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Students who have experienced trauma may be especially likely to present challenging behaviors in the classroom. With an increase of trauma-affected students in music classrooms, it is important for music educators to consider classroom management (CM) practices that support trauma-affected students' healing without triggering students' trauma responses. In this review of literature, I discuss childhood trauma and trauma-informed positive education (TIPE), research-supported CM strategies in music education, and the ways in which these CM practices do or do not support the trauma-informed approach outlined by TIPE. In addition, I provide my own definition for trauma-informed CM in music education and suggest implications for the music education field.

Abstract Background Rib fractures are one of the most common traumatic injuries and may result in significant morbidity and mortality. Despite growing evidence, technological advances and increasing acceptance, surgical stabilization of rib fractures (SSRF) remains not uniformly considered in trauma centers. Indications, contraindications, appropriate timing, surgical approaches and utilized implants are part of an ongoing debate. The present position paper, which is endorsed by the World Society of Emergency Surgery (WSES), and supported by the Chest Wall Injury Society, aims to provide a review of the literature investigating the use of SSRF in rib fracture management to develop graded position statements, providing an updated guide and reference for SSRF. Methods This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of experts then critically revised the manuscript and discussed it in detail, to develop a consensus on the position statements. Results A total of 287 studies (systematic reviews, randomized clinical trial, prospective and retrospective comparative studies, case series, original articles) have been selected from an initial pool of 9928 studies. Thirty-nine graded position statements were put forward to address eight crucial aspects of SSRF: surgical indications, contraindications, optimal timing of surgery, preoperative imaging evaluation, rib fracture sites for surgical fixation, management of concurrent thoracic injuries, surgical approach, stabilization methods and material selection. Conclusion This consensus document addresses the key focus questions on surgical treatment of rib fractures. The expert recommendations clarify current evidences on SSRF indications, timing, operative planning, approaches and techniques, with the aim to guide clinicians in optimizing the management of rib fractures, to improve patient outcomes and direct future research.

In Europe, half of the amount of sewage sludge from wastewater treatment plants (WWTPs) is used in agriculture, in Poland about 27%, respectively. Fertilizing products (compost or organic-mineral fertilizers) produced from sewage sludge are promise alternative for directly use of no-treated waste. The paper presents seasonal changes of Cu, Pb, Ni, Zn, Cr, Cd and Hg content in sewage sludge from different regions of Poland collected during one year. It was noted wide range of the metal amount in dependence on season andWWTPs capacity. The Cu concentration was from 0.4 to 784 mgkg–1 d.m., Ni from 0.25 to 1281 mgkg–1 d.m., Cd from 0.005 to 14.85 mgkg–1 d.m., Pb from 0.11 to 306.2 mgkg��1 d.m., Hg from

Abstract Background The effectiveness of the NSW Health “Get Healthy Information and Coaching Service® ”(Get Healthy) to facilitate weight loss on a population scale has been documented, but this was based on self-reported measures. Our study aims to test the effectiveness of the Get Healthy Service on objectively measured weight, BMI, waist circumference, and changes in other health behaviours, including nutrition, physical activity and alcohol intake. Methods Men and women aged 40–70 years (n = 154) with pre-diabetes (5.7% < HbA1c

Abstract Background Emerging randomized data, mostly from phase II trials, have suggested that patients with oligometastatic cancers may benefit from ablative treatments such as stereotactic ablative radiotherapy (SABR). However, phase III data testing this paradigm are lacking, and many studies have examined SABR in the setting of metachronous oligometastatic disease. The goal of the SABR-SYNC trial is to assess the effect of SABR in patients with oligometastatic cancers and a synchronous primary tumor. Methods One hundred and eighty patients will be randomized in a 1:2 ratio between standard of care (SOC) palliative-intent treatments vs. SOC + ablative therapy (SABR preferred) to all sites of known disease. Randomization will be stratified based on histology and number of metastases at enrollment. SABR may be delivered in 1-, 3- and 5-fraction regimens, with recommended doses of 20 Gy, 30 Gy, and 35 Gy, respectively. Non-SABR local modalities (e.g. surgery, thermal ablation, conventional radiation) may be used for treatment of the primary or metastases at the discretion of the treating physicians, if those modalities are clinically preferred. The primary endpoint is overall survival, and secondary endpoints include progression-free survival, time to development of new metastatic lesions, time to initiation of next systemic therapy, quality of life, and toxicity. Translational endpoints include assessment of circulating tumor DNA and immunological predictors of outcomes. Discussion SABR-SYNC will provide phase III data to assess the impact of SABR on overall survival in a population of patients with synchronous oligometastases. The translational component will attempt to identify novel prognostic and predictive biomarkers to aid in clinical decision making. Trial registration Clinicaltrials.gov NCT05717166 (registration date: Feb. 8, 2023).

