The diabetes community exercise programme plus usual care versus usual care in patients with type 2 diabetes: A randomised, two-arm, parallel, open-label trial.

Background: Exercise is important in type 2 diabetes (T2D) management. Focussing on Maori and Pacific people and those from deprived circumstances, the Diabetes Community Exercise Programme (DCEP) was developed to engage people with T2D in exercise. We report the evaluation of whether being offered DCEP (plus usual care) was more effective than usual care in improving glycaemic control at 1-year. Methods: A randomised, two-arm, parallel, open-label trial with blinding of outcome assessor and data analyst. Adults (age ≥35 years) with T2D recruited from two New Zealand (NZ) communities were randomised, using opaque sealed envelopes and stratified by centre with random block lengths, to DCEP or usual care. DCEP comprises twice-weekly, two-hour sessions of exercise and education over 12-weeks, followed by a twice-weekly maintenance exercise class. The primary outcome was between-group differences in mean changes of glycated haemoglobin (HbA1c) from baseline to 1-year follow-up with intention-to treat analysis. This trial is registered with the Australian NZ Clinical Trials Registry (ANZCTR): ACTRN12617001624370p and is closed to new participants. Findings: From 2018 - 2019, of 294 people screened, 165 (mean age 63·8, SD16·2 years, 56% female, 78·5% European, 14% Maori, 6% Pacific, 27% most deprived) were baseline evaluated, randomised, and analysed at study end (DCEP = 83, control = 82). Multimorbidity (≥2) and polypharmacy (>5 medications) were high (82%, 69%). We found no statistically significant between-groups differences in HbA1c (mmol/mol) change at 15 months (mean 3% higher in DCEP, 95% CI 2% lower to 8% higher, p = 0·23). Twelve-week intervention adherence was good (41% attended >80% available sessions). No adverse events were reported. Interpretation: DCEP was not effective in improving glycaemic control, possibly due to insufficient exercise intensity. Our attendance demonstrated DCEP's cultural accessibility. DCEP might be good to engage in exercise marginalised people with high Hb1Ac levels, multimorbidity, and high polypharmacy. Funding: Health Research Council of New Zealand.

The cost of failed first-line cancer treatment related to continued smoking in Canada.

Background: Smoking by cancer patients and survivors causes adverse cancer treatment outcomes, but little information is available about how smoking can affect cancer treatment costs. Methods: We developed a model to estimate attributable cancer treatment failure because of continued smoking after a cancer diagnosis (afs). Canadian health system data were used to determine the additional treatment cost for afs for the most common cancers in Canada. Results: Of 206,000 patients diagnosed with cancer annually, an estimated 4789 experienced afs. The annual incremental cost associated with treating patients experiencing afs was estimated at between $198 million and $295 million (2017 Canadian dollars), reflecting an added incremental cost of $4,810-$7,162 per patient who continued to smoke. Analyses according to disease site demonstrated higher incremental costs where the smoking prevalence and the cost of individual second-line cancer treatment were highest. Of breast, prostate, colorectal, and lung cancers, lung cancer was associated with the highest incremental cost for treatment after afs. Conclusions: The costs associated with afs in Canada after a cancer diagnosis are considerable. Populations in which the smoking prevalence and treatment costs are high are expected to benefit the most from efforts aimed at increasing smoking cessation capacity for patients newly diagnosed with cancer.

Stochastic Polarization Instability in PbTiO_{3}.

Although discussions of structural phase transitions in prototypical ferroelectric systems with the perovskite structure, such as BaTiO_{3} and PbTiO_{3}, started almost seventy years ago, an atomic-level description of the polar characteristics as a function of temperature, pressure, and composition remains topical. Here we provide a novel quantitative description of the temperature-driven local structural correlations in PbTiO_{3} via the development of characteristic relative cationic shifts. The results give new insights into the phase transition beyond those reliant on the long-range order. The ferroelectric-to-paraelectric transition of PbTiO_{3} is realized by the extent of a stochastic polarization instability driven by a progressive misalignment instead of a complete disappearance of the local dipoles, which further suggests that such polarization instability is chemically induced at the morphotropic phase boundary of PbTiO_{3}-based solid solutions with giant piezoelectric effect. As such, our results not only identify the evolving atomistic disorder in a perovskite-based ferroelectric system, but also suggest that polarization instability can serve as a generic fingerprint for phase transitions as well as for better understanding structure-property relationships in PbTiO_{3}-based ferroelectric solid solutions.

