A systematic review of polycyclic aromatic hydrocarbon pollution: A combined bibliometric and mechanistic analysis of research trend toward an environmentally friendly solution

Pollution caused by polycyclic aromatic hydrocarbons (PAHs) is a significant concern. This concern has become more problematic given the rapid modification of PAHs in the environment during co-contamination to form substituted PAHs. This review aims to integrate bibliometric analysis with a rigorous study of mechanistic insights, resulting in a more comprehensive knowledge of evolving research trends on PAH remediation. The results show that research in this field has progressed over the years and peaked in 2022, potentially due to the redirection of resources toward emerging pollutants, hinting at the dynamic nature of environmental research priorities. During this year, 158,147 documents were published, representing 7 % of the total publications in the field between 2000 and 2023. The different remediation methods used for PAH remediation were identified and compared. Bioremediation, having >90 % removal efficiency, has been revealed to be the best technique because it is cost-effective and easy to operate at large scale in situ and ex-situ. The current challenges in PAH remediation have been detailed and discussed. Implementing innovative and sustainable technologies that target pollutant removal and valuable compound recovery is necessary to build a more robust future for water management.

Synthetic Chemistry in Flow: From Photolysis & Homogeneous Photocatalysis to Heterogeneous Photocatalysis

Photocatalytic synthesis of value-added chemicals has gained increasing attention in recent years owing to its versatility in driving many important reactions under ambient conditions. Selective hydrogenation, oxidation, coupling, and halogenation with a high conversion of the reactants have been realized using designed photocatalysts in batch reactors with small volumes at a laboratory scale; however, scaling-up remains a critical challenge due to inefficient utilization of incident light and active sites of the photocatalysts, resulting in poor catalytic performance that hinders its practical applications. Flow systems are considered one of the solutions for practical applications of light-driven reactions and have experienced great success in photolytic and homogeneous photocatalysis, yet their applications in heterogeneous photocatalysis are still under development. In this perspective, we have summarized recent progress in photolytic and photocatalytic synthetic chemistry performed in flow systems from the view of reactor design with a special focus on heterogeneous photocatalysis. The advantages and limitations of different flow systems, as well as some practical considerations of design strategies are discussed.

Hydrogel capsules as new delivery system for Trichoderma koningiopsis Th003 to control Rhizoctonia solani in rice (Oryza sativa)

The incorporation of biological control agents (BCAs) such as Trichoderma spp. in agricultural systems favors the transition towards sustainable practices of plant nutrition and diseases control. Novel bioproducts for crop management are called to guarantee sustainable antagonism activity of BCAs and increase the acceptance of the farmers. The encapsulation in polymeric matrices play a prominent role for providing an effective carrier/protector and long-lasting bioproduct. This research aimed to study the influence of biopolymer in hydrogel capsules on survival and shelf-life of T. koningiopsis. Thus, two hydrogel capsules prototypes based on alginate (P1) and amidated pectin (P2), containing conidia of T. koningiopsis Th003 were formulated. Capsules were prepared by the ionic gelation method and calcium gluconate as crosslinker. Conidia releasing under different pH values of the medium, survival of conidia in drying capsules, storage stability, and biocontrol activity against rice sheath blight (Rhizoctonia solani) were studied. P2 prototype provided up to 98% survival to Th003 in fluid bed drying, faster conidia releasing at pH 5.8, storage stability greater than 6 months at 18 °C, and up to 67% of disease reduction. However, both biopolymers facilitate the antagonistic activity against R. solani, and therefore can be incorporated in novel hydrogel capsules-based biopreparations. This work incites to develop novel biopesticides-based formulations with potential to improve the delivery process in the target site and the protection of the active ingredient from the environmental factors.

Mainstreaming nature-based solutions through five forms of scaling: Case of the Kiiminkijoki River basin, Finland

Nature-based solutions (NBS) are considered as means to tackle climate change and biodiversity loss while simultaneously enhancing human well-being. Yet, it is still poorly understood how NBS could be mainstreamed. We address this gap by proposing a framework on NBS and employing it in Finland's Kiiminkijoki River basin through participatory workshops and a questionnaire. We examine socio-environmental challenges and visions, existing and emerging NBS to reach the visions, and ways to scale-up NBS to a river basin level. In the river basin, water quality is the priority challenge, due to its relationships with local culture, climate change, and biodiversity. Our results consider how (1) to ensure the relevance of NBS for local actors, (2) instrumental, intrinsic, and relational value perspectives can be enhanced simultaneously by NBS, and (3) site specific NBS can be mainstreamed (i.e., by scaling up, down, out, in, deep) to the river basin level and beyond.

Wet anaerobic digestion of organic fraction of municipal solid waste: experience with long-term pilot plant operation and industrial scale-up

This paper presents the analysis of a pilot anaerobic digestion plant that operates with organic fraction of municipal solid waste (OFMSW) from a wholesale market and can treat up to 500 kg d-1. The process was monitored for a period of 524 days during which the residue was characterized and the biogas production and methane content were recorded. The organic load rate (OLR) of volatile solids (VS) was 0.89 kg m-3 d-1 and the Hydraulic Retention Time (HRT) was 25 d during the process. The yield was 82 Nm3 tons OFMSW-1 biogas, equivalent to 586 Nm3 tons CH4 VS-1. The results obtained in the pilot plant were used to carry out a technical-economic evaluation of a plant that treats 50 tons of OFMSW from wholesale markets. A production of 3769 Nm3 d-1 of biogas and 2080 Nm3 d-1 of methane is estimated, generating 35.1 MWh d-1 when converted to electricity.

How can civil society organizations contribute to the scale-up of comprehensive sexuality education? Presentation of a scaling framework illustrated with examples from Indonesia

Comprehensive sexuality education (CSE) can substantially contribute to the health and well-being of young people. Yet, most CSE interventions remain limited to the small piloting or research phase and scale-up is often an afterthought at the end of a project. Because of the specificities of CSE, including it being a controversial topic in many contexts and a topic on the fringe between health, education and youth, a specific scaling approach to CSE is needed. The commentary presents a practical framework to support civil society organisations (CSOs), to address barriers to scaling up CSE in their contexts. The utilization and relevance of the framework is demonstrated in this article, by featuring examples from the scale up process of CSE in Indonesia. The framework identifies key principles for scaling up, including: taking a scaling mindset from the start, government ownership and political commitment for scale-up, and identifying the added value of CSOs. The framework starts with a self-assessment by the CSO and then follows four phases: making the case, engaging in dialogue, establishing building blocks and implementation and scale-up. Each of these phases are illustrated with examples from Indonesia.This framework is a call to action with practical guidelines to support CSOs to take on this role, because with the right scaling strategies, the largest generation of young people ever alive can become healthy, empowered and productive adults.

Implementation strategies, facilitators, and barriers to scaling up and sustaining demand generation in family planning, a mixed-methods systematic review

BACKGROUND

Demand generation aims to increase clients' desire to use family planning. The aim of this work was to systematically summarize strategies, facilitators, and barriers to scaling up and sustaining demand generation in family planning.

METHODS

We searched electronic bibliographic databases from inception to October 2022. We included quantitative, qualitative, and mixed methods reports on demand generation strategies in family planning, regardless of country, language, publication status, or methodological limitations. We assessed abstracts, titles and full-text papers according to the inclusion criteria, extracted data, and assessed methodological quality of included reports. We used the convergent integrated approach and a deductive thematic synthesis to summarize demand generation themes and subthemes. We used the health system building blocks to synthesize the factors affecting implementation (barriers and facilitators). We used GRADE-CERQual to assess our confidence in the findings.

