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Deep learning-based image registration (DLIR) has been widely developed, but it remains challenging in perceiving small and large deformations. Besides, the effectiveness of the DLIR methods was also rarely validated on the downstream tasks. In the study, a multi-scale complexity-aware registration network (MSCAReg-Net) was proposed by devising a complexity-aware technique to facilitate DLIR under a single-resolution framework. Specifically, the complexity-aware technique devised a multi-scale complexity-aware module (MSCA-Module) to perceive deformations with distinct complexities, and employed a feature calibration module (FC-Module) and a feature aggregation module (FA-Module) to facilitate the MSCA-Module by generating more distinguishable deformation features. Experimental results demonstrated the superiority of the proposed MSCAReg-Net over the existing methods in terms of registration accuracy. Besides, other than the indices of Dice similarity coefficient (DSC) and percentage of voxels with non-positive Jacobian determinant (|J(phi)|=<0), a comprehensive evaluation of the registration performance was performed by applying this method on a downstream task of multi-atlas hippocampus segmentation (MAHS). Experimental results demonstrated that this method contributed to a better hippocampus segmentation over other DLIR methods, and a comparable segmentation performance with the leading SyN method. The comprehensive assessment including DSC, |J(phi)|=<0, and the downstream application on MAHS demonstrated the advances of this method.
Small area estimation methods have become a widely used tool to provide accurate estimates for regional indicators such as poverty measures. Recent research has provided evidence that spatial modelling still can improve the precision of regional and local estimates. In this paper, we provide an intrinsic spatial autocorrelation model and prove the propriety of the posterior under a flat prior. Further, we show using the SAIPE poverty data that the gain in efficiency using a spatial model can be essentially important in the presence of a lack of strong auxiliary variables.
Model transformations are central to model-driven software development. Applications of model transformations include creating models, handling model co-evolution, model merging, and understanding model evolution. In the past, various (semi-)automatic approaches to derive model transformations from meta-models or from examples have been proposed. These approaches require time-consuming handcrafting or the recording of concrete examples, or they are unable to derive complex transformations. We propose a novel unsupervised approach, called Ockham, which is able to learn edit operations from model histories in model repositories. Ockham is based on the idea that meaningful domain-specific edit operations are the ones that compress the model differences. It employs frequent subgraph mining to discover frequent structures in model difference graphs. We evaluate our approach in two controlled experiments and one real-world case study of a large-scale industrial model-driven architecture project in the railway domain. We found that our approach is able to discover frequent edit operations that have actually been applied before. Furthermore, Ockham is able to extract edit operations that are meaningful—in the sense of explaining model differences through the edit operations they comprise—to practitioners in an industrial setting. We also discuss use cases (i.e., semantic lifting of model differences and change profiles) for the discovered edit operations in this industrial setting. We find that the edit operations discovered by Ockham can be used to better understand and simulate the evolution of models.
Terrestrial cyanobacteria grow as phototrophic biofilms and offer a wide spectrum of interesting products. For cultivation of phototrophic biofilms different reactor concepts have been developed in the last years. One of the main influencing factors is the surface material and the adhesion strength of the chosen production strain. In this work a flow chamber was developed, in which, in combination with optical coherence tomography and computational fluid dynamics simulation, an easy analysis of adhesion forces between different biofilms and varied surface materials is possible. Hereby, differences between two cyanobacteria strains and two surface materials were shown. With longer cultivation time of biofilms adhesion increased in all experiments. Additionally, the content of extracellular polymeric substances was analyzed and its role in surface adhesion was evaluated. To test the comparability of obtained results from the flow chamber with other methods, analogous experiments were conducted with a rotational rheometer, which proved to be successful. Thus, with the presented flow chamber an easy to implement method for analysis of biofilm adhesion was developed, which can be used in future research for determination of suitable combinations of microorganisms with cultivation surfaces on lab scale in advance of larger processes.