Structural investigations of amorphous metal-organic frameworks formed via different routes.

The structures of chemically identical amorphous zeolitic amorphous frameworks (ZIFs), which were prepared from crystalline ZIF-4 via three different routes, are compared by refining atomistic models against their neutron and X-ray total scattering data. The diffraction data are very similar at all but the lowest values of momentum transfer and this is reflected in the ability of models with the same continuous random network topology to fit the data from each of the three amorphous ZIFs. Despite this there are differences in the detail; the relative positions of the lowest-Q peak in the Zn-Zn partial structure factors are consistent with differences in the densities of the different amorphous samples, and peaks in the ZIF-4 glass total scattering structure factors are in general broader, suggesting shorter-ranged correlations.

Local-scale structures across the morphotropic phase boundary in PbZr1-x Ti x O3.

Lead zirconate titanate (PZT) is one of the most widely studied piezoelectric materials, mainly because of its 'mysterious' relationship between the so-called morphotropic phase boundary (MPB) and its strong piezoelectric coupling factor. Using results from a pair distribution function analysis, this paper examines how the complex local structure in PZT affects the long-range average structure across the MPB. A monoclinic M C type structure is discovered in PZT. A first-order transformation between the monoclinic M A and M C components in both the average and local structures explains the sudden change in piezoelectric effect around these compositions. The role of polarization rotation in the enhancement of the piezoelectric properties is discussed with respect to the composition of PZT. The structure-property relationship that is revealed by this study explains the unique properties of PZT, and may be applicable in the design of new MPB-type functional materials.

Participation of children on the autism spectrum in home, school, and community.

BACKGROUND: Children on the autism spectrum participate less frequently, and in a narrower range of activities, than their nonautistic peers, but little is known about exact participation patterns across contexts or how this is perceived by caregivers. This study aimed to document patterns of participation and caregiver views with regard to frequency and intensity of activities. METHOD: Caregivers of children on the spectrum aged 5 (n = 90) and 9-10 years (n = 128) completed the Participation and Environment Measure for Children and Youth for home, school, and community. Caregivers reported on frequency of child's participation, level of involvement, and caregivers' desire for change in participation patterns. RESULTS: Item-level analyses revealed similar patterns of participation across home, school, and community for both cohorts with some small age-appropriate differences. Caregivers generally desired increased diversity, frequency, and involvement in activities but a decreased use of electronics (computers, games, TV, and DVDs). CONCLUSION: The possibility of autism-specific participation patterns could inform future interventions aimed at enhancing social inclusion. This warrants further investigation through multiinformant designs that seek the perspectives of the child and caregivers.

Emergence of Long-Range Order in BaTiO_{3} from Local Symmetry-Breaking Distortions.

By using a symmetry motivated basis to evaluate local distortions against pair distribution function data, we show without prior bias, that the off-center Ti displacements in the archetypal ferroelectric BaTiO_{3} are zone centered and rhombohedral-like across its known ferroelectric and paraelectric phases. We construct a simple Monte Carlo model that captures our main experimental findings and demonstrate how the rich crystallographic phase diagram of BaTiO_{3} emerges from correlations of local symmetry-breaking distortions alone. Our results strongly support the order-disorder picture for these phase transitions, but can also be reconciled with the soft-mode theory of BaTiO_{3} that is supported by some spectroscopic techniques.

The proportion of minimally verbal children with autism spectrum disorder in a community-based early intervention programme.

