effect size 0.43) in the intervention group compared to the control group. Although women in the intervention group were 30% more likely to abstain from drinking than in the control group (RR=1.3, 95% CI 0.97 – 1.75), this result was not statistically significant (p=0.077). Conclusions. Knowledge regarding the effects of alcohol consumption as well as attitudes towards drinking significantly improved as a result of a mocktail recipe booklet. Improving knowledge and changing attitudes has the potential to change health behaviour. Therefore, this intervention may reduce the percentage of women who continue to drink alcohol while they are pregnant and improve outcomes for infants and children.

Adaption reveals a neural code for the visual location of orientation change

We apply an adaptation technique to explore the neural code for the visual location of textures defined by modulation of orientation over space. In showing that adaptation to textures modulated around one orientation shifts the perceived location of textures modulated around a different orientation, we demonstrate the existence of a neural code for the location of orientation change that generalises across orientation content. Using competitive adaptation, we characterise the neural processes underlying this code as single-opponent for orientation, that is with concentric excitatory/inhibitory receptive areas tuned to a single orientation.