Abstract Background Countries in the Middle East have some of the lowest rates of physical activity and some of the highest rates of obesity in the world. Policies can influence population levels of physical activity. However, there is a dearth of research on physical activity policies in the Gulf region. This qualitative study analyses cross-sectoral barriers and facilitators for the development, implementation and evaluation of physical activity policies in Saudi Arabia and Oman, two of the largest countries in the region. Methods Semi-structured interviews were conducted with 19 senior policymakers from the Ministries of Health, Education, and Sport in Saudi Arabia and Oman, and were examined using thematic analysis. Results We identified seven themes related to physical activity policies in Saudi Arabia and Oman: leadership; existing policies; physical activity programs related to policies; private sector policies; challenges; data/monitoring; and future opportunities. Both countries have a central document that guides policy-makers in promoting physical activity, and the available policies in both countries are implemented via multiple programs and initiatives to increase physical activity. Compared with Oman, in Saudi Arabia, programs from the non-profit sector, represented by community groups, play a more significant role in promoting physical activity outside the government framework. The private sector has contributed to promoting physical activity in both countries, but interviewees stated that more financial support is required. Policy limitations differ between Saudi Arabia and Oman: intersectoral collaboration in Oman is limited and mainly based on individuals’ own initiative, while the health transformation in Saudi Arabia tends to slow down policy implementation in relevant areas. Physical education in Saudi Arabia and Oman is similar; however, increased support and collaboration between government agencies and the private sector for out-of-school sports academies are needed. Conclusions This study addresses key gaps in analysing physical activity policies in Gulf Cooperation Council countries. Our study highlights the importance of increasing financial support, improving collaboration between governmental agencies and between them and the private sector and consolidating efforts to back physical activity policies and dismantle cross-sectoral barriers in Saudi Arabia and Oman. Educational institutions in Saudi Arabia and Oman play a crucial role in promoting physical activity from early childhood to young adults. Our insights assist policy-makers, public health officials and stakeholders in shaping effective physical activity-promoting policies, programs and interventions to prevent non-communicable diseases. Challenges identified in Saudi Arabia and Oman's policies will inform their future development.

Literature on student ideas about circuits largely focuses on misunderstandings and difficulties, with seminal papers framing student thinking as stable, difficult to change, and connected to incorrect ontological categorizations of current as a thing rather than a process. In this paper, we analyzed 417 student responses to a conceptual question about electric circuits using a lens consistent with resources theory. We found that though indicators of substance-based reasoning about current are common in student responses, this reasoning is not predictive of other difficulties reported in the literature, such as "current is consumed" or "the battery is a constant source of current." We also found that students use substance-based reasoning in resourceful ways, suggesting that substance-based reasoning may in fact be a productive starting place for instruction on circuits.

Background: A quality diet and an active lifestyle are both important cornerstones of cardiovascular disease (CVD) prevention. However, despite their interlinked effects on metabolic health, the 2 behaviors are rarely considered jointly, particularly within the context of CVD prevention. We examined the independent, interactive, and joint associations of diet and physical activity with CVD hospitalization, CVD mortality, and all-cause mortality. Methods: CVD-free Australian participants aged 45–74 years (n = 85,545) reported physical activity, diet, sociodemographic, and lifestyle characteristics at baseline (2006–2009) and follow-up (2012–2015), and data were linked to hospitalization and death registries (03/31/2019 for CVD hospitalization and all-cause mortality and 12/08/2017 for CVD mortality). Diet quality was categorized as low, medium, and high based on meeting dietary recommendations. Physical activity was operationalized as (a) total moderate-to-vigorous physical activity (MVPA) as per guidelines, and (b) the composition of MVPA as the ratio of vigorous-intensity physical activity (VPA) to total MVPA. We used a left-truncated cause-specific Cox proportional hazards model using time-varying covariates. Results: During a median of 10.7 years of follow-up, 6576 participants were admitted to the hospital for CVD and 6581 died from all causes (876 from CVD during 9.3 years). A high-quality diet was associated with a 17% lower risk of all-cause mortality than a low-quality diet, and the highest MVPA category (compared with the lowest) was associated with a 44% and 48% lower risk of CVD and all-cause mortality, respectively. Multiplicative interactions between diet and physical activity were non-significant. For all outcomes, the lowest risk combinations involved a high-quality diet and the highest MVPA categories. Accounting for total MVPA, some VPA was associated with further risk reduction of CVD hospitalization and all-cause mortality. Conclusion: For CVD prevention and longevity, one should adhere to both a healthy diet and an active lifestyle and incorporate some VPA when possible.