BACKGROUND: Estimates of the proportion of children with autism spectrum disorder (ASD) who are minimally verbal vary from 25%to 35%. However, there is a lack of consensus in defining minimally verbal and few detailed reports of communication outcomes for these children following intervention. The aim of this study was to explore how minimally verbal children have been defined and to document the proportion of minimally verbal children in a group of children with ASD receiving a community based early intervention programme. METHOD: A longitudinal cohort design was used to examine the proportion of children who met criteria for minimally verbal in 246 children with ASD when they entered and exited an early intervention programme. RESULTS: Overall, 26.3% of the children in this study exited the programme using 'fewer than five spontaneous and functional words' and 36.4% exited not using 'two word phrases' as indicated by direct assessment. However, our findings were mixed depending on measures and definitions used, with parent report indicating that as many as 29.4% of children were not 'naming at least three objects' consistently, and 43.3% not using 'phrases with a noun and verb' consistently at exit. More than half of the children who entered the programme with minimal speech exited the programme with a similar language profile. A small percentage of children (1.2%-4.7%) regressed in their language level over time. CONCLUSIONS: Despite advances in early intervention, and access to services at a younger age, around a quarter of individuals with ASD in this study exited early intervention with significant communication needs. Our findings are considered in relation to the literature and clinical implications, and future research directions are discussed.

Healthcare worker influenza immunization vaccinate or mask policy: strategies for cost effective implementation and subsequent reductions in staff absenteeism due to illness.

BACKGROUND: A new policy requiring staff in clinical areas to vaccinate or wear a mask was implemented in British Columbia (BC) in the 2012/13 winter. This review assessed the impact of the policy on absenteeism in health care workers. METHODS: A retrospective cohort study of full-time HCW that worked prior to and during the 2012/13 influenza season in a health authority in BC. The rate of absenteeism due to all cause illness was compared between vaccinated and unvaccinated staff controlling for behaviors outside influenza season. RESULTS: Of the 10079 HCW, 77% were vaccinated. By comparison to absenteeism rates in the pre-influenza season, unvaccinated staff in winter had twice the increase in absenteeism due to all-cause illness than vaccinated staff. CONCLUSION: After controlling for baseline differences between those vaccinated and unvaccinated, influenza vaccination was associated with reduced absenteeism, saving the Health Authority substantial money. Having regular staff in attendance increases the quality of care.

The missing boundary in the phase diagram of PbZr(1-x)TixO3.

PbZr(1-x)Ti(x)O3 (PZT) is one of the most important and widely used piezoelectric materials. The study of its local and average structures is of fundamental importance in understanding the origin of its high-performance piezoelectricity. Pair distribution function analysis and Rietveld refinement have been carried out to study both the short- and long-range order in the Zr-rich rhombohedral region of the PZT phase diagram. The nature of the monoclinic phase across the Zr-rich and morphotropic phase boundary area of PZT is clarified. Evidence is found that long-range average rhombohedral and both long- and short-range monoclinic regions coexist at all compositions. In addition, a boundary between a monoclinic (M(A)) structure and another monoclinic (M(B)) structure has been found. The general advantage of a particular monoclinic distortion (M(A)) for high piezoactivity is discussed from a spatial structural model of susceptibility to stress and electric field, which is applicable across the wide field of perovskite materials science.

Flexibility of zeolitic imidazolate framework structures studied by neutron total scattering and the reverse Monte Carlo method.

The zeolitic imidazolate framework ZIF-4 undergoes an amorphization transition at about 600 K, and then transforms at about 700 K to ZIF-zni, the densest of the crystalline ZIFs. This series of long-range structural rearrangements must give a corresponding series of changes in the local structure, but these have not previously been directly investigated. Through analysis of neutron total diffraction data by reverse Monte Carlo modelling, we assess the changes in flexibility across this series, identifying the key modes of flexibility within ZIF-4 and the amorphous phase. We show that the ZnN4 tetrahedra remain relatively rigid, albeit less so than SiO4 tetrahedra in silicates. However, the extra degrees of freedom afforded by the imidazolate ligand, compared to silicate networks, vary substantially between phases, with a twisting motion out of the plane of the ligand being particularly important in the amorphous phase. Our results further demonstrate the feasibility of reverse Monte Carlo simulations for studying intermolecular interactions in solids, even in cases, such as the ZIFs, where the pair distribution function is dominated by intramolecular peaks.