Disconnection in a left-hemispheric temporo-parietal network impairs multiplication fact retrieval
(2023)
Arithmetic fact retrieval has been suggested to recruit a left-lateralized network comprising perisylvian language areas, parietal areas such as the angular gyrus (AG), and non-neocortical structures such as the hippocampus. However, the underlying white matter connectivity of these areas has not been evaluated systematically so far. Using simple multiplication problems, we evaluated how disconnections in parietal brain areas affected arithmetic fact retrieval following stroke. We derived disconnectivity measures by jointly considering data from n = 73 patients with acute unilateral lesions in either hemisphere and a white-matter tractography atlas (HCP-842) using the Lesion Quantification Toolbox (LQT). Whole-brain voxel-based analysis indicated a left-hemispheric cluster of white matter fibers connecting the AG and superior temporal areas to be associated with a fact retrieval deficit. Subsequent analyses of direct gray-to-gray matter disconnections revealed that disconnections of additional left-hemispheric areas (e.g., between the superior temporal gyrus and parietal areas) were significantly associated with the observed fact retrieval deficit. Results imply that disconnections of parietal areas (i.e., the AG) with language-related areas (i.e., superior and middle temporal gyri) seem specifically detrimental to arithmetic fact retrieval. This suggests that arithmetic fact retrieval recruits a widespread left-hemispheric network and emphasizes the relevance of white matter connectivity for number processing.
Science on ecosystems and people to support the Kunming-Montreal Global Biodiversity Framework
(2023)
In December 2022, members of the Convention on Biological Diversity adopted the new Kunming-Montreal Global Biodiversity Framework (GBF) to guide international biodiversity conservation efforts until 2030 in order to be able to live ‘in harmony with nature’ by 2050. This framework addresses the implementation gap left after the Aichi Biodiversity Targets, which were the previous global instrument for mainstreaming biodiversity conservation between 2010 and 2020.
The aim of this editorial is to draw attention to the GBF targets that are most relevant to our readership, with two objectives: First, to suggest how Ecosystems and People may be a venue for emerging research insights in support of the GBF. Second, to highlight examples of recent research in Ecosystems and People that can contribute to enrich, or even challenge, the evidence and development of the GBF Targets.
Die Umbenetzungsagglomeration bietet die Möglichkeit einer Trennung nach zwei Partikeleigenschaften. Hierbei wird nach den Benetzungseigenschaften des Feststoffs in Bezug zur Suspensions- und Bindeflüssigkeit getrennt und nach der Größe. Ziel dieser Arbeit ist, die Reinheit der entstehenden Graphitagglomerate in einer Mischung mit Quarzsand gravimetrisch zu bestimmen und diese mit den Benetzungseigenschaften zu korrelieren. Die Güte dieser Ergebnisse wird mit einer Mikroröntgentomographie (µ-CT) untersucht. Es konnte gezeigt werden, dass sich Quarzsand mit Paraffinöl nicht benetzen lässt und somit Reinheiten von 99,5 % bis 99,9 % erreicht werden, was das Ergebnis der µ-CT bestätigt. Einen Einfluss der Partikelgröße des Quarzsandes konnte im untersuchten Bereich nicht bestätigt werden.
In 2020, a year of turbulence, seismic in scale and rapid in impact, luxury brands strengthen their relationship with art. While the world is still processing the effects of the last decades (digitalization, sustainability, diversity), luxury brands and art collaborations are used as a strategic tool in luxury brand management to create value. As the pandemic and broader social outrage exposed fault lines in society, even more luxury brands open flagship stores designed in collaboration with archistars (famous architects). Luxury brands establish foundations where art is exhibited and promoted. Culture funds become the new patrons of art. Limited art editions of iconic luxury products turn to revenue boosts. This research focuses on a case study of luxury brand and art collaborations. The ten most valuable luxury brands are used to analyze luxury brand and art collaborations as a leverage on brand equity and art(ist) equity. The bleeding of personal luxury good brands as well as contemporary visual arts are focused. The study identifies particularly positive effects deriving from art in the creation of equity value. The core issue discussed is whether contemporary art may represent a possible strategic tool for competing and differentiating in the global luxury industry up to 2030. The research investigates two main concepts that represents the theoretical framework: art and luxury. Literature research deductively links this case study with appropriate theories on brand equity and art(ist) equity. During this, a time horizon between 2019 and 2021 is chosen to address the latest insights in luxury brands and art collaborations. The topic is investigated explorative and qualitative with expert interviews. To tackle the research topic all-encompassing, the following groups of recognized stakeholders have been interviewed: (1) luxury brands, (2) artists, (3) art galleries, (4) trend and market researchers, (5) luxury customers and (6) city. Finally, managerial insights on the implementation of artistic collaborations are derived and suitable strategies for luxury brands who plan to be involved in such collaboration agreements are suggested. The sticking point in former academic research has always been concrete proof that luxury brands and art collaborations lead to an increase in equity beyond a short-term social media buzz or press coverage. This is the reason why this paper develops an S-O-R equity model to show the causality effects of such collaborations.