Abstract Background Learning Health Systems (LHS) – characterised by cycles of evidence generation and application – are increasingly recognised for their potential to improve public health interventions and optimise health impacts; however there is little evidence of their application in the context of public health practice. Here, we describe how an Australian public health unit applied a LHS approach to successfully improve a model of support for implementation of a school-based physical activity policy. Methods This body of work was undertaken in the context of a strong research-practice partnership. Core LHS capabilities included: i) partnerships and stakeholder engagement; ii) workforce development and learning health communities; iii) multi-disciplinary scientific expertise; iv) practice data collection and management system; v) evidence surveillance and synthesis; and vi) governance and organisational processes of decision making. Three cycles of data generation and application were used. Within each cycle, randomised controlled trials conducted in NSW primary schools were used to generate data on the support model’s effectiveness for improving schools’ implementation of a government physical activity policy, its delivery costs, and process measures such as adoption and acceptability. Each type of data were analysed independently, synthesised, and then presented to a multi-disciplinary team of researchers and practitioners, in consult with stakeholders, leading to collaborative decisions for incremental improvements to the support model. Results Cycle 1 tested the first version of the support model (composed of five implementation strategies targeting identified barriers of policy implementation) and showed the model’s feasibility and efficacy for improving schools’ policy implementation. Data-informed changes were made to enhance impact, including the addition of three implementation strategies to address outstanding barriers. Cycle 2 (now, testing a package of eight implementation strategies) established the model’s effectiveness and cost-effectiveness for improving school's policy implementation. Data-informed changes were made to reduce delivery costs, specifically adapting the costliest strategies to reduce in-person contact from external support personnel. Cycle 3 showed that the adaptations minimised the relative cost of delivery without adversely impacting on the effect. Conclusions Through this process, we identified an effective, cost-effective, acceptable and scalable policy implementation support model for service delivery. This provides important information to inform or support LHS approaches for other agencies seeking to optimise the health impact of evidence-based interventions.

A common practice used by the Germans and collaborators in World War II, as part of the Holocaust, was to use existing Jewish cemeteries as places for mass burial. Research was completed at the Old Jewish Cemetery in Riga, Latvia, the Livas Jewish Cemetery in Liepaja, Latvia, and the Zaliakalnis Jewish Cemetery in Kaunas, Lithuania. The Old Jewish Cemetery in Riga was adjacent to the Riga Ghetto and was used to bury individuals murdered in the ghetto. In Kaunas, an area of the Zaliakalnis Jewish Cemetery is devoid of grave stones, and literature sources and testimony indicate that this area was used for the mass burial of Jews from the Kaunas Ghetto and other mass killings. In Liepaja, the local Jewish Heritage Foundation believes that there are mass graves within the Livas Cemetery. Methodologies for this research include the use of a pulseEkko Pro 500-megahertz ground-penetrating radar (GPR) system. Electrical resistivity tomography (ERT) data were collected through a linear array of electrodes coupled to a direct current (DC) resistivity transmitter and receiver. Analysis of aerial photography and satellite images was also employed at each location. ERT and GPR data indicate three separate trench anomalies in the Old Jewish Cemetery in Riga. The presence of these anomalies corroborates Holocaust survivor testimony that bodies were buried in mass graves in that area. In the Zaliakalnis Jewish Cemetery in Kaunas, ERT and GPR data indicate an anomaly in the western part of the cemetery, and ERT data further indicate two other possible mass graves. In Liepaja, preliminary GPR analysis indicates an anomaly in a cleared section of the cemetery. Based on the presence of geophysical anomalies in all three cemeteries, which correlate with literature sources and Holocaust survivor testimony, there is a high probability that mass graves are present at each site. Future research directions include expanding the search areas in each cemetery, additional literature and testimony-based research, and the addition of other geophysical methodologies.