From quantum disorder to magnetic order in an s=1/2 kagome lattice: a structural and magnetic study of herbertsmithite at high pressure.

The structural and magnetic properties of deuterated herbertsmithite have been studied by means of neutron powder diffraction and magnetic susceptibility measurements in a wide range of temperatures and pressures. The experimental data demonstrate that a phase transition from the quantum-disordered spin-liquid phase to the long-range ordered antiferromagnetic phase with the Néel temperature T(N)=6 K is induced at P=2.5 GPa. The observed decrease of T(N) upon compression correlates with the anomalies in pressure behavior of Cu-O bond length and Cu-O-Cu bond angles. The reasons for the observed spin-freezing transition are discussed within the framework of the available theoretical models and the recent observation of the field-induced spin freezing.

Vibrational origin of the thermal stability in the high-performance piezoelectric material GaAsO4.

Theoretical calculations and experiments show the absence of libration modes of the tetrahedra in GaAsO(4), the most α-quartz-type distorted material. In consequence, the degree of dynamic disorder at high temperature is very low, making GaAsO(4) of high interest for high-temperature applications. This paper shows the importance of the theoretical calculations of vibration in oxide materials. In this way, it could be possible to extend this result to other materials and predict the thermal stability of the materials and their potential applications at high temperature.

Predictors and economic burden of serious workplace falls in health care.

AIMS: To examine the demographic and workplace risk factors of serious falls and associated economic burden in Canadian health care workers. METHODS: Fall injury data during 2005-2008 from a workplace health and safety surveillance system were linked with workers' compensation claims and payroll records. The costs for treatment and wage loss and days lost for accepted time-loss claims were calculated. Demographic and work-related factors were identified to distinguish the risk for more serious falls from less serious falls. RESULTS: Nine hundred and thirty-eight fall injury claims were captured among 48 519 full-time equivalent workers. Workers >60 years, part time or employed in the long-term care sector sustained a higher proportion of serious falls (>70%). Over 75% of falls were serious for care aides, facility support service workers and community health workers. In the multivariate analysis, the risk of serious falls remained higher for workers in the long-term care sector [odds ratio (OR) 1.71; P < 0.05] compared with those in acute care and for care aides (OR 1.72; P < 0.05), facility support service workers (OR 2.58; P < 0.01) and community health workers (OR 3.61; P < 0.001) compared with registered nurses (RNs). The median number of days lost was higher for females, long-term care workers, licensed practical nurses and care aides. Females, long-term care workers, RNs, licensed practical nurses, care aides and maintenance workers had the most costly falls. CONCLUSIONS: Reducing work-related serious fall injuries would be expected to bring about significant benefits in terms of reduced pain and suffering, improved workplace productivity, reduced absenteeism and reduced compensation costs.

Risks and causes of musculoskeletal injuries among health care workers.

BACKGROUND: Musculoskeletal injuries (MSIs) persist as the leading category of occupational injury in health care. Limited evidence exists regarding MSIs for occupations other than direct patient care providers. An evaluation of the risks, causes and activities associated with MSIs that includes non-patient care health care occupations is warranted. AIMS: To examine the risks and causes of time-loss MSIs for all occupations in health care. METHODS: Workers employed by a health region in British Columbia were followed from April 2007 to March 2008 using payroll data; injuries were followed using an incidence surveillance database. Frequency and rates were calculated for all occupational injuries and MSIs and relative risks (RRs) were computed using Poisson regression. Causes and occupational activities leading to MSIs were tabulated for direct care occupations and non-patient care occupations. RESULTS: A total of 944 injuries resulting in time-loss from work were reported by 23 742 workers. Overall, 83% injuries were musculoskeletal. The two occupations showing highest RR of MSIs relative to registered nurses were facility support service workers [RR = 3.16 (2.38-4.18), respectively] and care aides [RR=3.76 (3.09-4.59)]. For direct patient care occupations, the leading causes of MSIs were awkward posture (25%) and force (23%); for non-patient care occupations were force (25%) and slip/fall (24%). Patient handling activities accounted for 60% of all MSIs for direct care occupations. For non-patient care occupations, 55% of MSIs were due to material/equipment handling activities. CONCLUSIONS: Prevention efforts for MSIs should be directed to non-patient care occupations as well and consider their occupation-specific causes and activities.

