Effectiveness of a peer-led self-management program for older people with type 2 diabetes in China

Type 2 diabetes is a common chronic disease, which has a negative health impact and results in enormous economic burden. The prevalence of type 2 diabetes is increasing dramatically and it affects older people disproportionately. The healthcare system in China is faced with an overwhelming burden due to a large ageing population, high prevalence of diabetes and limited healthcare resources. Self-management has been widely accepted as the cornerstone of the clinical management of type 2 diabetes. Since self-management usually involves complex behaviour change and can be emotionally challenging, effective education is essential to facilitate this transition. However, there has been no existing program of type 2 diabetes self-management for older patients in China until now. Furthermore, the generalisation of any health education programs is often hampered due to limited healthcare resources in China. The primary purpose of this study was to develop a socially and culturally suitable self-management program, which addressed self-efficacy and social support to facilitate behaviour change and subsequent health improvement, for older people with type 2 diabetes living in the community in China. The secondary purpose was to test a feasible delivery model of the program through involvement of peer leaders and existing community networks. This study was conducted in three phases. Phase one gathered information about barriers related to self-management behaviours and help needed to address them, from the perspective of older people with type 2 diabetes and community health professionals, through focus group discussion. Data from Phase One, together with guidelines of the selected theoretical frame work, results from an extensive literature review, and experiences of previous relevant studies provided the basis for development of a peer-led type 2 diabetes self-management program (Phase Two). Phase Three involved a pre-test, post-test non-equivalent control group design to test the effectiveness of the self-management program on older people with type 2 diabetes in the community. The impact of the program on peer leaders was examined using a one group pre-test, post-test design. In addition, evaluation of the program from peer leaders’ and older people’s perceptions was conducted through a post-test questionnaire. Older people with type 2 diabetes and health professionals expressed broadly the same concerns, which were: social support; confidence to practice self-management behaviours; self-management behaviours; barriers to self-management behaviours; and advice for ongoing health education. However, their points of view were not always identical and different emphases were identified. The peer-led program produced significant improvement in social support, self-efficacy, self-management behaviours and depressive status in the experimental group, as compared to the non-equivalent control group. However, there was no significant effect on quality of life nor health care utilisation. Therefore, the effectiveness of the program among older people with type 2 diabetes was partially confirmed. In addition, the participants were supportive, giving positive feedback about the program. Suggestions for future improvement were provided as well. After receiving specific peer leader training and assisting in most of the delivery process of the program, the peer leaders improved, significantly, in overall self-management behaviours and in specific areas of social support and self-efficacy, though they did not improve in depressive status, quality of life and health care utlisation. In addition, these peer leaders enjoyed being peer leaders, and gave very positive feedback about the whole program. In conclusion, this study has implications for understanding and facilitating self-management behaviours for older people with type 2 diabetes in China. The peer-led self-management program was effective in improving levels of self-efficacy, social support, self-management behaviours and depressive status among older people with type 2 diabetes living in the community in China. The delivery process involving peer leaders was deemed feasible to implement within the health care system in China. The program is suitable to be used by community health professionals in their practice in China. The study also has potential wider benefit to nursing practice and global health practice

Concurrent probing of electron-lattice dephasing induced by photoexcitation in 1T-TaSeTe using ultrafast electron diffraction

It has been technically challenging to concurrently probe the electrons and the lattices in materials during non-equilibrium processes, allowing their correlations to be determined. Here, in a single set of ultrafast electron diffraction patterns taken on the charge-density-wave (CDW) material 1T-TaSeTe, we discover a temporal shift in the diffraction intensity measurements as a function of scattering angle. With the help of dynamic models and theoretical calculations, we show that the ultrafast electrons probe both the valence-electron and lattice dynamic processes, resulting in the temporal shift measurements. Our results demonstrate unambiguously that the CDW is not merely a result of the periodic lattice deformation ever-present in 1T-TaSeTe but has significant electronic origin. This method demonstrates a novel approach for studying many quantum effects that arise from electron-lattice dephasing in molecules and crystals for next-generation devices.Comment: 13 pages and 4 figures in main tex