RESULTS

Forty-six studies (published 1990-2022) were included: forty-one quantitative, one qualitative, and four mixed methods). Three were from one high-income country, and forty three from LMIC settings. Half of reports were judged to be of unclear risk of bias. There were unique yet interrelated strategies of scaling-up demand generation for family planning. Interpersonal communication strategies increase adoption and coverage of modern contraceptive methods, but the effect on sustainability is uncertain. Mass media exposure increases knowledge and positive attitudes and may increase the intention to use modern contraceptive methods. Demand-side financing approaches probably increase awareness of contraceptives and the use of modern contraceptive methods among poor clients. Multifaceted Demand generation approaches probably improve adoption, coverage and sustainability of modern methods use. Factors that influence the success of implementing these strategies include users knowledge about family planning methods, the availability of modern methods, and the accessibility to services.

CONCLUSIONS

Demand generation strategies may function independently or supplement each other. The myriad of techniques of the different demand generation strategies, the complexities of family planning services, and human interactions defy simplistic conclusions on how a specific strategy or a bundle of strategies may succeed in increasing and sustaining family planning utilization.

TRIAL REGISTRATION

Systematic review registration: Center for Open Science, osf.io/286j5.

Hydrogel capsules as new approach for increasing drying survival of plant biostimulant gram-negative consortium

Several plant growth-promoting bacteria (PGPB) are gram-negative, and their cell viability is affected during the bio-inoculant production. Hence, formulation-drying processes provide challenges that limit the adoption of these beneficial microorganisms in sustainable agricultural production. Among delivery system strategies for gram-negative PGPB, the encapsulating cells in biopolymeric materials are emerging as a promising alternative. This research aims to evaluate the effect of additives and crosslinking agents on the survival of the consortium of Herbaspirillum frisingense AP21, Azospirillum brasilense D7, and Rhizobium leguminosarum T88 in hydrogel capsules. Three crosslinkers and diverse potential drying protectors were tested. Calcium gluconate provides notable consortium survival advantages regarding colony-forming units (CFUs) (losses of up to 4 log CFU) compared to calcium lactate and calcium chloride (up to 6 log CFU). Additives such as skimmed milk, whey protein, and Gelita® EC improve the recovery of viable cells after the drying process, demonstrating an increase in cell survival of the three bacteria by up to 4 log CFU. The combination of these substances into a capsule prototype extends the storage stability of bacterial consortium up to 3 months at 18 ± 2 °C. This study expands the knowledge for formulating gram-negative PGPB consortium, regarding the crosslinker and drying protector relationship on encapsulation processes with drying survival and further storage stability performance. KEY POINTS: • Hydrogel immobilization formulation approach for PGPB consortium • Enhancing drying survival of gram-negative PGPB consortium • Increasing storage stability of PGPB consortium at 18 °C.

Strategies used throughout the scaling-up process of eConsult - Multiple case study of four Canadian Provinces

BACKGROUND

eConsult is a model of asynchronous communication connecting primary care providers to specialists to discuss patient care. This study aims to analyze the scaling-up process and identify strategies used to support scaling-up efforts in four provinces in Canada.

METHODS

We conducted a multiple case study with four cases (ON, QC, MB, NL). Data collection methods included document review (n = 93), meeting observations (n = 65) and semi-structured interviews (n = 40). Each case was analyzed based on Milat's framework.

RESULTS

The first scaling-up phase was marked by the rigorous evaluation of eConsult pilot projects and the publication of over 90 scientific papers. In the second phase, provinces implemented provincial multi-stakeholder committees, institutionalized the evaluation, and produced documents detailing the scaling-up plan. During the third phase, efforts were made to lead proofs of concept, obtain the endorsement of national and provincial organizations, and mobilize alternate sources of funding. The last phase was mainly observed in Ontario, where the creation of a provincial governance structure and strategies were put in place to monitor the service and manage changes.

CONCLUSIONS

Various strategies need to be used throughout the scaling-up process. The process remains challenging and lengthy because health systems lack clear processes to support innovation scaling-up.

Implementation strategies, facilitators, and barriers to scaling up and sustaining post pregnancy family planning, a mixed-methods systematic review

BACKGROUND

Post pregnancy family planning includes both postpartum and post-abortion periods. Post pregnancy women remain one of the most vulnerable groups with high unmet need for family planning. This review aimed to describe and assess the quality of the evidence on implementation strategies, facilitators, and barriers to scaling up and sustaining post pregnancy family planning.

METHODS

Electronic bibliographic databases (MEDLINE, PubMed, Scopus, the Cochrane Library, and Global Index Medicus) were searched from inception to October 2022 for primary quantitative, qualitative, and mixed method reports on scaling up post pregnancy family planning. Abstracts, titles, and full-text papers were assessed according to the inclusion criteria to select studies regardless of country, language, publication status, or methodological limitations. Data were extracted and methodological quality assessed using the Mixed Methods Appraisal Tool. The convergent integrated approach and a deductive thematic synthesis were used to identify themes and sub-themes of strategies to scale up post pregnancy family planning. The health system building blocks were used to summarize barriers and facilitators. GRADE-CERQual was used to assess our confidence in the findings.

RESULTS

Twenty-nine reports (published 2005-2022) were included: 19 quantitative, 7 qualitative, and 3 mixed methods. Seven were from high-income countries, and twenty-two from LMIC settings. Sixty percent of studies had an unclear risk of bias. The included reports used either separate or bundled strategies for scaling-up post pregnancy family planning. These included strategies for healthcare infrastructure, policy and regulation, financing, human resource, and people at the point of care. Strategies that target the point of care (women and / or their partners) contributed to 89.66% (26/29) of the reports either independently or as part of a bundle. Point of care strategies increase adoption and coverage of post pregnancy contraceptive methods.

CONCLUSION

Post pregnancy family planning scaling up strategies, representing a range of styles and settings, were associated with improved post pregnancy contraceptive use. Factors that influence the success of implementing these strategies include issues related to counselling, integration in postnatal or post-abortion care, and religious and social norms.

TRIAL REGISTRATION

Center for Open Science, OSF.IO/EDAKM.

Implementation and scaling-up of an effective mHealth intervention to increase adherence to triage of HPV-positive women (ATICA study): perceptions of health decision-makers and health-care providers

BACKGROUND

The ATICA study was a Hybrid I type randomized effectiveness-implementation trial that demonstrated effectiveness of a multicomponent mHealth intervention (Up to four SMS messages sent to HPV-positive women, and one SMS message to CHWs to prompt a visit of women with no triage Pap 60 days after a positive-test), to increase adherence to triage of HPV positive women (ATICA Study). We report data on perceptions of health decision-makers and health-care providers regarding the intervention implementation and scaling-up.

METHODS

A qualitative study was carried out based on individual, semi-structured interviews with health decision-makers (n = 10) and health-care providers (n = 10). The themes explored were selected and analyzed using domains and constructs of the Consolidated Framework for Implementation Research (CFIR) and the maintenance dimension of the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework.

RESULTS

Both health-care providers and decision-makers had a positive assessment of the intervention through most included constructs: knowledge of the intervention, intervention source, design quality, adaptability, compatibility, access to knowledge and information, relative advantage, women's needs, and relative priority. However, some potential barriers were also identified including: complexity, leadership engagement, external policies, economic cost, women needs and maintenance. Stakeholders conditioned the strategy's sustainability to the political commitment of national and provincial health authorities to prioritize cervical cancer prevention, and to the establishment of the ATICA strategy as a programmatic line of work by health authorities. They also highlighted the need to ensure, above all, that there was staff to take Pap tests and carry out the HPV-lab work, and to guarantee a constant provision of HPV-tests.