The objective of the German non-profit association NFDI (German short form for ”National Research Data Infrastructure”) is to make the data stock of the entire German science system accessible to the public. To do so, it should involve all stakeholders. However, currently the Universities of Applied Sciences (UAS) are underrepresented in the NFDI, and there is a danger of neglecting their needs. Therefore, we present the project ”Research Data Management at Universities of Applied Sciences in the State of Rhineland-Palatinate” (FDM@HAW.rlp), which is funded by the German Federal Ministry of Education and Research (BMBF) and financed within the Recovery and Resilience Facility of the European Union. In the project, seven public UAS in Rhineland-Palatinate and the Catholic University of Applied Sciences (CUAS) Mainz follow a common goal: They intend to establish an institutional RDM within a period of three years by building up competencies at the UAS, setting up services for researchers and finding solutions for a common technical infrastructure.
Ephemeroptera, Plecoptera and Trichoptera are three orders of freshwater macroinvertebrates with a short terrestrial adult life-stage that they use to disperse by flying upstream. This aerial dispersal can be assisted by native riparian forest, but regional variation has not yet been empirically tested. In this study we compared the EPT community of 153 sampling sites located in freshwater streams in four European regions (Central Plains, Central Highlands, Alps, Iberia). In each site, we assessed the EPT community dispersal ability using the Species Flying Propensity index. We also calculated the native deciduous forest cover in the riparian buffer and several environmental stressors such as saprobic pollution or catchment anthropization. Finally, we tested which of these parameters have a significant effect on the EPT community. In the Central Highlands and in Iberia, the share of weak dispersers increased with native deciduous forest cover, indicating a positive effect on dispersal of EPTs. In the Central Plains and the Alps, no such effect was found. We conclude that the effect of native deciduous forest depends on regional landscape characteristics and the regional species pool, but considering the dispersal of the regional EPT communities is needed to create effective river management policies.
1. Woody riparian vegetation (WRV) benefits benthic macroinvertebrates in running waters. However, while some functions are provided by WRV irrespective of surrounding and catchment land use, others are context-specific. In recent large-scale studies, effects of WRV on macroinvertebrates were therefore small compared to catchment land use, raising the question about the relevance of WRV for restoration.
2. Model-based recursive partitioning was used to identify context-dependent effects of WRV on the macroinvertebrates' ecological status in small (catchment area 10–100 km2) lowland (n = 361) and mountain (n = 748) streams. WRV cover was quantified from orthophotos along the near (500 m) and far (5000 m) upstream river network and used to predict the site's ecological status. Agricultural, urban and woodland cover at the local and catchment scales along with hydromorphology were considered as partitioning variables.
3. In rural agricultural landscapes, the effect of WRV on the ecological status was large, indicating that establishing near-upstream WRV can improve the ecological status by as much as two of the five classes according to the EU Water Framework Directive.
4. Even in urban landscapes, effects of far-upstream WRV were large if catchments had a moderate share of agricultural land use in addition. The beneficial effects of WRV were only limited in purely urban catchments or in a multiple stressor context.
5. Synthesis and applications. While woody riparian vegetation (WRV) can even improve the ecological status in urban settings, it is especially relevant for river management in rural agricultural catchments, where developing WRV potentially are effective measures to achieve good ecological status.
Background: Physiotherapy education and practice have country-specific peculiarities which may limit globalization in health care. This study aimed to characterize physiotherapy practice and treatment preferences, educational qualifications, and research in Nigeria, with a view of providing vital information for transnational integration and collaboration.
Methods: A cross-sectional survey of 104 Nigerian physiotherapists was conducted. The Physical Therapy Practice Questionnaire and a self-developed proforma were used as survey tools.
Results: The mean age of respondents was 33.5 ± 9.4 years. About two-fifth of all respondents (39.4%) had an MSc and mostly practice as clinicians (51.0%) in teaching hospitals (34.6%). The respondents were mostly involved in general practice (50.0%), with a caseload of 1–10 patients per day (67.3%). Soft tissue mobilization (83%), proprioceptive neuromuscular facilitation (76%), breathing exercises (77%), and transcutaneous electrical neuromuscular stimulation (83%) were commonly used. Respondents were familiar databases and evidence-based resources (81.2%) and mostly utilize PubMed (73.3%). Regular case conferences with professional colleagues (47.6%) and treatment planning of between 11 and 30 min (40.6%) were common. Educators spend 1–3 h planning educational work (91.8%). Clinical decision-making is mostly based on professional experience, while journals are the primary resource for educational information.