Chronic disease and multimorbidity in the Chinese older adults’ population and their impact on daily living ability: a cross-sectional study of the Chinese Longitudinal Healthy Longevity Survey (CLHLS)

Abstract Background Owing to an increase in life expectancy, it is common for the older adults to suffer from chronic diseases that can result in disability and a low quality of life. This study aimed to explore the influence of chronic diseases and multimorbidities on activities of daily living (ADLs) and instrumental ADLs (IADLs) in an older Chinese population. Methods Based on the Chinese Longitudinal Healthy Longevity Survey (2018), 9,155 older adults aged 65 years and above were included in the study. A self-administered questionnaire was used to collect information on demographic characteristics, chronic diseases, ADLs, and IADLs. The impact of factors affecting ADL and IADL impairment in older adults was analysed using binary logistic regression. Results In total, 66.3% participants had chronic diseases. Hypertension, heart disease, arthritis, diabetes and cerebrovascular disease were among the top chronic diseases. Of these, 33.7% participants had multimorbidities. The most common combination of the two chronic diseases was hypertension and heart disease (11.2%), whereas the most common combination of the three chronic diseases was hypertension, heart disease, and diabetes (3.18%). After categorising the older adults into four age groups, dementia, visual impairment, and hearing impairment were found to be more prevalent with increasing age. The prevalence of hypertension, heart disease, cerebrovascular disease, gastrointestinal ulcers, arthritis and chronic nephritis gradually increased with age until the age of 75 years, peaked in the 75–84 years age group, and then showed a decreasing trend with age. Multimorbidity prevalence followed a similar pattern. Regression analysis indicated that the increase in age group and the number of chronic diseases independently correlated with impairments in ADL as well as IADL. Additionally, gender, physical activity, educational background, obesity, depressive symptoms, and falls also had an impact on ADLs or IADLs. Conclusion Chronic diseases and multimorbidities are common in older adults, and it is important to note that aging, multimorbidity, obesity, and unhealthy lifestyle choices may interfere with ADLs or IADLs in older adults. Therefore, it is imperative that primary healthcare providers pay special attention to older adults and improve screening for multimorbidity and follow-up needs

Research on the application and effect of flipped-classroom combined with TBL teaching model in WeChat-platform-based biochemical teaching under the trend of COVID-19

Abstract Background Biochemistry is a core subject in clinical medical education. The traditional classroom teaching model led by teachers is often limited to the knowledge transfer of teachers and the passive acceptance of students. It lacks interactive and efficient teaching methods and is not enough to meet the learning needs and educational goals of modern students. The combination of WeChat public platform, flipped classroom and TBL teaching model is closer to the needs of real life and workplace, helping students to cultivate comprehensive literacy and the ability to solve practical problems. At the same time, this teaching model has yet to be used in biochemistry courses. Objective To explore the influence of the mixed teaching model of flipped classroom and combining TBL based on WeChat public platform upon undergraduates in biochemistry. Methods Using the mixed research method of quasi-experimental research design and descriptive qualitative research, 68 students were selected into the traditional and the blended teaching groups. Among them, the blended teaching group adopts the blended teaching model of flipped classroom combined with TBL based on the WeChat platform to learn biochemical courses. In this study, an independent sample t-test was intended to analyze the differences in final scores, a chi-square test was served to analyze the differences in satisfaction questionnaires, and thematic analysis was used to analyze semi-structured interview data. Results Compared with the traditional teaching model, the mixed teaching model significantly improved students' final exam scores (P < 0.05). The teaching satisfaction of the mixed teaching group was also higher than that of the traditional teaching group with statistical significance (P < 0.05). The results of the interviews with eight students were summarized into three topics: (1) Stimulating interest in learning; (2) Improving the ability of autonomous learning; (3) Recommendations for improvement. Conclusions The combination of the WeChat platform and flipped classroom with TBL has a positive effect on improving medical students' autonomous learning ability and problem-solving ability. The research shows that the teaching mode of flipped classroom combined with TBL based on the WeChat platform is effective and feasible