CONCLUSION

Health decision-makers and health-care providers had a positive perception regarding implementation of the multicomponent mHealth intervention designed to increase adherence to triage among women with HPV self-collected tests. This increases the potential for a successful scaling-up of the intervention, with great implications not only for Argentina but also for middle and low-income countries considering using mHealth interventions to enhance the cervical screening/follow-up/treatment process.

Scaling-up through piloting: dual-track provider payment reforms in China's health system

Gaining wide prominence in the global health arena, scaling-up increases the coverage of health innovations emerging from pilots and experimental projects to a larger scale. However, scaling-up in the health sector should not follow a linear 'pilot-diffusion' pathway in order to better facilitate local adaptation and policy refinement. This paper puts forth 'scaling-up through piloting' as a distinctive pathway for the strategic management of scaling-up in the health sector. It analyses the recent development of provider payment reforms in China, focusing particularly on the ongoing pilot programmes, namely diagnosis-related groups (DRGs) and diagnosis-intervention packet (DIP), that are being piloted in a dual-track fashion since 2020. Data were drawn from extensive documentary analysis and 20 in-depth interviews with key stakeholders, including decision-makers and implementers. This paper finds that scaling-up through piloting helps Chinese policymakers minimize the vast uncertainties associated with complex payment reforms and maximize the local adaptability of provider payment innovations. This pathway has forged a phased implementation process, allowing new payment models to be tested, evaluated, compared and adjusted in a full spectrum of local contexts before national rollout. The phased implementation creates a 'slower is faster' effect, helping reduce long-term negative consequences arising from improperly managed scaling-up in a complex system. Error detection and correction and recalibration of new policy tools can support national-level policy refinement in a more robust and dynamic fashion. Several key factors have been identified as crucial for strategic scaling-up: necessary central steering, a pragmatic piloting design, strong technical capacity and effective policy learning mechanisms.

Analyzing influencing factors to scale up agroforestry systems in Colombia: A comparative ex-ante assessment of cacao farming and cattle ranching in two regions

Agroforestry systems (AFS) are proved to enhance sustainable land management. Thus, there is increasing demand for effective ways to scale up AFS so that more people can benefit. Consequently, this study assesses the scaling-up potential of agroforestry systems (AFS) using cacao farming and cattle ranching in Caquetá and Cesar, Colombia, as examples. An ex-ante assessment using the ScalA tool is conducted through interviews with AFS experts from institutions promoting AFS. Using a comparative approach, results reveal that AFS have different scaling-up potential depending on the type of farming system and location characteristics. In our case, it is slightly higher for cacao farming than for cattle ranching in both regions and it is higher in Caquetá than in Cesar for both systems. Factors hindering the scaling-up potential for both regions are economic conditions at the local and regional levels since there is a lack of stable and differentiated markets to absorb AFS products. In contrast, the scaling-up potential in both regions is increased by the factors related to the capacity of the organizations that promote AFS and the attitudes of local communities toward them. The study generates information about factors that may hinder or foster AFS scaling-up, including not just the capacities and mechanisms to promote them but also the enabling conditions. This contributes to prioritizing AFS interventions and better allocating their resources to increase their chances of successful scaling-up.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10457-022-00730-1.

Primary care implementation study to scale up early identification and brief intervention and reduce alcohol-related negative outcomes at the community level (PINO): study protocol for a quasi-experimental 3-arm study

BACKGROUND

Primary healthcare-based Early Identification and Brief Intervention (EIBI) for hazardous and harmful alcohol use is both a clinically relevant and cost-effective strategy to reduce heavy drinking. Unfortunately, it remains poorly implemented in daily practice. Multiple studies have shown that training and support (T&S) programs can increase the use of EIBI. Nonetheless, gains have only been modest and short-term at best. Suggestions have been made to rely more on multicomponent programs that simultaneously address several barriers to the implementation of EIBI. The PINO-project aims to evaluate the added value of such a multicomponent program to improve EIBI delivery in daily practice.

METHODS/DESIGN

A quasi-experimental three-arm implementation study in Flanders (Belgium) will assess the effects of tailored T&S to General Practitioners (GPs) with or without community mobilisation on EIBI delivery in general practice. The study lasts 18 months and will take place in three comparable municipalities. In municipality 1 and 2, GPs receive a tailored T&S program. The T&S is theoretically founded and tailored to the GPs' views, needs and practice characteristics. Furthermore, community actions will be embedded within municipality 1 providing additional, contextual, support. In municipality 3, GPs are offered a minimal intervention to facilitate data collection. The primary outcome is the proportion of adult patients screened for hazardous and harmful alcohol use at the end of an 18-month implementation period. The secondary outcome is the scaling up activity at municipal level in screening rates, as assessed every 3 months, and the proportion of patients who received an additional brief intervention when necessary. Furthermore, the correlation between the opinions and needs of the GP's, their practice organisation and their EIBI performance will be explored.

DISCUSSION

The PINO-project addresses the gap between what is theoretically possible and the current practice. This is an innovative study combining T&S at GP level with community actions. At the same time, it implements and evaluates practice T&S based on the theoretical domains framework.

TRIAL REGISTRATION

This trial was approved by the Ethics Committee for Research of UZ/KU Leuven (reference number s63342 and G-2020-2177-R2(MAR)) and is registered on clinicaltrials.gov ( NCT04398576 ) in May 2020.

What is required to scale-up and sustain biofortification? Achievements, challenges and lessons from scaling-up Orange-Fleshed Sweetpotato in Sub-Sahara Africa

This review presents results of the ex-post survey on Reaching Agents of Change (RAC) project, highlighting experiences, lessons, challenges and recommendations for scaling up orange-fleshed sweetpotato (OFSP). The RAC project was a three-and halfyear initiative (2011 and 2015), implemented in three primary countries, namely Tanzania, Mozambique, Nigeria, and to a lesser extent Ghana and Burkina Faso. The project advocated for policy change and increased investments to scale-up the orangefleshed sweetpotato (OFSP) to combat vitamin A deficiency. RAC planned to generate new investments totaling US$ 18 million for OFSP activities in the three years of its life but exceeded this target by 20%. RAC further expected to benefit at least 600,000 households directly and is currently on track, having reached 309,974 direct beneficiaries (of whom 20.3% were women). The RAC experience demonstrated a potential scaling-up model for biofortified crops based on the hypothesis that scaling up can be achieved through supportive policies (and investments), strong institutional capacities and appropriate innovative technologies working through a partnership of governmental and non-governmental organizations and civil society.

New approach for the dimensionless analysis of a unidirectional flow solar reactor based on Damköhler's number profiles

A methodology for the analysis of the behavior of complex reactors based on the construction of profiles of a dimensionless number (Damköhler) for each main chemical species (Dai) was proposed. A 4-chlorophenol mineralization reaction in a heterogeneous solar reactor with suspended TiO₂ and addition of H₂O₂ with tubular geometry and radiation collectors, fluid flow and a recirculation system was selected as a complex model system in order to validate the approach. The dynamic behavior of the reactor in dimensionless variables was modeled as a function of Dai. Where Dai(z,t) is a local property and grouped the optical and surface's properties of the catalyst, catalyst load, radiation intensity, the photon absorption rate, rate of non-photochemical reactions, the H₂O₂ effect, the reaction rate of different stages like adsorption, attack of radicals, surface reactions, plus design and operation variables like reactor volume and volumetric flow.

A coupling of orthogonal collocation and Runge-Kutta methods were used to solve the PDEs and carry out the simulations to the different experimental conditions, resulting in profiles of Dai, Ci, and conversion in function of time and space. The Dai profiles proposed in the new methodology are capable of describing the disturbances in solar reactors, to indicate consumption and generation rates, instantaneous changes of reaction rate, to describe competitive reactions and quenching effects and to determine equilibrium concentrations, all of the above at each time and space. Therefore, this approach is a analysis tool of reactors which complements the concentration profile. This methodology can be extended to other reactive systems, adapting the intrinsic reaction rates.

