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This 23-color mouse immunophenotyping panel was designed and developed by the Virginia Commonwealth University’s (VCU) flow cytometry shared resource (FCSR) to easily bring new use to our high-parameter spectral cytometers. Our method is broadly applicable to multiple tissue types, is modifiable, and provides a reproducible, cost-effective option for utilizing high-parameter flow cytometry. To facilitate the mouse immunophenotyping panel, researchers can be provided with optimized reagents, a step-by-step staining protocol, instrument training, pre-run single-color controls, and acquisition and analysis templates to streamline the workflow. Data analysis is generally done with a traditional manual gating strategy, but t-stochastic neighbor embedding (tSNE) and uniform manifold approximation projection (uMAP) generation can be performed, as desired. In an FCSR, this panel requires only light preparation work for shared resource (SR) staff with maximum benefit for researchers. Overall, this publication describes how SR facilities can provide additional benefits and services to their clientele by reducing costs, increasing reproducibility, and lowering the barriers of entry for researchers into the field of high parameter spectral flow cytometry. The panel described is used as an example of the application of the included methods, as well as a complete resource for other institutions to utilize themselves.

Background Research on perception of chiropractic is abundant in Western contexts, yet sparse in Asia. This study aims to bridge this gap by examining the perceptions of chiropractic among Taiwanese adults, focusing on demographics, utilisation, beliefs, and understanding. Methods An adapted survey with 27 close-ended items was administered to assess Taiwanese adults’ perception of chiropractic. The electronic survey, using Qualtrics, was delivered worldwide via Taiwanese Facebook groups from January 31 to March 31, 2024. Descriptive statistics, including frequencies and cross tabulations, were performed. Results A total of 769 individuals were surveyed, with 475 participants providing complete data. Over half of the participants (62%) had never visited a chiropractor, but in those who had visited a chiropractor 78% reported satisfaction. Of 475 participants, 45% considered chiropractic care safe while 34% were unsure. Though almost half (42%) were unclear about what chiropractors do, most participants (67%) expressed interest in learning more. Among the 151 participants with prior experience of chiropractic care, the demographic profile was 54% women, and individuals aged 28 to 37 (44%), and those with an undergraduate degree (52%) were most common. Conclusion Overall, our study found a positive perception and high acceptance of chiropractic among the Taiwanese population; however, generalisability may be limited due to the risk of selection bias. An understanding of the chiropractic profession was notably limited. Hence, efforts are needed to enhance awareness of chiropractic accreditation, clinical competencies, and its potential role in public healthcare in Taiwan.

Background Spinal pain and disorders are a major burden on our population and health systems. Previous research showed people with diabetes were 1.35 times and 1.24 times more likely to report low back pain and neck pain than people without diabetes respectively, but diabetes was not a predictor of future spinal pain. Here we update a previous systematic review to determine whether in an adult population, diabetes is associated with low back, neck, or spinal pain. Methods The search was performed in PUBMED, Medline, CINAHL and EMBASE. Studies between 2017–2025, of cross-sectional, case–control, twin-control, and cohort designs, assessing diabetes and low back, neck, or spinal pain in adult populations, were included. Excluded were single-case studies, spinal pathologies, multiple chronic diseases, additional pain sites, and gestational or pre-diabetes. Two independent reviewers extracted data on the incidence of pain and reported associations. Odds ratios (ORs) of the association between the exposure (diabetes) and outcome (back, neck, or spinal pain) were calculated using a random effects model. Systematic review registration: PROSPERO registration CRD42022333064. Results A total of 15 studies were included with 11 studies included in the meta-analysis. When compared to people without diabetes, people with diabetes had 1.44 times higher odds of reporting low back pain (n = 592,901; OR 1.44; 95% Confidence Interval (CI) 1.20- 1.74; p  = 0.001), a 1.11 times higher odds of reporting neck pain (n = 465,130; OR 1.11; 95%CI 1.13–1.20; p  =  < 0.001) and a 1.42 times higher odds of reporting spinal pain (n = 1,335,999; OR 1.42; 95%CI 1.26–1.63; p  =  < 0.001). Diabetes was significantly associated with 1.27 times higher odds of developing spinal pain (n = 35,435; OR 1.27; 95%CI 1.08–1.50; p  = 0.004) and 1.44 higher odds of developing neck pain (n = 15,075; OR 1.44; 95%CI 1.09 -1.90; p  = 0.010). There was no significant association between diabetes and developing low back pain (n = 21,215; OR 1.11; 95%CI 0.88–1.41, p  = 0.388). Conclusions With the inclusion of fifteen additional studies providing an overall sample size five and a half times larger than the previous review, diabetes was associated with prevalent neck, low back and spinal pain, as well as incident neck and neck and spinal pain. Clinicians must be adept at identifying co-morbid conditions and risk factors, understanding the interplay between them and creating well managed networks to address these complex presentations.

