An e-learning program improves low back pain beliefs of physiotherapists: a randomised trial

Question: How effective is an e-learning program based on international clinical guidelines in promoting beliefs more aligned with the current evidence for the management of low back pain among physiotherapists? Design: Randomised controlled trial with concealed allocation and intention-to-treat analysis. Participants: 106 physiotherapists who treat patients with low back pain. Interventions: The experimental group received access to an e-learning program, based on recommendations of clinical practice guidelines for the management of low back pain, over a 6-week period. The program consisted of six units, totalling 15 hours, and was offered in a self-instructional and self-paced format. The control group was instructed to continue their activities as usual. Outcome measures: The primary outcome was beliefs about low back pain measured using the Modified Back Beliefs Questionnaire (MBBQ, –50 worst to 50 best). Secondary outcomes included the Back Pain Attitudes Questionnaire (Back-PAQ, –20 worst to 20 best) and agreement with two statements (1: X-rays or scans are necessary to get the best medical care for low back pain; 2: Everyone with low back pain should have spine imaging). Participants were evaluated at baseline and 6 weeks. Results: Out of 53 participants allocated to the e-learning program, two completed only the first unit and one did not complete any units, resulting in an overall adherence rate of 94%. Compared with control, the e-learning program improved the MBBQ (MD 8 points, 95% CI 5 to 10) and the Back-PAQ score (MD 3.1 points, 95% CI 1.8 to 4.3). For the imaging beliefs statements, the e-learning program was able to increase the proportion of participants with beliefs aligned with the current evidence (statement 1: RD 38%, 95% CI 21 to 52; statement 2: RD 17%, 95% CI 7 to 29) compared with the control group. Conclusion: The e-learning program based on recommendations of clinical practice guidelines for the management of low back pain improved physiotherapists’ beliefs about the management of low back pain. Registration: NCT05661968

Development of an internationally agreed national minimum dataset for low back pain: a modified Delphi study

BACKGROUND: Low back pain is the leading cause of disability worldwide and the burden is expected to rise due to increases in ageing and population growth. The 2018 Lancet Low Back Pain Series proposed urgent actions to reverse the rising trend of disability due to low back pain including the need for a set of data indicators to routinely monitor progress in achieving these actions worldwide. PURPOSE: To reach international consensus on a national minimum dataset of low back pain indicators that could be used across all countries to monitor progress in improving care and reducing disability from low back pain. STUDY DESIGN: Modified Delphi study. SAMPLE: Nineteen participants attended a preliminary workshop at the 2023 International Back and Neck Pain Forum, The Netherlands. Subsequently, 305 and 339 participants (researchers, clinicians, policy makers, educators and consumers) completed Delphi surveys Rounds 1 and 2, respectively. OUTCOME MEASURES: A 9-point Likert scale rated importance and feasibility of low back pain indicators (1=not important/feasible; 9=extremely important/feasible, 0 unsure). In Round 2, indicators that achieved consensus on importance and feasibility were ranked 'most important' (top-ranked) to 'least important'. METHODS: Workshop participants were divided into four groups and asked to independently consider the importance and feasibility of 105 indicators identified from previous reviews divided into six themes. Participants could remove indicators considered unimportant or not feasible. This required unanimous agreement from independent workshop groups. Participants could also suggest improvements to the wording of indicators, the best unit of measure and additional missing indicators. RESULTS: Thirty-eight indicators were recommended by workshop participants for inclusion in the Delphi study. Survey responses over two rounds reached consensus for 21 indicators (11 burden, 10 care) ranked from most to least important after reaching consensus on importance and feasibility in Round 1. Number of work days lost and number of opioid prescriptions for low back pain were the highest ranked indicators for burden and care respectively. Importance rankings were similar across subgroups comparing high-income and low- and middle-income countries, and consumers and non-consumers. CONCLUSION: We reached international consensus that 21 indicators could be used to monitor progress in improving care and outcomes for people with low back pain globally. Future work is needed to confirm the acceptability and feasibility of these indicators across countries, and, if implemented, to determine their value over time

The National Disability Data Asset (NDDA): A case study for ANZSOG's project on co-governance and trust in government