Conclusion: Physiotherapy practice in Nigeria is degree based and requires registration board’s licensure. Practitioners deal with a high caseload and utilize a wide range of techniques and modalities and have tendencies to utilize personal experience and research in making clinical decisions. The parity in education and practice with advanced climes inadvertently gives physiotherapy practice in Nigeria a global purview.
Species distribution models (SDMs) are key tools in biodiversity and conservation, but assessing their reliability in unsampled locations is difficult, especially where there are sampling biases. We present a spatially-explicit sensitivity analysis for SDMs – SDM profiling – which assesses the leverage that unsampled locations have on the overall model by exploring the interaction between the effect on the variable response curves and the prevalence of the affected environmental conditions. The method adds a ‘pseudo-presence’ and ‘pseudo-absence’ to unsampled locations, re-running the SDM for each, and measuring the difference between the probability surfaces of the original and new SDMs. When the standardised difference values are plotted against each other (a ‘profile plot’), each point's location can be summarized by four leverage measures, calculated as the distances to each corner. We explore several applications: visualization of model certainty; identification of optimal new sampling locations and redundant existing locations; and flagging potentially erroneous occurrence records.
In this paper, the radio frequency (RF) behavior of mechanically stressed coaxial and for the first time also twisted-pair transmission lines is investigated over their service life. The main goal is to enable predictive maintenance for cables in moving applications and avoid preventive replacement. This also reduces the use of high-cost resources. For this purpose, stranded and solid-core variants of coaxial and twisted-pair type cables are mechanically loaded on the two-pulley apparatus according to EN 50396. Their RF transmission (S21) behavior is measured using a vector network analyzer and presented over bending cycles. For the first time, the phase response of mechanically loaded transmission lines is evaluated with respect to their service life. Two significant causes for the increasing attenuation and altered phase response are identified: breakage in foil screen and increasing surface roughness on the copper conductors. The identified causes are supported with literature evidence. Through measurements and theoretical calculations, it is proven that the phase is much more suitable for an assessment of the remaining service life than the amplitude. The findings can be used to implement a cable monitoring system in industrial environments which monitors the lines in-situ and reminds the user to replace them, whenever a certain wear-level is reached.
The Saarschleife geotope (SE-Germany) represents one of the most prominent geotopes of the SaarLorLux region and is known far beyond the borders of the Greater Region. Surprisingly, there is no visual representation of the relief history and genesis of this river meander, which is unique for Central Europe - as is common at places with comparable outstanding phenomena, such as e.g. the Rocher Saint-Michel d'Aiguilhe (France) or some national parks in the U.S. (e.g. Grand Canyon). The Saarschleife geotope therefore was choosen as a pilot object for the envisaged analysis of the landscape genesis but also regarding the 3D mapping and visualization. The visualisation presents the relief history and geological evolution of the last 300 million years in selected geological epochs, which are of fundamental importance for the understanding of today's geomorphological relief conditions, and is compiled into a summarized chronology.
More and more universities are recognizing their role model and creative function in society and are acting accordingly - also in terms of mobility. In this way, universities can make an important contribution to climate protection, as mobility is responsible for more than 20 percent of global greenhouse gas emissions. The GreenMetric ranking also takes the area of mobility into account via the Transportation category, which is weighted at 18%. This paper uses the example of the Environmental Campus Birkenfeld at Trier University of Applied Sciences, Germany, to show what opportunities universities in rural areas have to reduce transportation-related emissions of students and employees. The possibilities of avoiding transportation as well as different solutions for the reduction of transportation-related greenhouse gas emissions are discussed. Furthermore, conflicts of objectives inherent to the university system in the area of mobility are considered, especially in the area of internationalization.