Investigation of Micro-Bending of Sheet Metal Laminates by Laser-Driven Soft Punch in Warm Conditions

Microscale laser dynamic flexible forming (µLDFF) is a novel ultrahigh strain rate manufacturing technology with high efficiency and low cost. However, the µLDFF is just confined to single-layer foil at present. In this work, sheet metal laminates (Cu/Ni) were selected as the experimental material for its excellent mechanical and functional properties, and a new micro-bending method of sheet metal laminates by laser-driven soft punch was proposed in warm conditions. The micro-mold and warm platform were designed to investigate the effects of temperature and energy on formability, which were characterized by forming accuracy, surface quality, element diffusion, and so on. The experimental results show that the forming accuracy and quality increased first and then decreased with laser energy, but the hardness increased consistently. In warm conditions, the fluidity of material was improved. The forming depth and accuracy increased for the relieved springback, and the surface quality increased first and then decreased. The tensile fracture disappeared with temperature for the decreased hardness and thinning ratio, and the element diffusion occurred. Overall, this study indicates that the formability can be improved in warm conditions and provides a basis for the investigation of micro-bending of sheet metal laminates by µLDFF in warm conditions

EX-Action: Automatically Extracting Threat Actions from Cyber Threat Intelligence Report Based on Multimodal Learning

With the increasing complexity of network attacks, an active defense based on intelligence sharing becomes crucial. There is an important issue in intelligence analysis that automatically extracts threat actions from cyber threat intelligence (CTI) reports. To address this problem, we propose EX-Action, a framework for extracting threat actions from CTI reports. EX-Action finds threat actions by employing the natural language processing (NLP) technology and identifies actions by a multimodal learning algorithm. At the same time, a metric is used to evaluate the information completeness of the extracted action obtained by EX-Action. By the experiment on the CTI reports that consisted of sentences with complex structure, the experimental result indicates that EX-Action can achieve better performance than two state-of-the-art action extraction methods in terms of accuracy, recall, precision, and F1-score

An Experimental Study on Micro-Shear Clinching of Metal Foils by Laser Shock

This work proposes a micro-shear clinching process by laser shock for joining similar and dissimilar metal foils. The joint appearance and cross-section were investigated to determine basic process parameters. The soft punch thickness was 100 &#956;m. The numbers of laser pulses on the upper and lower foil sides were set as two and one, respectively. Joint deformation was divided into three stages and we investigated the deformation law of the joints. The process windows of the Al foil combinations were acquired to determine a reasonable range of process parameters for obtaining qualified joints. The mechanical properties and failure modes of different joints were analyzed to identify the process characteristics. Mechanical properties were related to shear test directions and were influenced by upper and lower foil thicknesses. One failure mode was observed in the parallel shear test, and four failure modes were observed in the perpendicular shear test. These modes were determined by the differences between upper and lower foil thicknesses. Results showed that the proposed process can be used to join Al and Cu foils successfully. The laws governing the mechanical properties and failure modes of dissimilar materials were similar to those governing the mechanical properties and failure modes of similar materials

The Investigation on Mask and Plasticine Laser Shock Forming

A novel technology called mask and plasticine laser shock forming (MAPLSF) was introduced to manufacture micro-features on the surface of pure copper foil with the thickness of 40μm. In this process, the laser-generated shock wave and plasticine are used to replace the conventional rigid punch and die. The result showed that the shape of laser beam can be roughly manufactured on the surface of the workpiece and this mold-free laser shock forming process is a fast method to fabricate controlled micro-feature on the metallic foils. In this damage-free forming process, the workpicec can keep good surface, because the plasticine is softer than metal foils