Implementation science in nutrition: a summary and synthesis

Objective:

This paper aimed to summarise and critically synthesise the key findings of the articles included in the supplement entitled ‘Nutrition Implementation Science: The Experience of a Large-Scale Home Fortification in Bangladesh’.

Design:

Commentary, summary and synthesis.

Settings:

Low- and middle-income country.

Results:

The supplement included six articles, including this summary paper. The second article presented an implementation science framework that facilitated conceptualising and evaluating the home-fortification programme in Bangladesh implemented by the Bangladesh Rural Advancement Committee (BRAC). The framework encompasses five components: identifying an ‘effective’ intervention; scaling-up and implementation fidelity; course corrections during implementation and assessing the implementation’s effectiveness; promoting sustainability of interventions and consideration of a concurrent evaluation to identify ‘effective’ interventions and to assess the process and outcome indicators of implementation. The other four articles in this supplement addressed the different components of the framework. For example, the third article addressed the implementation fidelity of a home-fortification programme, and the fourth article described the use of concurrent evaluation to course correct the implementation plan that resulted in improved implementation fidelity. The fifth article explained the outcome of course correction in the programme coverage, and the sixth article described the cost-effectiveness of the BRAC home-fortification programme.

Conclusions:

Overall, the supplement provides a comprehensive understanding of nutrition implementation science, which is very new in the field. The lessons learned in this supplement may enhance the capacity of researchers, policymakers and key stakeholders in the nutrition field to scale up new nutrition interventions and sustain them until malnutrition is alleviated.

Seed coating as a delivery system for the endophyte Trichoderma koningiopsis Th003 in rice (Oryza sativa)

Seed coating is a technique to cover seeds with external agents to upgrade their performance, handling, and plant establishment. Plant beneficial microbes (PBMs), such as plant growth-promoting bacteria, mycorrhizal fungi, and other fungi (e.g., Trichoderma spp.), decrease agrochemical inputs, enhance tolerance to biotic-abiotic stresses, and increase essential plant nutrition. The demand for pre-treated seeds as delivery systems for biological agents is advancing. Here, a seed coating formulation containing Trichoderma koningiopsis is presented. The physicochemical and biological characterization of the seed coating prototypes included drying protector screening, the effect of the inoculum concentration on survival, the assessment of microbial release profiles in soil extract, and plant tissue colonization capability under semi-controlled conditions. Gelatine and pectin, two of the tested drying protectors, maintained fungus germination after 60 days at 18 °C with significantly higher values of up to 38% compared with the control. The initial concentration of 10⁶ colony-forming units (CFU) per seed undergoes a positive effect on survival over time. Regarding plant tissue colonization, the fungus establishes endophytically in rice. In conclusion, seed coating is a promising alternative for the formulation of beneficial microbial agents such as Trichoderma sp., maintaining cell survival and further promoting the establishment in rice systems.Key points• Enhancing drying survival of T. koningiopsis formulates• Seed coating formulation approach for T. koningiopsis in rice• Colonization capacity of formulated T. koningiopsis in rice tissue.

Novel external-loop-airlift milliliter scale bioreactors for cell growth studies: Low cost design, CFD analysis and experimental characterization

Many researchers have limited access to fully equipped laboratory-scale batch bioreactors and chemostats due to their relatively high cost. This becomes particularly prohibitive when multiple replicas of the same experiment are required, but not enough bioreactors are available to operate simultaneously. Additionally, experiments using shaken flasks are common but show significant limitations in terms of maintaining homogeneous conditions in liquid cultures or installing instrumentation for monitoring. Here, we proposed to tackle this significant hurdle by providing a route to make available the manufacture of low-cost, milliliter-scale bioreactors. This approach seems plausible for enabling proof-of-concept experiments before moving to a larger scale without significant investments. The conceptually designed systems were based on external-loop bioreactors due to their flexibility, simplicity, and ease of assembling and testing. Designs were initially evaluated in silico with the aid of COMSOL Multiphysics. The successfully evaluated systems were then constructed via additive manufacturing and assembled for hydrodynamics testing via tracer methods. This was enabled by a newly home-made optical absorbance sensor (OAS) for in-line and real-time measurements. Both the in silico and experimental results indicated close to ideal mixing conditions and low shear stress. Cell growth curves were prepared by culturing Escherichia coli and following its cell density in real-time. Our cell growth rate and maximum cell density were similar to those previously obtained in closely related systems. Therefore, the proposed bioreactors are an affordable alternative for batch and continuous cell growth studies rapidly and inexpensively.

From the lab to the field: Self-stratifying microbial fuel cells stacks directly powering lights

The microbial fuel cell (MFC) technology relies on energy storage and harvesting circuitry to deliver stable power outputs. This increases costs, and for wider deployment into society, these should be kept minimal. The present study reports how a MFC system was developed to continuously power public toilet lighting, with for the first time no energy storage nor harvesting circuitry. Two different stacks, one consisting of 15 and the other 18 membrane-less MFC modules, were operated for 6 days and fuelled by the urine of festival goers at the 2019 Glastonbury Music Festival. The 15-module stack was directly connected to 2 spotlights each comprising 6 LEDs. The 18-module stack was connected to 2 identical LED spotlights but going through 2 LED electronic controller/drivers. Twenty hours after inoculation the stacks were able to directly power the bespoke lighting system. The electrical energy produced by the 15-module stack evolved with usage from ≈280 mW (≈2.650 V at ≈105 mA) at the beginning to ≈860 mW (≈2.750 V at ≈300 mA) by the end of the festival. The electrical energy produced by the LED-driven 18-module stack increased from ≈490 mW at the beginning to ≈680 mW toward the end of the festival. During this period, illumination was above the legal standards for outdoor public areas, with the 15-module stack reaching a maximum of ≈89 Lx at 220 cm. These results demonstrate for the first time that the MFC technology can be deployed as a direct energy source in decentralised area (e.g. refugee camps).

Degradation of pharmaceuticals from wastewater in a 20-L continuous flow bio-electro-Fenton (BEF) system

The bio-electro-Fenton (BEF) technology has proven to be an effective and energy-saving method for treating wastewaters containing a single pharmaceutical in the lab-scale. However, the continuous degradation of pharmaceuticals in a scaled-up BEF has never been reported. In this study, a 20-L dual-chamber BEF reactor was designed and tested for treating six model pharmaceuticals. The effect of key operational factors including applied voltage, cathode Fe²⁺ dosage, initial pharmaceuticals concentration and hydraulic retention time (HRT), were assessed. By implementing 0.1 V voltage, 0.3 mM Fe²⁺ and HRT of 26 h, the six selected pharmaceuticals (500 μg L^-1 for each) were removed completely. Moreover, transformation products during clofibric acid degradation, such as 4-chlororesorcinol, were detected and the relevant transformation pathway was proposed. Additionally, it successfully removed these pharmaceuticals in the real wastewater matrix. This paper contributes to scaling-up the BEF process for continuous and effective treating pharmaceuticals-contaminated wastewater.

Electrochemistry-stimulated environmental bioremediation: Development of applicable modular electrode and system scale-up

Bioelectrochemical systems (BESs) have been studied extensively during the past decades owing primarily to their versatility and potential in addressing the water-energy-resource nexus. In stark contrast to the significant advancements that have been made in developing innovative processes for pollution control and bioresource/bioenergy recovery, minimal progress has been achieved in demonstrating the feasibility of BESs in scaled-up applications. This lack of scaled-up demonstration could be ascribed to the absence of suitable electrode modules (EMs) engineered for large-scale application. In this study, we report a scalable composite-engineered EM (total volume of 1 m³), fabricated using graphite-coated stainless steel and carbon felt, that allows integrating BESs into mainstream wastewater treatment technologies. The cost-effectiveness and easy scalability of this EM provides a viable and clear path to facilitate the transition between the success of the lab studies and applications of BESs to solve multiple pressing environmental issues at full-scale.