Abstract Human activities and climate change are transforming fire regimes globally. The interaction between these two drivers is poorly understood, yet critical if we aim at predicting how biomes will respond to novel fire regimes. In the Brazilian Cerrado, altered fire regimes are threatening its unique biodiversity and ecosystem functioning. Here, using geospatial data for the period 1985-2020 and a causal inference framework to design Bayesian statistical models, we demonstrate that a larger human presence in the landscape (≥40% land-use area) reduces the Cerrado’s burned area and hinders its responsiveness to climate; while climatic effects only become apparent in landscapes with little human presence, where hotter and drier conditions increase burned area. Finally, we find spatially heterogeneous burned area trends over time, with increases associated to climate change in landscapes that have remained mostly intact, and decreases caused by anthropic expansion. Both diverging trends have important implications for the conservation of the Cerrado as land-use expansion and climate change continue to unfold.

Describing where a place is situated is an innate communication skill that relies on spatial cognition, spatial reasoning, and linguistic systems. Accordingly, textual geolocation, a task for retrieving the coordinates of a place from linguistic descriptions, requires computerized spatial inference and natural language understanding. Yet, machine-based textual geolocation is currently limited, mainly due to the lack of rich geo-textual datasets necessitated to train natural language models that, in-turn, cannot adequately interpret the language-based expressions. These limitations are intensified in morphologically rich and resource-poor languages, such as Hebrew. This study aims to analyze and understand the linguistic systems used for place descriptions in Hebrew, later to be used to train machine learning natural language models. A novel crowdsourced geo-textual dataset is developed, composed of 5,695 written place descriptions provided by 1,554 native Hebrew speakers. All place descriptions rely on memory only, which increases spatial vagueness and requires referring expression resolution. Qualitative linguistic analysis of place descriptions shows that geospatial reasoning is greatly used in Hebrew, while empirical analysis with textual geolocation engines indicates that literal descriptions pose challenges for existing methods, as they require real understanding of space and geospatial references and cannot simply be geolocated by matching gazetteer with textual geo-entity extractions. The findings offer improved understanding of the challenges entailed in natural language processing of Hebrew geolocation, contributing to formalizing computerized systems used in future machine learning models for complex geographic information retrieval tasks.

Abstract Background Coronary heart disease (CHD) is the leading cause of deaths and disability worldwide. Cardiac rehabilitation (CR) effectively reduces the risk of future cardiac events and is strongly recommended in international clinical guidelines. However, CR program quality is highly variable with divergent data systems, which, when combined, potentially contribute to persistently low completion rates. The QUality Improvement in Cardiac Rehabilitation (QUICR) trial aims to determine whether a data-driven collaborative quality improvement intervention delivered at the program level over 12 months: (1) increases CR program completion in eligible patients with CHD (primary outcome), (2) reduces hospital admissions, emergency department presentations and deaths, and costs, (3) improves the proportion of patients receiving guideline-indicated CR according to national and international benchmarks, and (4) is feasible and sustainable for CR staff to implement routinely. Methods QUICR is a multi-centre, type-2, hybrid effectiveness-implementation cluster-randomized controlled trial (cRCT) with 12-month follow-up. Eligible CR programs (n = 40) and the individual patient data within them (n ~ 2,000) recruited from two Australian states (New South Wales and Victoria) are randomized 1:1 to the intervention (collaborative quality improvement intervention that uses data to identify and manage gaps in care) or control (usual care with data collection only). This sample size is required to achieve 80% power to detect a difference in completion rate of 22%. Outcomes will be assessed using intention-to-treat principles. Mixed-effects linear and logistic regression models accounting for clusters within allocated groupings will be applied to analyse primary and secondary outcomes. Discussion Addressing poor participation in CR by patients with CHD has been a longstanding challenge that needs innovative strategies to change the status-quo. This trial will harness the collaborative power of CR programs working simultaneously on common problem areas and using local data to drive performance. The use of data linkage for collection of outcomes offers an efficient way to evaluate this intervention and support the improvement of health service delivery. Ethics Primary ethical approval was obtained from the Northern Sydney Local Health District Human Research Ethics Committee (2023/ETH01093), along with site-specific governance approvals. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623001239651 (30/11/2023) ( https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386540&isReview=true ).