Autism, ethnicity and maternal immigration.

BACKGROUND: A growing number of European studies, particularly from Nordic countries, suggest an increased frequency of autism in children of immigrant parents. In contrast, North American studies tend to conclude that neither maternal ethnicity nor immigrant status are related to the rate of autism-spectrum disorders. AIMS: To examine the hypotheses that maternal ethnicity and/or immigration are linked to the rate of childhood autism-spectrum disorders. METHOD: Retrospective case-note analysis of all 428 children diagnosed with autism-spectrum disorders presenting to the child development services in two centres during a 6-year period. RESULTS: Mothers born outside Europe had a significantly higher risk of having a child with an autism-spectrum disorder compared with those born in the UK, with the highest risk observed for the Caribbean group (relative risks (RRs) in the two centres: RR = 10.01, 95% CI 5.53-18.1 and RR = 8.89, 95% CI 5.08-15.5). Mothers of Black ethnicity had a significantly higher risk compared with White mothers (RR = 8.28, 95% CI 5.41-12.7 and RR = 3.84, 95% CI 2.93-5.02). Analysis of ethnicity and immigration factors together suggests the increased risk is predominately related to immigration. CONCLUSIONS: Maternal immigration is associated with substantial increased risk of autism-spectrum disorders with differential risk according to different region of birth and possibly ethnicity.

Amino acid geochronology of the type Cromerian of West Runton, Norfolk, UK.

Aminostratigraphic studies of continental deposits in the UK have hitherto relied almost exclusively on data from the aragonitic shells of non-marine molluscs for dating Pleistocene sequences. This is usually based on the d/l value of a single amino acid, d-alloisoleucine/l-isoleucine (A/I), in the total shell proteins. Two genera of freshwater gastropods (Valvata and Bithynia) are used to explore the value of using multiple amino acids from the intra-crystalline fraction, which should be more protected from the effects of diagenesis than the inter-crystalline component. Results are compared from both the aragonitic shells and opercula composed of calcite, a more stable form of calcium carbonate. In order to put the amino acid data from the West Runton Freshwater Bed into perspective, statistical analyses are used to compare them with results from the Hoxnian (MIS 11) site at Clacton-on-Sea, Essex. Twelve protein decomposition indicators revealed that the results from the shells were not as clear-cut as those from the opercula. Five indicators from the Valvata shell suggest that West Runton is older than Clacton (at a 95% significance level), but two actually suggested a younger age. Seven indicators show that the Bithynia shells from West Runton are older than congeneric shells from Clacton. In marked contrast, all 12 indicators isolated from the opercula demonstrate that West Runton is significantly older than Clacton. The data are also compared with results from Waverley Wood, an important archaeological site in the English Midlands falling within the 'Cromerian Complex'. Contrary to earlier interpretations, the new amino acid data from Bithynia opercula indicate that West Runton is older than Waverley Wood, a relationship now consistent with the available biostratigraphy.

Critical evaluation of the reliability and validity of ABPI measurement in leg ulcer assessment.

Clinimetric analysis of the measurement of ABPI by Doppler ultrasound suggests this method is valid and reliable if the practitioner is competent and able to interpret the result within the context of a full clinical assessment.

A review of research examining the regulatory role of lymphocytes in normal wound healing.

Lymphocytes play a distinct, regulatory role in normal wound healing through the secretion of lymphokines. This paper evaluates the current research on the regulatory role of lymphocytes and their secretions in normal wound healing.