Scalability and stacking of self-stratifying microbial fuel cells treating urine

The scalability of Microbial fuel cells (MFCs) is key to the development of stacks. A recent study has shown that self-stratifying membraneless MFCs (S-MFCs) could be scaled down to 2 cm without performance deterioration. However, the scaling-up limit of S-MFC is yet unknown. Here the study evaluates the scale-up height of S-MFCs treating urine, from 2 cm, 4 cm to 12 cm high electrodes. The electrochemical properties of the S-MFCs were investigated after steady-states were established, following a 70-days longevity study. The electrochemical properties of the 2 cm and 4 cm conditions were similar (5.45 ± 0.32 mW per cascade). Conversely, the 12 cm conditions had much lower power output (1.48 ± 0.15 mW). The biofilm on the 12 cm cathodes only developed on the upper 5-6 cm of the immersed part of the electrode suggesting that the cathodic reactions were the limiting factor. This hypothesis was confirmed by the cathode polarisations showing that the 12 cm S-MFC had low current density (1.64 ± 9.53 µA cm-2, at 0 mV) compared to the other two conditions taht had similar current densities (192.73 ± 20.35 µA cm-2, at 0 mV). These results indicate that S-MFC treating urine can only be scaled-up to an electrode height of around 5-6 cm before the performance is negatively affected.

Commentary on Scaling-Up Evidence-Based Interventions in Public Systems

This commentary reviews the findings and recommendations from the Society for Prevention Research (SPR) Mapping Advances in Prevention Science (MAPS) IV Task Force as detailed in the article by Fagan et al. (Prevention Science, 2019). In addition to highlighting similarities and differences with the prior MAPS II Task Force findings, discussion focuses on four extension recommendations: the importance of attending to equitable implementation as a pathway to evidence-based intervention (EBI) uptake by communities, the value of broadening conceptualization of data monitoring and evaluation capacity beyond EBI-specific data, the opportunity to more precisely guide EBI-referrals from public systems, and the importance of EBI developers and purveyors proactively and deliberately operationalizing fidelity measurement using actionable constructs.

Scaling-up PrEP Delivery in Sub-Saharan Africa: What Can We Learn from the Scale-up of ART?

Purpose of Review

Clinical trials have found that PrEP is highly effective in reducing risk of HIV acquisition across types of exposure, gender, PrEP regimens, and dosing schemes. Evidence is urgently needed to inform scale-up of PrEP to meet the ambitious WHO/UNAIDS prevention target of 3,000,000 individuals on PrEP by 2020.

Recent Findings

Successful models of delivering HIV services at scale evolved from years of formal research and programmatic evidence. These efforts produced lessons-learned relevant for scaling-up PrEP delivery, including the importance of streamlining laboratory tests, expanding prescription and management authority, differentiating medication access points, and reducing stigma and barriers of parental consent for PrEP uptake. Further research is especially needed in areas differentiating PrEP from ART delivery, including repeat HIV testing to ensure HIV negative status and defining and measuring prevention-effective adherence.

Summary

Evidence from 15 years of ART scale-up could immediately inform a public health approach to PrEP delivery.

Scaling up the electrokinetic-assisted phytoremediation of atrazine-polluted soils using reversal of electrode polarity: A mesocosm study

Electrokinetic-assisted phytoremediation (EKPR) has been recently proposed for the removal of pesticides from polluted soils. In this work, we report the results from an EKPR experiment that was carried out in a mesocosm mock-up of 0.386 m³ using ryegrass (Lolium perenne L.) and a low permeability soil spiked with atrazine. Plants were initially grown for 35 days; then, the soil was spiked with atrazine at a dose of 2 mg kg^-1 soil. A DC electrical field of 0.6 V cm^-1 was applied 24 h every day, switching polarity daily. Another identical mock-up with the same experimental conditions but without plants was used for comparison purposes. The duration of the EKPR test was 19 days during which some operational parameters were registered (electric current intensity, soil pH and temperature) and soil porewater samples were taken and analysed. Plant tissues and soil samples from the different sections in which the mock-ups were divided, were also collected and analysed at the end of the experiment. 3-D profiles of soil pH, water content and atrazine residues concentration in plants and soil were obtained and discussed. The results of this experiment were compared with others previously reported by us from a similar EKPR pot test. In spite of the difficulties to get an adequate geometric and operational similarity between setups of different scale, the main output parameters of the EKPR process (electric current, specific current charge, overall atrazine removal, specific atrazine removal efficiency, root biomass:soil weight ratio) were discussed. It was shown that, although the processes carried out are essentially the same in both scales, their extent may be quite different; it highlights the limitations of small-scale experiments to predict the results at field conditions.

Scaling Up a Strengthened Youth-Friendly Service Delivery Model to Include Long-Acting Reversible Contraceptives in Ethiopia: A Mixed Methods Retrospective Assessment

BACKGROUND

Donor funded projects are small scale and time limited, with gains that soon dissipate when donor funds end. This paper presents findings that sought to understand successes, challenges and barriers that influence the scaling up and sustainability of a tested, strengthened youth-friendly service (YFS) delivery model providing an expanded contraceptive method choice in one location - the YFS unit - with additional units in Amhara and Tigray, Ethiopia.

METHODS

This retrospective mixed methods study included interviews with key informants (KIs) (qualitative arm) and analysis of family planning (FP) uptake statistics extracted from the sampled health facilities (quantitative arm). A multistage convenience purposive sampling technique was adopted to randomly select 8 health facilities aligned with respective woredas, zones and regional health bureaus (RHBs). A semi-structured interview guide soliciting information on 6 scaling-up elements (stakeholder engagement, roles and responsibility, policy environment, financial resources, quality of voluntary FP services and data availability and use) guided the interviews. Fifty-six KI interviews were conducted with policy-makers, program managers, and clinic staff. Recurring themes were triangulated across administrative levels and implementing partners. Relevant FP data (acceptor status, age and method uptake) were extracted from the 8 sampled health facilities for a thirteen-month period. Qualitative findings triangulated with FP service statistics assessed the influence of the 6 scaling-up elements with trends in long-acting reversible contraceptive (LARC) uptake before and after training.

RESULTS

Our findings depict that respondents were knowledgeable and supportive of an expanded method mix. Statistically significant increases in long-acting contraceptive uptake were noted at 2 of the 8 health centers. Fidelity to the tested model was operationally constrained; respondents frequently mentioned trained staff absences and turnover as obstacles in offering quality FP services.

CONCLUSION

Despite conducive policy environment, supportive stakeholders, favorable environment, and financial support for trainings, statistically significant increases in LARC uptake occurred at only 2 of the 8 health centers; indicating the influence of weak health systems, poor quality of voluntary FP services and a ceiling effect. Scale-up processes must consider potential bottlenecks of weak health systems and availability of financial resources by addressing these as crucial elements in any systematic scale-up framework.