Abstract Background Zip codes classified by the Food Insecurity Index with moderate and high food insecurity (FI) risk can be a threat to the health and well-being of children during the first 1,000 days (from pregnancy to 2 years). The presence of nurturing care assets (i.e., stable environments that promote health and nutrition, learning opportunities, security and safety, and responsive relationships) can contribute to supporting families and their communities, and ultimately reduce systemic barriers to food security. We aimed to identify and characterize nurturing care assets in under-resourced communities with moderate and high FI risk. Methods Four steps were used to conduct a Community Asset Mapping (CAM): (1) review of community documents across five zip codes in Clark County, Nevada (2), engagement of community members in identifying community assets (3), definition of the assets providing nurturing care services, and (4) classification of assets to nurturing care components, i.e., good health, adequate nutrition, safety and security, opportunities for early learning, and responsive caregiving. The Food Insecurity Index was used to determine FI risk in each zip code. Analyses explored whether disparities in nurturing care assets across zip codes with moderate and high FI exist. Results We identified 353 nurturing care assets across zip codes. A more significant number of nurturing care assets were present in zip codes with high FI risk. The adequate nutrition component had the most assets overall (n = 218, 61.8%), while the responsive caregiving category had the least (n = 26, 7.4%). Most of the adequate nutrition resources consisted of convenience stores (n = 96), food pantries (n = 33), and grocery stores (n = 33). Disparities in the number and type of good health, early learning, and security and safety assets were identified within zip codes with high FI risk compared to moderate FI risk. Conclusions The quantity and type of nurturing care assets can exacerbate existing demographic disparities across zip codes, which are tied to barriers to access to food in under-resourced communities in Clark County, Nevada. Co-creating a nurturing care asset-based zip code strategy to address high FI risk will require strengthening systems across existing nurturing care assets.

Abstract Designing conservation interventions for rare species can be hindered by a lack of relevant data. Local ecological knowledge (LEK) has potential to provide rapidly collected, cost‐effective data across large spatio‐temporal scales, but has rarely been used as a source of conservation‐relevant information for the Asian Songbird Crisis. The Blue‐crowned Laughingthrush (Pterorhinus courtoisi; BCLT) is a Critically Endangered passerine found only in southeastern China. It is unclear why the species' breeding range and global population are extremely small, as it occurs in human‐occupied forest‐agricultural landscapes similar to surrounding environments across southern China. We conducted systematic range‐wide interviews on BCLT (n = 519) to collect novel information on the species' temporal and spatial distribution, and on potential human activities and landscape changes associated with its presence or absence. Recognition of BCLT was moderate (45.0% of respondents reported sightings), with sightings within the previous 18 months across the study area, within and beyond their known distribution. Over half of known breeding villages were confirmed by LEK data, and nesting was reported from two villages with no previous breeding records. BCLT trapping was reported across the study landscape, mostly from the last decade and associated with trappers from urban centres. BCLT trapping and lack of fengshui forest were associated with sites where BCLTs did not breed. Breeding sites were associated with increases in vegetable gardens over respondents' lifetimes, and other sites within the species' range were associated with decreases in bush/scrub. We demonstrate that LEK can identify potential threats, new breeding sites and landscape changes correlated with species presence or absence for threatened birds affected by the Asian songbird crisis. This study provides the first evidence of ongoing trapping as a threat to BCLT, and remedial measures are urgently required across the region. Read the free Plain Language Summary for this article on the Journal blog.

Abstract Background A key role of public health policy-makers and practitioners is to ensure beneficial interventions are implemented effectively enough to yield improvements in public health. The use of evidence to guide public health decision-making to achieve this is recommended. However, few studies have examined the relative value, as reported by policy-makers and practitioners, of different broad research outcomes (that is, measures of cost, acceptability, and effectiveness). To guide the conduct of research and better inform public health policy and practice, this study aimed at describing the research outcomes that Australian policy-makers and practitioners consider important for their decision-making when selecting: (a) public health interventions; (b) strategies to support their implementation; and (c) to assess the differences in research outcome preferences between policy-makers and practitioners. Method An online value-weighting survey was conducted with Australian public health policy-makers and practitioners working in the field of non-communicable disease prevention. Participants were presented with a list of research outcomes and were asked to select up to five they considered most critical to their decision-making. They then allocated 100 points across these – allocating more points to outcomes perceived as more important. Outcome lists were derived from a review and consolidation of evaluation and outcome frameworks in the fields of public health knowledge translation and implementation. We used descriptive statistics to report relative preferences overall and for policy-makers and practitioners separately. Results Of the 186 participants; 90 primarily identified as policy-makers and 96 as public health prevention practitioners. Overall, research outcomes of effectiveness, equity, feasibility, and sustainability were identified as the four most important outcomes when considering either interventions or strategies to implement them. Scores were similar for most outcomes between policy-makers and practitioners. Conclusion For Australian policy-makers and practitioners working in the field of non-communicable disease prevention, outcomes related to effectiveness, equity, feasibility, and sustainability appear particularly important to their decisions about the interventions they select and the strategies they employ to implement them. The findings suggest researchers should seek to meet these information needs and prioritize the inclusion of such outcomes in their research and dissemination activities. The extent to which these outcomes are critical to informing the decision of policy-makers and practitioners working in other jurisdictions or contexts warrants further investigation.