Owing to a long history of anthropogenic pressures, freshwater ecosystems are among the most vulnerable to biodiversity loss1. Mitigation measures, including wastewater treatment and hydromorphological restoration, have aimed to improve environmental quality and foster the recovery of freshwater biodiversity2. Here, using 1,816 time series of freshwater invertebrate communities collected across 22 European countries between 1968 and 2020, we quantified temporal trends in taxonomic and functional diversity and their responses to environmental pressures and gradients. We observed overall increases in taxon richness (0.73% per year), functional richness (2.4% per year) and abundance (1.17% per year). However, these increases primarily occurred before the 2010s, and have since plateaued. Freshwater communities downstream of dams, urban areas and cropland were less likely to experience recovery. Communities at sites with faster rates of warming had fewer gains in taxon richness, functional richness and abundance. Although biodiversity gains in the 1990s and 2000s probably reflect the effectiveness of water-quality improvements and restoration projects, the decelerating trajectory in the 2010s suggests that the current measures offer diminishing returns. Given new and persistent pressures on freshwater ecosystems, including emerging pollutants, climate change and the spread of invasive species, we call for additional mitigation to revive the recovery of freshwater biodiversity.
Digital transformation is both an opportunity and a challenge. To take advantage of this opportunity for humans and the environment, the transformation process must be understood as a design process that affects almost all areas of life. In this paper, we investigate AI-Based Self-Adaptive Cyber-Physical Process Systems (AI-CPPS) as an extension of the traditional CPS view. As contribution, we present a framework that addresses challenges that arise from recent literature. The aim of the AI-CPPS framework is to enable an adaptive integration of IoT environments with higher-level process-oriented systems. In addition, the framework integrates humans as actors into the system, which is often neglected by recent related approaches. The framework consists of three layers, i.e., processes, semantic modeling, and systems and actors, and we describe for each layer challenges and solution outlines for application. We also address the requirement to enable the integration of new networked devices under the premise of a targeted process that is optimally designed for humans, while profitably integrating AI and IoT. It is expected that AI-CPPS can contribute significantly to increasing sustainability and quality of life and offer solutions to pressing problems such as environmental protection, mobility, or demographic change. Thus, it is all the more important that the systems themselves do not become a driver of resource consumption.
Social media data are transforming sustainability science. However, challenges from restrictions in data accessibility and ethical concerns regarding potential data misuse have threatened this nascent field. Here, we review the literature on the use of social media data in environmental and sustainability research. We find that they can play a novel and irreplaceable role in achieving the UN Sustainable Development Goals by allowing a nuanced understanding of human-nature interactions at scale, observing the dynamics of social-ecological change, and investigating the co-construction of nature values. We reveal threats to data access and highlight scientific responsibility to address trade-offs between research transparency and privacy protection, while promoting inclusivity. This contributes to a wider societal debate of social media data for sustainability science and for the common good.
A systemic framework of energy efficiency in schools: Experiences from six European countries
(2023)
Schools are complex physical and social institutions within national education systems. They account for significant energy consumption and like other buildings can demonstrate inefficient patterns of energy use. Poor energy performance of educational facilities is an intricate issue driven by complex causality of interconnected and dynamic factors. Addressing this issue requires a systemic approach, which is heretofore lacking. The aim of this research is to present and describe a systemic framework to facilitate energy reduction in schools across different European contexts. This transdisciplinary approach to sustainable energy use has been piloted in 13 post-primary schools located in six countries in northwest Europe. The research implements a series of planned activities and interventions, which help to unveil a systemic approach to improving energy efficiency in schools. The findings demonstrate how this approach, together with its ensuing methodologies and strategies, can contribute to reducing carbon emissions and improve knowledge and awareness around sustainable energy.
Dielectric properties of unidirectional and biaxial flax/epoxy composites at frequencies up to 1 GHz
(2023)
The relative permittivity of flax/epoxy composites in unidirectional and biaxial orientations was mapped in the frequency range of 1 kHz to 200 kHz, and for the first time in the range of 1 MHz to 1 GHz. In addition, permittivity was investigated for the first time in the temperature range between − 20 °C and 50 °C. These composites, produced using the vacuum infusion process, are increasingly used for sustainable and lightweight structural components in the automotive industry. The relative permittivity was determined using a self-developed plate capacitor with an LCR bridge and an impedance analyzer. An examination of the microstructure of the flax/epoxy composites shows that the fibers are disordered in the composite, resulting in local variations in fiber volume fraction. Furthermore, it was shown that the matrix also infiltrates into the fiber itself, resulting in an increase of the matrix fraction. It was found that unidirectional fabrics had a higher relative permittivity than biaxial fabrics, due to a higher fiber volume fraction and lower proportion of epoxy. The results suggest that it is the fiber volume fraction, rather than the manufacturing process and fiber orientation, that primarily determines the relative permittivity. It was also found that the permittivity continues to decrease below room temperature and thus behaves in a manner typical of the material in this temperature range as well.