Inducing human induced pluripotent stem cell differentiation through embryoid bodies: A practical and stable approach

Human induced pluripotent stem cells (hiPSCs) are invaluable resources for producing high-quality differentiated cells in unlimited quantities for both basic research and clinical use. They are particularly useful for studying human disease mechanisms in vitro by making it possible to circumvent the ethical issues of human embryonic stem cell research. However, significant limitations exist when using conventional flat culturing methods especially concerning cell expansion, differentiation efficiency, stability maintenance and multicellular 3D structure establishment, differentiation prediction. Embryoid bodies (EBs), the multicellular aggregates spontaneously generated from iPSCs in the suspension system, might help to address these issues. Due to the unique microenvironment and cell communication in EB structure that a 2D culture system cannot achieve, EBs have been widely applied in hiPSC-derived differentiation and show significant advantages especially in scaling up culturing, differentiation efficiency enhancement, ex vivo simulation, and organoid establishment. EBs can potentially also be used in early prediction of iPSC differentiation capability. To improve the stability and feasibility of EB-mediated differentiation and generate high quality EBs, critical factors including iPSC pluripotency maintenance, generation of uniform morphology using micro-pattern 3D culture systems, proper cellular density inoculation, and EB size control are discussed on the basis of both published data and our own laboratory experiences. Collectively, the production of a large quantity of homogeneous EBs with high quality is important for the stability and feasibility of many PSCs related studies.

The pitfalls of scaling up evidence-based interventions in health

Policy-makers worldwide are increasingly interested in scaling up evidence-based interventions (EBIs) to larger populations, and implementation scientists are developing frameworks and methodologies for achieving this. But scaling-up does not always produce the desired results. Why not? We aimed to enhance awareness of the various pitfalls to be anticipated when planning scale-up. In lower- and middle-income countries (LMICs), the scale-up of health programs to prevent or respond to outbreaks of communicable diseases has been occurring for many decades. In high-income countries, there is new interest in the scaling up of interventions that address communicable and non-communicable diseases alike. We scanned the literature worldwide on problems encountered when implementing scale-up plans revealed a number of potential pitfalls that we discuss in this paper. We identified and discussed the following six major pitfalls of scaling-up EBIs: 1) the cost-effectiveness estimation pitfall, i.e. accurate cost-effectiveness estimates about real-world implementation are almost impossible, making predictions of economies of scale unreliable; 2) the health inequities pitfall, i.e. some people will necessarily be left out and therefore not benefit from the scaled-up EBIs; 3) the scaled-up harm pitfall, i.e. the harms as well as the benefits may be amplified by the scaling-up; 4) the ethical pitfall, i.e. informed consent may be a challenge on a grander scale; 5) the top-down pitfall, i.e. the needs, preferences and culture of end-users may be forgotten when scale-up is directed from above; and 6) the contextual pitfall, i.e. it may not be possible to adapt the EBIs to every context. If its pitfalls are addressed head on, scaling-up may be a powerful process for translating research data into practical improvements in healthcare in both LMICs and high-income countries, ensuring that more people benefit from EBIs.

The transfer of knowledge on integrated care among five European regions: a qualitative multi-method study

BACKGROUND

To examine how the knowledge transfer processes unfolded within SCIROCCO, a EU funded project (3rd Health Programme (2014-2020)) that aimed to facilitate the process of knowledge sharing across five European regions, to speed up adoption and scaling-up of integrated care initiatives.

METHODS

A qualitative multi-method design was used. Data collection methods included focus groups, project documents and action plans of the regions. The data was analysed using a qualitative content-analysis procedure, which was guided by the frameworks of knowledge exchange and the why, whose, what, how framework for knowledge mobilisers.

RESULTS

All five components (including the themes) of knowledge exchange could be identified in the approach developed on the knowledge transfer processes. The four questions and accompanying categories of the framework of knowledge mobilisation were also identified to a large degree.

CONCLUSIONS

The observed incorporation of distinct forms of knowledge from multiple sources and the observed dynamic and fluid knowledge transfer processes both suggest that SCIROCCO developed a comprehensive knowledge transfer approach aiming to enable the adoption and scaling-up of integrated care. Overall, the multi-method qualitative nature of this research has allowed some new and practical insights in the knowledge transfer activities on integrated care between several European regions. To obtain a clear understanding of the content of the knowledge transfer approaches, which could assist the operationalising of models to support the evaluation of knowledge transfer activities, it is strongly recommended that further research of this type should be conducted in other research settings.

Feasibility and applicability of the scaling-up of bio-electro-Fenton system for textile wastewater treatment

Textile wastewater entering natural water bodies could cause serious environment and health issues. Bio-electro-Fenton (BEF) as an efficient and energy saving wastewater treatment technology has recently attracted widespread attention. So far, there is no research available on the scaling-up of BEF process. In this work, an innovative 20 L up-scaled BEF system was constructed for the treatment of methylene blue (MB) containing wastewater. The system was first tested in batch mode. The results showed that the system performance was majorly related to the operating parameters including initial MB concentration, catholyte pH and concentration, cathodic aeration rate, Fe²⁺ dosage, and applied voltage. At the optimal condition, 20 mg L^-1 of MB was efficiently removed following the apparent first order kinetics. The corresponding rate constants for the decolorization and mineralization were 0.68 and 0.20 h^-1, respectively. Furthermore, MB decolorization efficiency of 99% and mineralization efficiency of 74% were observed when the hydraulic retention time was 28 h in continuous mode. This work demonstrates the scaling-up potential of BEF for recalcitrant wastewater treatment.

Selecting the best piping arrangement for scaling-up an annular channel reactor: An experimental and computational fluid dynamics study

This study is focused on the selection of the best piping arrangement for a pilot scale annular channel reactor intended for the remediation of waters and wastewaters. Two annular channel reactors composed of a single UV lamp and distinct piping arrangements were considered: (i) a novel reactor with tangential inlet/outlet pipes - the FluHelik reactor, and (ii) a conventional Jets reactor. These two reactors were manufactured at lab scale and characterized in terms of residence time distribution (RTD), radiant power and ability to degrade aqueous solutions spiked with a model compound - 3-amino-5-methylisoxazole (AMI) - by H₂O₂/UVC and UVC processes. Computational fluid dynamics (CFD) simulations were used to assess the hydrodynamics, RTD and UV radiation intensity distribution of both reactors at pilot scale. In general, experimental results at lab scale revealed quite similar RTDs, radiant powers and AMI degradation rates for both reactors. On the other hand, CFD simulations at pilot scale revealed the generation of a helical motion of fluid around the UVC lamp in the FluHelik reactor, inducing: (i) a longer contact time between fluid particles and UV light, (ii) more intense dynamics of macromixing as a result of larger velocity gradients, turbulent intensities and dispersion of RTD values around the peak, and (iii) a more homogeneous UV radiation distribution. In addition, the design of the FluHelik reactor can favor the implementation of various reactors in series, promoting its application at industrial scale. The FluHelik reactor was chosen for scaling-up. A pre-pilot scale treatment unit containing this reactor was constructed and its feasibility was proven.

Assessing the maturity of the healthcare system for integrated care: testing measurement properties of the SCIROCCO tool

Background

The Scaling Integrated Care in Context (SCIROCCO) tool has been developed to facilitate knowledge transfer and learning about the implementation and scaling-up of integrated care in European regions. To adequately test the functionality of the tool in assessing the maturity for integrated care within regions, this study evaluated its structural validity, internal consistency and convergent validity.

Methods

Exploratory factor analysis was used to investigate the structural validity of the 12-items of the SCIROCCO tool. Hereafter, the internal consistency was assessed by calculating Cronbach’s and ordinal alpha. The convergent validity was explored by testing 23 pre-hypothesized relationships between items of the SCIROCCO tool and items of an instrument measuring a similar construct.

Results

Factor analysis revealed a one-factor structure. Cronbach’s alpha of the overall instrument was 0.92, ordinal alpha was 0.94. Only 30.34% of the hypotheses for testing the convergent validity were met.