This is one of three case studies that form a larger project to identify methods to operationalise and implement co-governance arrangements. This project is being undertaken by the Social Policy Research Centre (SPRC), UNSW Sydney, funded by the Australia and New Zealand School of Government (ANZSOG) and the NSW Government. The process of establishing the co-governance of the NDDA, through the collaborative work of the Pilot DAC and its recommendations to Ministers, is included as a case study in this project given the rich insights from the process of designing co-governance and any relevant lessons for practices that may enable co-governance. The NDDA case study focuses on the process of designing the co-governance for the enduring asset during a Pilot phase. Some interview participants were also involved in co-governance arrangement for the enduring asset (the NDDA Council) and provided additional insights for this study by comparing one arrangement with the other. Each stage in the process starts with a summary of the evidence from the literature. This is followed by observations from the case study and references to data sources (listed in Appendix B). Bold text provides emphasis of the analysis to highlight key points – i.e. is added emphasis. **Note that fieldwork was completed between May 2024 and September 2024. The data in this report reflects individuals’ reflections on a process that occurred up to four years earlier. *

Structural and Biophysical Characterisation of the Human T-cell Leukaemia Virus 1 Capsid Protein

Human T-cell leukaemia virus 1 (HTLV-1) is an oncogenic retrovirus that causes adult T-cell leukaemia (ATL) and HTLV-1-associated myelopathy (HAM). HTLV-1 subtype C is highly prevalent in the indigenous peoples of central Australia with reported infection rates of nearly 40% in some communities. The viral capsid is essential for completion of the viral lifecycle, with important roles in genome protection, virus assembly, and intracellular host-engagement. This makes the capsid genetically fragile, as point mutations negatively impact viral infectivity and interrupt interactions between capsid and cofactors. The anti-HIV capsid targeting drug, lenacapavir, has demonstrated 100% efficacy in clinical trials when used as a pre-exposure prophylaxis. Development of lenacapavir was aided by structural knowledge of the HIV-1 capsid protein (CA). As such, the use of capsid inhibitors to target HTLV-1 is therefore a distinct possibility, however, detailed information regarding its CA structure is currently lacking. In this thesis, fundamental aspects of HTLV-1 CA biology relating to structure determination, inhibitor identification and lattice assembly were investigated. Chapter 3 presents high-resolution crystal structures of the HTLV-1 CA N-terminal domain (NTD), C-terminal domain (CTD) as well as CA full-length. The novel structural information demonstrates that a hexagonal lattice of CA by 6-fold crystallographic symmetry and a sulfate/phosphate binding site of the CA-NTD, which provides insights for developing anti-HTLV-1 capsid targeting inhibitors and understanding the HTLV-1 CA assembly mechanism. Chapter 4 explores the use of fragment-based drug discovery (FBDD) via NMR, and a potential weak binder targeting a sulfate/phosphate binding site was identified. The protein-fragment interacting interface was validated using X-ray crystallography and fragment docking assays. Chapter 5 outlines the strategies employed for CA assembly, including the use of IP6, disulfide cross-linking CA with high salt, and RNA- or liposome- templating. The results illustrate that the HTLV-1 CA can successfully assemble in the presence of IP6 or the Ni-chelated lipid vesicles and highlights differences between HTLV and HIV CA assembly. Overall, this work provides important structural insight into the HTLV-1 CA. More work will be required to realise the potential of this information for the development of novel compounds targeting the HTLV-1 CA

Gayborhoods as Spaces of Risk and Resilience: Associations of Gayborhood Residence with Psychological Distress and Substance Use among Ethnically Diverse Sexual Minority Men

Gayborhoods are urban neighborhoods characterized by a high concentration of LGBTQ + residents, businesses, community spaces, and subcultures. Living in gayborhoods may foster a sense of community and belonging that can be particularly beneficial for sexual minority men. However, existing research on gayborhoods has predominantly centered on the experiences of White gay men. The extent to which gayborhoods serve as an inclusive space for ethnically diverse sexual minority men remains largely unexplored. This paper examines the associations of gayborhood residence with LGBTQ + community connectedness, psychological distress, and substance use among ethnically diverse sexual minority men. Utilizing data from the 2023 Gay Asian Men Survey, this paper included 1071 cisgender sexual minority men of Asian backgrounds in Australia. The results indicated that older, middle-class, and gay men were more likely to live in gayborhoods than their younger, lower-class, and bisexual counterparts. The mediation analysis revealed the coexistence of positive and negative impacts of living in gayborhoods. Specifically, gayborhood residence was positively associated with LGBTQ + community connectedness, which was in turn associated with reduced levels of psychological distress but heightened levels of alcohol and drug use. The findings have significant implications for community organizing, mental health support, and substance use prevention. While leveraging gayborhoods to foster support networks and improve mental health among Asian sexual minority men is beneficial, it is equally crucial to address the pressures associated with conforming to community norms, particularly regarding social drinking and recreational drug use