This study provides a typological analysis of public, four-year institutions implementing programs for men of color (MoC). The purpose of the study is to expand our understanding of the institutional context and conditions in which these interventions operate. As more of these programs emerge, it is important to understand if and how institutional mission, composition, and resources shape supports and opportunities for underrepresented men of color attending four-year public institutions. Through an exhaustive search process, we identified 177 MoC programs across 166 public four-year institutions across the United States and organized them along a range of institutional characteristics. We then applied descriptive statistics and cluster analysis to program search findings. Results show that public institutions implementing MoC programs can be understood as seven clusters or institutional types. This research provides important information and context for stakeholders who are interested in addressing educational disparities for men of color by illuminating the institutional diversity through which these programs are catalyzed and implemented. To date, this is the first study to organize MoC programs located across four-year public institutions by a range of institutional categories.

Traumatic spinal cord injury (SCI) results in the disruption of physiological systems below the level of the spinal lesion. Connexin hemichannels (CxHCs) are membrane-bound, non-selective pore proteins that are lost in mature myofibers but reappear de novo on the sarcolemma after peripheral denervation, chronic SCI, diabetes, and severe systemic stress such as sepsis. Cx43 and Cx45 have been implicated as the major CxHCs present in diseased muscle, and muscle-restricted knockout of these genes reduces muscle atrophy after denervation, likely by reducing excess calcium influx with resultant inflammasome activation. A muscle-restricted Cx43/45 conditional knockout (mKO) mouse model was developed and tested to check whether it would improve outcomes following either a complete spinal cord transection at the level of thoracic vertebrae-9 (T9) or a motor-incomplete T9 impact-contusion SCI. mKO had no effect on the body mass after complete T9 transection. There was reduced atrophy of the plantaris 15 days post-SCI that was not associated with molecular markers of inflammation, hypertrophic/atrophic protein signaling, or protein and mRNA expression related to mitochondrial integrity and function. mKO mice had faster and greater locomotor recovery across 28 days after a motor-incomplete contusion SCI with no differences in spared white matter; male mKO mice generally had greater muscle mass than genotype controls post-injury, but muscle sparing was not observed in female mKO mice post-injury. The data establish a new paradigm where muscle Cx43/45 may contribute to the tissue crosstalk that determines the neuromuscular function of sub-lesional musculature after motor-incomplete SCI in a sex-dependent manner. Our novel findings should promote investigation to develop innovative treatment strategies to improve the function and quality of life for persons with SCI.

Background: In this paper we outline the protocol for an implementation-effectiveness trial of ecofit, a multi-component mHealth intervention aimed at increasing participation in resistance and aerobic physical activity using the outdoor built environment (i.e., outdoor gyms) and social support. We have previously demonstrated the efficacy and effectiveness of the ecofit program in insufficiently active people with (or at risk of) type 2 diabetes and community-dwelling adults, respectively. The objective of this trial is to compare the effects of two implementation support models (i.e., ‘Low’ versus ‘Moderate’) on the reach (primary outcome), uptake, dose received, impact and fidelity of the ecofit program. Research design and methods: This hybrid type III implementation-effectiveness study will be evaluated using a two-arm randomized controlled trial, including 16 outdoor gym locations in two large regional municipalities in New South Wales, Australia. Outdoor gym locations will be pair-matched, based on an established socio-economic status consensus-based index (high versus low), and randomized to the ‘Low’ (i.e., ecofit app only) or ‘Moderate’ (i.e., ecofit app, face-to-face workout sessions and QR codes) implementation support group. The primary outcome of ‘reach’ will be measured using a modified version of the ‘System for Observing Play and Recreation in Communities’, capturing outdoor gym use amongst community members. Conclusion: This implementation-effectiveness trial will evaluate the effects of different levels of implementation support on participation in resistance-focused physical activity using mHealth and outdoor gyms across the broader community. This may guide widespread dissemination for councils (municipalities) nation-wide wanting to promote outdoor gym usage. Trial registry: This trial was preregistered with the Australian and New Zealand Clinical Trial Registry (ACTRN12624000261516).