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Coatings of anisotropic nanoparticles such as cellulose nanocrystals (CNCs) can provide tuneable physicochemical surface properties to a substrate such as modifying wettability. These coatings are often formed using dip coating, with CNCs enriched at the air–water interface transferred to a substrate as a monolayer. This process is commonly facilitated by surfactants, which can remain present in the final product, affecting coating properties. In this work, an “additive free” method for creating CNC coatings by exploiting electrostatic interactions within the pH window between pH 2–4 is demonstrated. Within this pH window, the air–water interface is positively charged and CNCs are negatively charged, with surface pressure tensiometry, X‐ray reflectivity, and Brewster angle microscopy indicating that CNCs are driven to the air–water interface. The optimal condition for monolayer coverage was pH 3; at pH 2 charge screening causes localized flocculation at the air–water interface, and at pH 4 interparticle repulsion leads to incomplete, patchy coverage. These findings successfully translate to dip coated CNC monolayers as characterized by atomic force microscopy, showing that the manipulation of pH can facilitate the surfactant‐free dip coating of CNCs, with advantages over the surfactants that are more typically used. An “additive‐free” method for dip coating of cellulose nanocrystal (CNCs) monolayers is developed. Electrostatic interactions are exploited in the pH window between pH 2 and 4 where the air–water interface is positively charged and CNCs are negatively charged. Controlling particle–particle and particle–interface interactions allows for manipulation of the coverage and properties of the resulting coatings.

Background Increased outdoor play time in young children is associated with many health and developmental benefits. This study aims to evaluate the impact of a multi-strategy implementation strategy delivered at scale, to increase opportunities for outdoor free play in Early Childhood Education and Care (ECEC) services. Methods The study will employ a parallel-group randomised controlled trial design. One hundred ECEC services in the Hunter New England region of New South Wales, Australia, will be recruited and randomised to receive either a 6-month implementation strategy or usual care. The trial will seek to increase the implementation of an indoor-outdoor routine (whereby children are allowed to move freely between indoor and outdoor spaces during periods of free play), to increase their opportunity to engage in outdoor free play. Development of the strategy was informed by the Behaviour Change Wheel to address determinants identified in the Theoretical Domains Framework. ECEC services allocated to the control group will receive ‘usual’ implementation support delivered as part of state-wide obesity prevention programs. The primary trial outcome is the mean minutes/day (calculated across 5 consecutive days) of outdoor free play opportunities provided in ECEC services measured at baseline, 6-months (primary end point) and 18-months post baseline. Analyses will be performed using an intention-to-treat approach with ECEC services as the unit of analysis, using a linear mixed effects regression model to assess between-group differences. A sensitivity analysis will be undertaken, adjusting for service characteristics that appear imbalanced between groups at baseline, and a subgroup analysis examining potential intervention effect among services with the lowest baseline outdoor free play opportunities. Discussion Identifying effective strategies to support the implementation of indoor-outdoor routines in the ECEC setting at scale is essential to improve child population health. Trial registration Australian New Zealand Clinical Trials Registry ( ACTRN12621000987864 ). Prospectively registered 27th July 2021, ANZCTR - Registration.

Background Increased outdoor free play is associated with health and developmental benefits for preschool-aged children. It is therefore recommended that early childhood education and care (ECEC) services provide increased time for outdoor free play. This study seeks to understand the impact of a multi-component implementation strategy (Get Outside Get Active) on ECEC service provision of opportunities for outdoor free play. Methods This was a parallel-group randomised controlled trial involving 84 ECEC services located in one region of New South Wales, Australia. Forty-one services were randomised to a 6-month multi-component implementation strategy or to a usual care group ( n  = 43). To increase total scheduled outdoor free play time, services were supported to modify their routines to increase provision of outdoor free play and/or indoor-outdoor free play opportunities (whereby children are allowed to move freely between indoor and outdoor spaces). The primary trial outcome, mean minutes per day of outdoor free play opportunities provided in ECEC services, was measured at baseline, 6-months (primary endpoint), and 18-months. Secondary outcomes were mean minutes of indoor-outdoor free play only and proportion implementing indoor-outdoor free play for the full day. The quality of the movement environment was assessed using direct observations in 30 ECECs at 6 months only. Results At 6 months, the intervention group showed a significant increase in mean daily minutes of outdoor free play (61.3 min; 95% CI 2.5 to 120.01; p  = 0.041) and indoor-outdoor free play (59.1 min; 95% CI 9.1 to 109.1; p  = 0.021) relative to the control group. However, no significant between-group differences were observed at 18 months. The proportion implementing a full-day indoor-outdoor program (OR 1.97; 95% CI 0.81 to 4.78; p  = 0.196) and the quality of movement environments did not differ between groups at 6 months. Conclusions The implementation strategy significantly increased outdoor free play opportunities in ECEC services post-intervention, though the between group effects were not sustained at 18 months. Future research should focus on ensuring the long-term impact of implementation strategies and understanding the factors driving changes in control group behaviour. Trial registration This trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12621000987864).