Background: Stratified care approach involving use of the STarT-Back tool to optimise care for patients with low back pain is gaining widespread attention in western countries. However, adoption and implementation of this approach in low-and-middle-income countries will be restricted by context-specific factors that need to be addressed. This study aimed to develop with physiotherapists, tailored intervention strategies for the implementation of stratified care for patients with low back pain.
Methods: A two-round web-based Delphi survey was conducted among purposively sampled physiotherapists with a minimum of three years of clinical experience, with post-graduation certification or specialists. Thirty statements on barriers and enablers for implementation were extracted from the qualitative phase. Statements were rated by a Delphi panel with additional open-ended feedback. After each Delphi round, participants received feedback which informed their subsequent responses. Additional qualitative feedback were analysed using qualitative content analysis. The criteria for consensus and stability were pre-determined using percentage agreement (≥ 75%), median value (≥ 4), Inter-quartile range (≤ 1), and Wilcoxon matched-pairs test respectively.
Results: Participants in the first round were 139 and 125 of them completed the study, yielding a response rate of 90%. Participants were aged 35.2 (SD6.6) years, and 55 (39.6%) were female. Consensus was achieved in 25/30 statements. Wilcoxon’s test showed stability in responses after the 5 statements failed to reach consensus: ‘translate the STarT-Back Tool to pidgin language’ 71% (p = 0.76), ‘begin implementation with government hospitals’ 63% (p = 0.11), ‘share knowledge with traditional bone setters’ 35% (p = 0.67), ‘get second opinion on clinician’s advice’ 63% (p = 0.24) and ‘carry out online consultations’ 65% (p = 0.41). Four statements strengthened by additional qualitative data achieved the highest consensus: ‘patient education’ (96%), ‘quality improvement appraisals’ (96%), ‘undergraduate training on psychosocial care’ (96%) and ‘patient-clinician communication’ (95%).
Conclusion: There was concordance of opinion that patients should be educated to correct misplaced expectations and proper time for communication is vital to implementation. This communication should be learned at undergraduate level, and for already qualified clinicians, quality improvement appraisals are key to sustained and effective care. These recommendations provide a framework for future research on monitored implementation of stratified care in middle-income countries.
Evaluation of a blended learning approach on stratified care for physiotherapy bachelor students
(2023)
Background: Stratified models of care are valuable for addressing psychosocial factors which influence the outcome of patients with musculoskeletal disorders. Introducing such models in undergraduate training has the potential to propagate this knowledge with evidence and foster its implementation. The objective of this paper is to explore the perception and changes in the fear-avoidance beliefs of physiotherapy students participating in a developed blended learning course on stratified care.
Methodology: A mixed-methods with a convenient sample of two consecutive cohorts were given a blended learning course on stratified care for patients with low back pain. The blended learning course comprised scientific rudiments and application of stratified care in clinical practice conceptualised using the KERN’ 6-step approach. The exam scores, perceptions, performance on self-reflection-tests and pre- and post-scores on The Tampa Scale for Kinesiophobia for Physiotherapists’ (TSK-PT) were obtained. After gaining clinical experience, participants were invited to discuss their clinical experiences and perceptions in workshops. The quantitative data was analysed explorative-descriptively. The qualitative data was analysed following an inductive coding system with constant comparisons.
Results: Ninety-one participants consented to the evaluation (mean age = 22.9 ± 1.6 years), 66% were female. Exam scores correlated with time spent in training (r = 0.30) and scores on self-reflection-tests 1 and 2 (r = 0.40 and r = 0.41). Participants in both cohorts described the learning resources as promoting their interest in the subject (72% and 94%), up-to-date (91% and 93%) and helpful (91% and 97%). The fear-avoidance scores for participants decreased from 53.5 (± 9.96) to 40.1 (± 12.4) with a large effect size (d = 1.18). The regression model [F (2, 49) = 1151.2, p < 0.001] suggests that pre-TSK-PT and the interest of participants in the training predicted post-TSK-PT. The workshop participants (n = 62) all worked in clinical practice. Emerging from the analysis were 4 categories (evolving to maturity in practice, perceiving determinants of stratified care, strategising for implementation and adopting an outlook for future practice).
Conclusion: The quality of engagement in learning, training strategy and interest in the subject contributes immensely to learning outcomes. This blended learning course was successful in reducing kinesiophobia and influencing the participants’ attitude towards care with the potential of being translated into long-term practice.