Conclusion

The one-factor structure is considered relevant in representing the structural validity of the SCIROCCO tool. The scale of the SCIROCCO tool shows good internal consistency. The tool (DMIC Quickscan) used to assess the convergent validity might measure a different aspect of integrated care than the SCIROCCO tool. Further research is needed to continue investigating the validity and reliability of the tool.

Electronic supplementary material

The online version of this article (10.1186/s12874-019-0704-1) contains supplementary material, which is available to authorized users.

Hydrodynamic performance of floating photobioreactors driven by wave energy

BACKGROUND

Unlike conventional cultivation systems, liquid mixing in floating photobioreactors (PBRs) is solely induced by their hydrodynamic movement in response to waves, and this movement is affected by the wave conditions (wave height and wave period), the PBR configuration and the culture depth. However, to the best of our knowledge, a practical study of the hydrodynamic movements of PBRs has not been previously conducted.

RESULTS

This study aims to investigate the hydrodynamic performance of floating PBRs in response to wave conditions. First, the effects of the experimental wave height (2-10 cm) and wave period (0.8-1.8 s) on movement was investigated using two 1.0 m2 PBR models: a square PBR (1.0 m/1.0 m; length/width) and a rectangular PBR (1.7 m/0.6 m). The results indicated that wave movement became not only more intense with increasing wave height, but also less intense when the wave period decreased. However, the square PBR experienced more intense movement than the rectangular PBR, but also little mooring force. The effects of culture depth (0.5, 1.0 and 2.0 cm) were investigated and the results showed that the culture depth significantly affected the hydrodynamic movements of the PBRs; however, the mooring forces were unaffected. Finally, the movement and mooring-line forces of PBRs equipped with different mooring systems were investigated. The use of two different mooring systems had little effect on PBR movement; however, a mooring system with floaters was able to significantly reduce the mooring line forces compared to a system without floaters. During this study, the greatest force (10.5 N) was found for the rectangular PBR using a mooring system without floaters, whereas the lowest force (0.67 N) was observed for a rectangular PBR using a mooring system with floaters.

CONCLUSIONS

These studies have provided basic data describing the fluid dynamics of floating PBRs; as well as their structural design and scale up. These results also provide guidance for the selection of ocean fields with suitable wave conditions; as well as a proper mooring methods to ensure safe operation.

Improvement of caproic acid production in a Clostridium kluyveri H068 and Methanogen 166 co-culture fermentation system

The aim of this study was to develop a bioprocess capable of producing caproic acid using a binary fermentation system consisting of Clostridium kluyveri H068 and Methanogen 166 which could then be applied to the brewing of Chinese strong flavor liquor. We initially explored the mechanism by which the Methanogen 166 strain facilitates caproic acid accumulation, revealing its ability to convert accumulated H₂ that is produced by C. kluyveri H068 into methane, thereby eliminating the hydrogen-mediated feedback inhibition that normally constrains C. kluyveri H068 and thus enhancing caproic acid production. In addition, laboratory experiments were conducted to optimize this binary fermentation system, allowing us to determine that the optimum conditions for caproic acid production are a mixed inoculum size of 10% with a C. kluyveri H588/Methanogen 166 inoculation ratio of 2:1 (v/v), a sodium acetate concentration of 20 g/L, a 4% ethanol content (v/v), and a yeast extract concentration of 10 g/L. We further scaled this optimized condition up to use in a 1000 L fermenter and the obtained caproic acid broth was subjected to pit-entry fermentation. Our results demonstrated that this pit-entry fermentation approach was an efficient means of improving the quality of Chinese strong flavor liquor.

Exploring factors associated with the uneven utilization of telemedicine in Norway: a mixed methods study

BACKGROUND

Norway has a long history of using telemedicine, especially for geographical reasons. Despite the availability of promising telemedicine applications and the implementation of national initiatives and policies, the sustainability and scaling-up of telemedicine in the health system is still far from accomplished. The main objective of this study was to explore and identify the multi-level (micro, meso and macro) factors affecting telemedicine utilization in Norway.

METHODS

We used a mixed methods approach. Data from a national registry were collected to analyze the use of outpatient visits and telemedicine contacts in Norway from 2009 to 2015. Interviews with key stakeholders at national, regional and local level helped complete and contextualize the data analysis and explore the main issues affecting the use of telemedicine by health authorities and hospitals. Relevant national documents were also used to support, contradict, contextualize or clarify information and data.

RESULTS

Telemedicine use in Norway from 2009 to 2015 remained very low, not exceeding 0.5% of total outpatient activity at regional level and 0.1% at national level. All four regions used telemedicine. Of the 29 hospitals, 24 used it at least once over the 7-year period. Telemedicine was not used regularly everywhere, with some hospitals using it sporadically. Telemedicine was mostly used in selected specialties, including rehabilitation, neurosurgery, skin and venereal diseases. Three major themes affecting implementation and utilization of telemedicine in Norway emerged: (i) governance and strategy; (ii) organizational and professional dimensions; (iii) economic and financial dimensions. For each theme, a number of factors and challenges faced at different health care levels were identified.

CONCLUSIONS

This study allowed shedding light on multi-level and interdependent factors affecting utilization of telemedicine in Norway. The identification of the main implementation and utilization challenges might support decision makers and practitioners in the successful scaling-up of telemedicine. This work provides a knowledge base useful to other countries which intend to implement telemedicine or other digital health services into their healthcare systems.

Increasing the bio-electrochemical system performance in azo dye wastewater treatment: Reduced electrode spacing for improved hydrodynamics

The electrodes spacing would exert a pronounced effect on bio-electrochemical systems (BESs) performance, especially for the scaling-up of reactors and practical applications. In this study, we traced the effect of electrode spacing on wastewater treatment performances from the aspects of hydrodynamics and electrochemical characteristics. Three series of folded stainless steel mesh (f-SSM) electrodes with electrode spacing of 2, 4 and 8mm were designed for azo dye (acid orange 7 (AO7)) wastewater treatment. Results showed that BES with electrode spacing of 2mm (R_S2) obtained the highest efficiencies of AO7 decolorization (90.9±0.4%) and COD removal (36.8±3.8%) at HRT of 8h, which was 30.7% and 15.2% higher than that in BES with electrode spacing of 8mm (R_S8), respectively. Moreover, the relationship between pollutants removal, internal resistance and hydrodynamics of BESs with different electrode spacing supported the hydrodynamics was significantly influence the pollutants removal performance.

Orodispersible films: Product transfer from lab-scale to continuous manufacturing

Orodispersible films have been described as new beneficial dosage forms for special patient populations. Due to various production settings, different requirements on film formulations are required for non- continuous and continuous manufacturing. In this study, a continuous coating machine was qualified in regards of the process conditions for film compositions and their effects on the formed films. To investigate differences between both manufacturing processes, various film formulations of hydrochlorothiazide and hydroxypropylcellulose (HPC) or hydroxypropylmethycellulose (HPMC) as film formers were produced and the resulting films were characterized. The qualification of the continuously operating coating machine reveals no uniform heat distribution during drying. Coating solutions for continuous manufacturing should provide at least a dynamic viscosity of 1 Pa*s (wet film thickness of 500 μm, velocity of 15.9 cm/min). HPC films contain higher residuals of ethanol or acetone in bench-scale than in continuous production mode. Continuous production lead to lower drug content of the films. All continuously produced films disintegrate within less than 30 s. There are observed significant effects of the production process on the film characteristics. When transferring film manufacturing from lab-scale to continuous mode, film compositions, processing conditions and suitable characterization methods have to be carefully selected and adopted.