High-Throughput 3D Bioprinting of Cancer Spheroids: Investigating the Role of Spheroid Size in Drug Sensitivity and Biomarker Expression

The fabrication of complex 3D models with high cell viability remains a significant challenge in bioprinting. To address this, a novel printing mode was developed to enhance cell viability. This innovative method utilises a high-throughput 3D bioprinting platform capable of producing uniform cancer spheroids with controlled sizes. The research presented here evaluates the effectiveness of this bioprinting approach, focusing on its ability to print alginate-based hydrogel models and fabricate sophisticated 3D models using MCF-7 breast cancer cells. Using a drop-on-demand 3D bioprinter, alginate-based bioink and calcium chloride activator were sequentially layered to form hydrogel models. The bioprinting parameters, including printing pressure and microvalve open time, were optimised to ensure uniformity and structural integrity. MCF-7 cells were bioprinted into the hydrogel cavities, resulting in spheroid formation within 72 hours. By manipulating bioprinter settings, spheroid sizes were precisely controlled by adjusting the cavity diameters into three sizes: 300, 600, and 900 µm. These spheroids were then exposed to two chemotherapeutic agents, and cancer stem cell biomarkers were analysed via immunohistochemical staining to explore how spheroid size influences drug response. Optimising bioprinting parameters was essential for achieving high fidelity and reproducibility in 3D cancer modelling, as these parameters significantly affected printing resolution. Fine-tuning the printing pressure between 30–45 kPa enabled the generation of spheroids with a 5%-10% size variation, allowing for the construction of 96 models within 2 hours. The bioprinted cells maintained over 80% viability and continued proliferating within the spheroids. This study also revealed a size-dependent response to chemotherapeutic agents, with smaller spheroids exhibiting greater sensitivity. IC50 values increased from 12 to 44.7 µM for doxorubicin, and for tamoxifen, they increased from 14.8 to 22.9 µM as spheroid size increased from 300 to 900 µm. While the observed size-dependent increase in IC50 values for doxorubicin and tamoxifen is consistent with established understandings of 3D tumour models, our findings provide a quantitative demonstration of how spheroid diameters ranging from 300–900 µm specifically influence drug efficacy, thereby offering new and practical insights for optimising drug screening and treatment strategies. The developed 3D bioprinting technology supports the high-throughput creation of cancer spheroids with precise size control, replicating in vivo size-dependent drug sensitivity. This technology offers a robust platform for investigating the critical role of size in drug response and biomarker discovery, advancing cancer treatment strategies

Generative AI’s Legal Leap. Navigating Risk While Fostering Innovation in Litigation

Paper outlining research and related article, seeking feedback on scope and content. Documenting research on the impact of generative artificial intelligence (GenAI) on legal services and the legal profession. Describing dataset of GenAI use in legal proceedings, and responses of courts and tribunals and legal regulators. Identifying key user groups, and recommending adoption of established approaches to risk management (RM) e.g. RM benchmarks and standards, when developing court, tribunal and legal regulatory responses to GenAI use

The talent burden—Identity threats and threat responses in the context of an early-career talent program

Although previous research has mainly assumed that talent designation “buoys” individuals' identities, current research is increasingly pointing at the mixed blessing of being identified as a talent. Adopting an identity work perspective, we examine what identity threats talents perceive in the context of an early-career talent program and how they respond to these perceived threats. Our study builds on qualitative interviews conducted in a large Swedish MNC during three different phases of a talent program. Our findings advance the literature by developing a deeper understanding of the “identity struggles” early-career talents face during their talent journeys. We conceptualize these struggles as identity threats and identify and analyse specific threats as well as how talents respond to these threats. Our findings show a strong willingness to protect the talent identity, but responses vary over time and between individuals. The study sheds light on how different sources of identity threat and different critical experiences, especially regarding career progress and perceived social support, lead to different responses and outcomes of talent designation