Introduction Low back pain (LBP) is a highly prevalent and disabling condition. People with LBP may be referred to elective surgical clinics for further evaluation and consideration of surgery. Despite long waits for an initial appointment, many of these patients are not surgical candidates and may be discharged, receiving minimal‐to‐no care, advice or alternative treatment options, leaving a critical gap in care. Methods Approximately 25 participants with dominant, chronic non‐specific axial LBP who are (1) referred to and (2) discharged without spinal surgery following consultation in two elective spinal surgery clinics in Western Australia will participate in a one‐on‐one pre‐consultation semi‐structured interview and a similar post‐consultation qualitative interview. Purposive sampling will be used to recruit participants. Interviews will be audio‐recorded and transcribed, underpinned by a qualitative descriptive approach to explore participants' care journey, including pre‐consultation expectations and overall experiences post‐consultation. We will use inductive content analysis to analyse our data, allowing for the identification of themes that are generated from the participants' responses. Discussion/Conclusion This protocol outlines the methodological process for a qualitative study exploring the experiences and expectations of LBP patients before and after consulting in elective spinal surgery clinics in Western Australia. The findings may give rise to consumer‐focused solutions to improve the care journey and highlight gaps in patient expectations and understanding of non‐surgical management, informing the development of tailored educational resources, communication strategies and new care pathways. Patient or Public Contribution This study will incorporate patient and/or public involvement by engaging representatives from Musculoskeletal Australia (https://muscha.org/) to contribute to the study design and interpretation of findings. Specifically, a consumer with lived experience of low back pain will be invited to review and provide feedback on the semi‐structured interview questions, to ensure they are appropriate, accessible and reflective of patient experiences. Clinical Trial Registration This study is not a clinical trial and is therefore not registered.

Background Despite the well-known benefits of physical activity, physical inactivity is presently a global health pandemic. Allied healthcare providers, such as chiropractors, knowingly recognise the importance of physical activity and are prepared to routinely discuss and/or counsel patients on this topic; however, little is known about Australian chiropractors in the physical activity setting. Our aim was to explore and identify factors associated with physical activity promotion among Australian chiropractors, including their knowledge of the physical activity and sedentary behaviour guidelines and their own levels of physical activity. Methods From February to May 2021, a convenience sample of Australian chiropractors completed an online survey. Items assessed by Likert scale included: physical activity promotion frequency, with the type, quantity, barriers, perceptions, and feasibility. We asked questions about their familiarity with, and knowledge of, Australian Physical Activity and Sedentary Behaviour Guidelines, chiropractors’ own physical activity, and whether the chiropractors met activity guidelines. Survey responses were descriptively reported. Univariable logistic regression models explored factors explaining frequent physical activity promotion. Results Of 217 respondents, 64% reported that they frequently (≥ 70%) recommended a more physically active lifestyle. Only 15% often performed pre-exercise screening, 73% frequently prescribed resistance exercise, 19% reported time as the most frequent barrier, while 37% reported being not at all familiar with the guidelines. Univariable logistic regression models found male chiropractors were more likely to promote physical activity, [odds ratio (OR) = 2.33; 95% confidence interval (CI): 1.32–4.12)], while chiropractors who frequently treat children 0–3 years (OR = 0.5; 95% CI: 0.28–0.87), children 4–18 years (OR = 0.42; 95% CI: 0.21–0.86), and pregnant women (OR = 0.5; 95% CI: 0.26–0.94) were less likely. Chiropractors were more likely to promote physical activity if they were familiar with the activity guidelines (OR = 2.9; 95% CI: 1.32–6.41), were confident promoting (OR = 11.6; 95% CI: 1.37–98.71) and prescribing physical activity programs (OR = 4.5; 95% CI: 2.03–9.99). Conclusion Most chiropractors confidently and regularly integrate physical activity into practice. Yet, despite acknowledging its importance, one third of chiropractors reported poor knowledge of the Physical Activity and Sedentary Behaviour Guidelines. Identifying barriers to the awareness, and implementation of physical activity guidelines should be further explored within chiropractic clinical settings.