Issue addressed: Smoking by patients, staff and visitors on the grounds of Central Coast Local Health District (CCLHD). Methods: NSW Health introduced a smoke-free buildings and vehicles policy in 1988. A smoke-free grounds policy was implemented in 1999, and a smoke-free by-law adopted by CCLHD in 2013, making smoking on CCLHD grounds an offence. Smoking in high-profile areas near hospital entrances was counted regularly since 2000. Several methods for communicating, monitoring and enforcing these smoke-free interventions have been adopted, including signage, Public Address announcements and enforcement patrols to ensure by-law compliance and to issue fines where required. Compliance with the smoke-free interventions has been supported with the availability of Nicotine Replacement Therapy for patients and visitors. Results: When monitoring counts first commenced in 2000, smoking rates in high-profile areas were 8.1% at Gosford Hospital and 11.1% at Wyong Hospital. Counts conducted in 2018 indicated a substantial improvement, with the smoking rate in high-profile areas reducing to 0.25% at Gosford Hospital and 0.5% at Wyong Hospital. Smoking rates in high-profile areas have held steady at approximately 0.3% since 2014, after the by-law was implemented. Conclusions: The introduction of the smoke-free by-law added extra impetus to efforts to reduce smoking on CCLHD hospital grounds by providing the option to fine people who breach the by-law. Smoking in high-profile areas has declined substantially since 2011, and is minimal since the establishment of the smoke-free by-law.

Piezoelectric materials directly convert between electrical and mechanical energies. They are used as transducers in applications such as nano-positioning and ultrasound imaging. Improving the properties of these devices requires piezoelectric materials capable of delivering a large longitudinal strain on the application of an electric field. A large longitudinal strain of more than 1% is generally anticipated in suitably oriented single crystals of specific compositions of ferroelectric materials 1 . Polycrystalline piezoceramics typically show a longitudinal strain of approximately 0.2–0.4%. We demonstrate that when the thickness of a polycrystalline piezoceramic is reduced to such an extent that a large fraction of the grains are in the triaxial–biaxal crossover regime, the domain-switching fraction increases considerably. If the positive and the negative surfaces of the piezoceramic respond to electric fields symmetrically, as in the classical PbZr x Ti x O 3 , a longitudinal strain of approximately 1% can be achieved in a 0.2 mm disc of the morphotropic phase boundary composition (a 300% increase from a thickness of 0.7 mm). We show that oxygen vacancies in piezoceramics cause asymmetrical switching at the positive and negative surfaces, which causes thin piezoceramics to bend. We expect these findings will encourage further engineering of these mechanisms across different piezoelectric material systems, opening new applications for electromechanical actuation. We find that if the thickness of a polycrystalline piezoceramic is reduced such that a large fraction of the grains are in the triaxial–biaxal crossover regime, the longitudinal strain is enhanced and the piezoceramic bends.

Abstract Get Outside Get Active (GOGA) is a multi-component implementation strategy (six strategies) to increase the provision of outdoor free play opportunities in early childhood education and care (ECEC). A randomized controlled trial with 84 ECECs within New South Wales, Australia found an increase of 61 min of outdoor free play opportunities per day, per service in the intervention compared with usual care at 6-months follow-up (P = .041). This study estimated the absolute costs associated with delivery of GOGA, and cost-effectiveness in terms of cost per additional minute of outdoor free play opportunities per day, per service. Costs ($AUD) were evaluated from health and ECEC service perspectives. Total and average costs per service to deliver GOGA and costs per strategy, per ECEC were calculated. Incremental cost-effectiveness ratios (ICERs) were estimated for differences in costs and effects between intervention and usual care. The total cost of GOGA (42 intervention services) was $69 351 (average $1651 per service). Educational outreach visits were most expensive at $32 498 (average $774 per service, average one visit per service), with develop and distribute educational materials least expensive at $1490 (average $35 per service). The difference in mean cost between usual care and intervention (adjusted for baseline) was $3740 (95% CI $418, $11 218) per service, with an adjusted ICER of $64 (95% CI −$10, $809) per additional minute of outdoor free play opportunity per day, per service. Findings suggest GOGA may be considered cost-effective compared with a school-based physical activity implementation programme. Economic evaluations of similar ECEC-based programmes are recommended.

Abstract Early childhood education and care (ECEC) services are a recommended setting to deliver interventions improving children’s physical activity (PA). Indoor–outdoor free play, where children move freely between indoor–outdoor environments, can increase child PA. However, these programmes in ECECs are often not sustained. This study aims to assess the acceptability, feasibility, impact, adoption and cost of the Sustaining Play, Sustaining Health (SPSH) programme on sustainment of indoor–outdoor free play programmes in ECECs. A 6-month parallel-group pilot randomized controlled trial was conducted with 16 ECEC services across New South Wales, Australia, following removal of COronaVIrus Disease of 2019 (COVID-19) recommendations. Services implementing indoor–outdoor programmes were randomized to (i) SPSH programme (n = 8) or (ii) usual care control group (n = 8). The intervention included eight strategies to target identified barriers, informed by the Integrated Sustainability Framework. Primary outcomes at 6 months were acceptability, feasibility, adoption, cost, and barriers/facilitators. Potential impact (sustainment) was measured at 6 (primary) and 12 months using nonparametric analysis. Overall, 31.48% (17/54) of eligible services consented and 16 randomized. Statistically insignificant mean differences between groups in indoor–outdoor free play were 26.27 minutes at 6 months, and 2.87 minutes at 12 months, favouring the intervention group. The SPSH programme was considered acceptable and feasible and costed AUD $452.38 ($289.74 USD) to deliver per service. There were no changes in sustainability barriers/facilitators. This pilot found mean differences favouring the intervention group for sustaining indoor–outdoor free play programmes in ECECs, particularly at 12 months. Future fully powered trials should consider addressing broader barriers including staff turnover, motivation/attitudes, and fit within broader contexts to increase impact.