Background Physical inactivity is a global health pandemic. Allied healthcare providers, including chiropractors, are well placed to integrate individual physical activity (PA) promotion into routine care. A previous systematic review identified that approximately 90% of chiropractors held a positive opinion towards healthier patient lifestyles; however, the extent to which chiropractors promote PA to their patients within routine care is unclear. This systematic review aimed to describe chiropractors' attitudes towards and current practice in advising, counselling, discussing, supporting, or recommending PA to patients. Methods Five databases were searched from inception to December 2021 for cross-sectional surveys that explored PA promotion by chiropractors in practice. We assessed the risk of bias of the included studies with the ‘Risk of Bias in Cross-Sectional Surveys of Attitudes and Practices’ tool. Descriptive data were extracted, grouping similar survey questions and responses into emerging categories. Chiropractors’ views regarding the perceived importance and/or their preparedness to counsel and provide PA or exercise information are reported. Results From 661 studies, 15 met the selection criteria. Surveys included 7999 chiropractors primarily from the USA, UK, Australia, and Sweden. All studies were rated as moderate-to-high risk of bias, with methodological weaknesses characterised by inconsistent reporting of missing data, non-representative samples, low response rates (i.e., less than 60%), and unknown validity of survey instruments. Chiropractors frequently recognised the importance of PA promotion, as demonstrated by the proportion of respondents reporting that they: (1) support the importance of providing PA or exercise information and counselling (64% to 100%); (2) are prepared to provide PA or exercise information and/or counselling to patients (91% to 92%,); (3) frequently obtain PA or exercise information from patients (87% to 97%,); 4) frequently discuss PA or exercise and/or provide PA or exercise information to patients (68% to 99%); and 5) frequently provide PA counselling to patients (50% to 81%.). Conclusion A large majority of practising chiropractors actively engage with PA promotion. However, the results should be interpreted with caution owing to the moderate-to-high risk of bias of the included studies. Forthcoming research initiatives should explore unbiased surveys, further PA education and training as well as capitalising on chiropractors’ own PA participation.

The increasing demand of cycle life performance of Pb-acid batteries requires the improvement of the negative Pb electrode’s charge capacity. Electrochemical investigations were performed on Pb electrode and Pb+Carbon (Carbon black and Graphite) electrodes to evaluate the ability of the additives to enhance the electrochemical faradaic reactions that occur during the cycle of Pb-acid battery negative electrode. The electrodes were characterized through Cyclic Voltammetry (CV), Potentiodynamic Polarization (PP), and Electrochemical Impedance Spectroscopy (EIS). CV revealed that the addition of carbon on the Pb electrode increased anodic and cathodicreactions by tenfold. The kinetics of PbSO4 passivation measured through PPrevealed that the addition of Carbon on the Pb electrode accelerated the oxide formation by tenfold magnitude. The Nyquist plot measured through EIS suggest that the electrochemical mechanism and reaction kinetics is under charge-transfer. From the equivalent circuit and physical model, Pb+CB1 electrode has the lowest EIS parameters while Pb+G has the highest which is attributed to faster faradaic reaction.The Nyquist plot of the passivated Pb+CB1 electrode showed double semicircular shape. The first layer represents to the bulk passive PbSO4 layer and the second layer represents the Carbon+PbSO4 layer. The enhancements upon addition of carbon on the Pb electrode were attributed to the additive’s electrical conductivity and total surface area. The electrochemical active sites for the PbSO4 to nucleate and spread increases upon addition of electrical conductive and high surface area carbon additives.

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.

Purpose Total skin electron therapy (TSET) is a complex radiotherapy technique, posing challenges in commissioning and quality assurance (QA), especially due to significant variability in patient body shapes. Previous studies have correlated dose with factors such as obesity index, height, and gender. However, current treatment planning systems cannot simulate TSET plans, necessitating heavy reliance on QA methods using standardized anthropomorphic phantoms and in‐vivo dosimetry. Given the relatively few studies on rotational techniques, comprehensive data in commissioning could streamline the process. Methods Developing a full‐body phantom would enable a more thorough TSET commissioning process, including testing for position‐specific dose distributions and comprehensive measurements across all body surfaces, unlike the typical torso‐only phantoms. This was created using digital modeling software, fabricated using 3D‐printing FDM technology, and filled with tissue‐equivalent gelatine. The phantom was positioned at an SSD of 340 cm and irradiated with a standard rotational TSET plan using the 6E HDTSE mode on a Varian TrueBeam linac at gantry angles of ± 18° from the horizontal. The dose was measured at over 50 points across the surface using Gafchromic EBT3 film. Results Dose distributions were generally consistent with existing literature values from in‐vivo dosimetry, with several position‐specific differences identified, including the hands and scalp compared to conventional positions. Hotspots were observed for the mid‐dorsum of the foot and nose, with areas under 80% of the dose identified as the soles of the feet, perineum, vertex of the scalp, top of the shoulder, and palm of the hand. Additionally, analysis using an interpolated dose heatmap found that 90% of the pixel area received a dose within 10% of the prescribed dose, indicating good uniformity with the commissioned technique. Conclusions With high agreement with the current literature, a 3D‐printed phantom proves effective for measuring doses in areas typically unmeasurable in TSET commissioning.

Background Musculoskeletal pain frequently occurs in more than one body region, with up to 80% of adults reporting more than one joint pain site in the last 12 months. Older people and females are known to be more susceptible to multiple joint pain sites, however the association of multisite joint pain with physical and psychosocial functions in this population are unknown. Methods Cross-sectional data from 579 women were analyzed. Women were asked “Which of your joints have been troublesome on most days of the past month?” Pain qualities were measured using the McGill Pain Questionnaire (Short Form) and PainDETECT, and health was assessed using the SF-36 and sociodemographic variables. Statistical analysis using generalized ordinal logistic regression included comparison of three joint pain groups: no joint pain, 1–4 sites of joint pain and ≥ 5 sites of joint pain. Results Two thirds of respondents had multisite pain (>1 site), and one third had ≥5 joint pain sites. Compared to women with fewer joint pain sites, women with >5 joint pain sites (multisite joint pain) had significantly poorer physical and emotional health-related quality of life, more severe pain, a higher probability of neuropathic pain, and a longer duration of pain. More than half of women in the multisite joint pain group were still employed, statistically significantly more than women with no joint pain. In the final model, pain duration, the number of medications, pain intensity (discomforting and distressing) and the physical component of health-related quality of life were significantly associated with increased number of joint pain sites. Conclusions Over one-third of older women in our sample had >5 painful joints in the last month. These women demonstrated significantly poorer psychosocial health, and increased medication use, than women with no or fewer sites of joint pain. Many women with multisite joint pain were still in the workforce, even when nearing retirement age. This study has important implications for future research into musculoskeletal pain, particularly in regards to womens health and wellbeing, and for clinical practice where there should be increased awareness of the implications of concurrent, multisite joint pain.