Increased outdoor free play is associated with health and developmental benefits for preschool-aged children. It is therefore recommended that early childhood education and care (ECEC) services provide increased time for outdoor free play. This study seeks to understand the impact of a multi-component implementation strategy (Get Outside Get Active) on ECEC service provision of opportunities for outdoor free play. This was a parallel-group randomised controlled trial involving 84 ECEC services located in one region of New South Wales, Australia. Forty-one services were randomised to a 6-month multi-component implementation strategy or to a usual care group (n = 43). To increase total scheduled outdoor free play time, services were supported to modify their routines to increase provision of outdoor free play and/or indoor-outdoor free play opportunities (whereby children are allowed to move freely between indoor and outdoor spaces). The primary trial outcome, mean minutes per day of outdoor free play opportunities provided in ECEC services, was measured at baseline, 6-months (primary endpoint), and 18-months. Secondary outcomes were mean minutes of indoor-outdoor free play only and proportion implementing indoor-outdoor free play for the full day. The quality of the movement environment was assessed using direct observations in 30 ECECs at 6 months only. At 6 months, the intervention group showed a significant increase in mean daily minutes of outdoor free play (61.3 min; 95% CI 2.5 to 120.01; p = 0.041) and indoor-outdoor free play (59.1 min; 95% CI 9.1 to 109.1; p = 0.021) relative to the control group. However, no significant between-group differences were observed at 18 months. The proportion implementing a full-day indoor-outdoor program (OR 1.97; 95% CI 0.81 to 4.78; p = 0.196) and the quality of movement environments did not differ between groups at 6 months. The implementation strategy significantly increased outdoor free play opportunities in ECEC services post-intervention, though the between group effects were not sustained at 18 months. Future research should focus on ensuring the long-term impact of implementation strategies and understanding the factors driving changes in control group behaviour.

Early Childhood Education and Care (ECEC) settings are important environments to support children’s physical activity (PA). In 2021, COVID-19 regulations recommended the provision of indoor–outdoor free-play programs in ECEC settings to reduce the transmission of COVID-19, resulting in an increased uptake of this practice. As the context has since changed, research suggests that ECEC services could cease the implementation of these practices. Therefore, this pilot randomised controlled trial (RCT) aims to examine the feasibility, acceptability, and impact of a sustainment strategy to ensure the ongoing implementation (sustainment) of ECEC-delivered indoor–outdoor free-play programs. Twenty ECEC services located in New South Wales, Australia that have implemented indoor–outdoor free-play programs since the release of COVID-19 guidelines will be recruited. The services will be randomly allocated either the sustainment strategy or usual care. The “Sustaining Play, Sustaining Health” program consists of eight strategies, developed to address key barriers against and facilitators of sustainment informed by the Integrated Sustainability Framework. The outcomes will be assessed via internal project records, staff surveys, and a self-reported measure of free play. This study will provide important data to support the performance of a fully powered trial within Australian ECEC settings and to inform the development of future sustainment strategies.

Increased outdoor play time in young children is associated with many health and developmental benefits. This study aims to evaluate the impact of a multi-strategy implementation strategy delivered at scale, to increase opportunities for outdoor free play in Early Childhood Education and Care (ECEC) services. The study will employ a parallel-group randomised controlled trial design. One hundred ECEC services in the Hunter New England region of New South Wales, Australia, will be recruited and randomised to receive either a 6-month implementation strategy or usual care. The trial will seek to increase the implementation of an indoor-outdoor routine (whereby children are allowed to move freely between indoor and outdoor spaces during periods of free play), to increase their opportunity to engage in outdoor free play. Development of the strategy was informed by the Behaviour Change Wheel to address determinants identified in the Theoretical Domains Framework. ECEC services allocated to the control group will receive 'usual' implementation support delivered as part of state-wide obesity prevention programs. The primary trial outcome is the mean minutes/day (calculated across 5 consecutive days) of outdoor free play opportunities provided in ECEC services measured at baseline, 6-months (primary end point) and 18-months post baseline. Analyses will be performed using an intention-to-treat approach with ECEC services as the unit of analysis, using a linear mixed effects regression model to assess between-group differences. A sensitivity analysis will be undertaken, adjusting for service characteristics that appear imbalanced between groups at baseline, and a subgroup analysis examining potential intervention effect among services with the lowest baseline outdoor free play opportunities. Identifying effective strategies to support the implementation of indoor-outdoor routines in the ECEC setting at scale is essential to improve child population health.