Achieving scale rapidly in public health: Applying business management principles to scale up an HIV prevention program in India

Numerous public-health interventions have demonstrated effectiveness in pilots or on a small scale, but have proven challenging to scale up for population-level impact. Avahan, the Bill & Melinda Gates Foundation's HIV prevention program in 6 states of India, confronted the challenge of rapidly scaling up services to reach 300,000 people most at risk of HIV. This meant working in diverse and complex environments with marginalized and largely hidden populations. This case report presents a number of business-management principles that the foundation drew upon to successfully scale up this public-health program: 1) strategy development through market segmentation and complexity analysis, 2) a dynamic and evolving strategy, 3) developing an implementation and management structure to match the strategy, 4) standardization with flexibility, 5) generating demand to balance supply, 6) a customer-centric approach, and 7) data-driven management. Lessons learned from this experience include the crucial role of data in guiding decision-making and strategic and programmatic change; the need for a central body to set strategy; a willingness to change course when experience and data demonstrate the need; and the importance of partnering with program beneficiaries at all stages of program design, operation, evaluation and sustainability. We believe these lessons are applicable to other development programs that seek to foster widespread and sustainable program benefits at scale.

"Scaling-out" evidence-based interventions to new populations or new health care delivery systems

Background

Implementing treatments and interventions with demonstrated effectiveness is critical for improving patient health outcomes at a reduced cost. When an evidence-based intervention (EBI) is implemented with fidelity in a setting that is very similar to the setting wherein it was previously found to be effective, it is reasonable to anticipate similar benefits of that EBI. However, one goal of implementation science is to expand the use of EBIs as broadly as is feasible and appropriate in order to foster the greatest public health impact. When implementing an EBI in a novel setting, or targeting novel populations, one must consider whether there is sufficient justification that the EBI would have similar benefits to those found in earlier trials.

Discussion

In this paper, we introduce a new concept for implementation called “scaling-out” when EBIs are adapted either to new populations or new delivery systems, or both. Using existing external validity theories and multilevel mediation modeling, we provide a logical framework for determining what new empirical evidence is required for an intervention to retain its evidence-based standard in this new context. The motivating questions are whether scale-out can reasonably be expected to produce population-level effectiveness as found in previous studies, and what additional empirical evaluations would be necessary to test for this short of an entirely new effectiveness trial. We present evaluation options for assessing whether scaling-out results in the ultimate health outcome of interest.

Conclusion

In scaling to health or service delivery systems or population/community contexts that are different from the setting where the EBI was originally tested, there are situations where a shorter timeframe of translation is possible. We argue that implementation of an EBI in a moderately different setting or with a different population can sometimes “borrow strength” from evidence of impact in a prior effectiveness trial. The collection of additional empirical data is deemed necessary by the nature and degree of adaptations to the EBI and the context. Our argument in this paper is conceptual, and we propose formal empirical tests of mediational equivalence in a follow-up paper.

Carbon dynamics on agricultural land reverting to woody land in Ontario, Canada

The 2015 Paris Agreement reinforces the importance of the land sector and its contribution to greenhouse gas (GHG) reductions. Thus, there is growing interest in improving estimates of the GHG balance in response to land-use changes (LUCs) involving agriculture and forestry, for national-scale reporting, and for carbon (C) offsets. Large agricultural areas in Europe, Russia and North America are reverting to forest, either naturally or through planting, after abandonment of agricultural land, and this trend may have a substantial impact on carbon budgets. We report results of a pilot project in the Mixedwood Plains ecozone of eastern Canada to analyze the change in the C budget on a landscape over 15 years on abandoned cropland where woody vegetation is regenerating. Thirty-six plots (2 km × 2 km) with paired aerial photographs taken circa 1994 and circa 2008 at a scale of 1:10,000 or larger were randomly selected from the 20 km × 20 km National Forest Inventory (NFI) grid. A spatially-explicit version of the Carbon Budget Model of the Canadian Forest Sector (CBM-CFS3) was used to estimate impacts of LUC on C stocks and fluxes. Polygons identifying areas of LUC within each photo plot were delineated, classified, and evaluated to provide input data for the model. The rate of C accumulation in our study area was found to be relatively constant over the entire simulation period, at 1.07 Mg C/ha/yr. Abandoned agricultural land reverting to woody lands could play an important role in regional and national C sequestration in Canada, but more research is required to quantify the areal extent of this LUC.

Stem Cell Spheroids and Ex Vivo Niche Modeling: Rationalization and Scaling-Up

Improved protocols/devices for in vitro culture of 3D cell spheroids may provide essential cues for proper growth and differentiation of stem/progenitor cells (S/PCs) in their niche, allowing preservation of specific features, such as multi-lineage potential and paracrine activity. Several platforms have been employed to replicate these conditions and to generate S/PC spheroids for therapeutic applications. However, they incompletely reproduce the niche environment, with partial loss of its highly regulated network, with additional hurdles in the field of cardiac biology, due to debated resident S/PCs therapeutic potential and clinical translation. In this contribution, the essential niche conditions (metabolic, geometric, mechanical) that allow S/PCs maintenance/commitment will be discussed. In particular, we will focus on both existing bioreactor-based platforms for the culture of S/PC as spheroids, and on possible criteria for the scaling-up of niche-like spheroids, which could be envisaged as promising tools for personalized cardiac regenerative medicine, as well as for high-throughput drug screening.

Evaluation of scaling-up of HPV self-collection offered by community health workers at home visits to increase screening among socially vulnerable under-screened women in Jujuy Province, Argentina

BACKGROUND

Self-collection has been proposed as a strategy to increase cervical screening coverage among hard-to-reach women. However, evaluations of the implementation of this strategy on a large scale are scarce. This paper describes the process and measurement of the scaling-up of self-collection offered by community health workers during home visits as a strategy to reach under-screened women aged 30+ with public health coverage, defined as the target women.

METHODS

We used an adaptation of the Health System Framework to analyze key drivers of scaling-up. A content analysis approach was used to collect and analyze information from different sources. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) model was used to evaluate the impact of the strategy.

RESULTS

HPV self-collection was scaled-up in the province of Jujuy in 2014 after a RCT (Self-collection Modality Trial, initials EMA in Spanish) was carried out locally in 2012 and demonstrated effectiveness of the strategy to increase screening uptake. Facilitators of scaling-up were the organizational capacity of the provincial health system, sustainable funding for HPV testing, and local consensus about the value of the technology. Reach: In 2014, 9% (2983/33,245) of target women were screened through self-collection in the Jujuy public health sector. Effectiveness: In 2014, 17% (n = 5657/33,245) of target women were screened with any HPV test (self-collected and clinician-collected tests) vs. 11.7% (4579/38,981) in 2013, the pre-scaling-up period (p < 0.0001).

IMPLEMENTATION

Training about the strategy was provided to 84.2% (n = 609/723) of total community health workers (CHWs). Of 414 HPV+ women, 77.5% (n = 320) had follow-up procedures. Of 113 women with positive triage, 66.4% (n = 75) had colposcopic diagnosis. Treatment was provided to 80.7% of CIN2+ women (n = 21/26). Adoption: Of trained CHWs, 69.3% (n = 422/609) had at least one woman with self-collection; 85.2% (n = 315/368) of CHWs who responded to an evaluation survey were satisfied with self-collection strategy. Maintenance: During 2015, 100.0% (723/723) CHWs were operational and 63.8% (461/723) had at least one woman with self-collection.

CONCLUSIONS

The strategy was successfully scaled-up, with a high level of adoption among CHWs, which resulted in increased screening among socially vulnerable under-screened women.

Utilizing a train-the-trainer model for multi-site naloxone distribution programs

BACKGROUND

In order to have a substantial impact on overdose prevention, the expansion and scaling-up of overdose prevention with naloxone distribution (OPEND) programs are needed. However, limited literature exists on the best method to train the large number of trainers needed to implement such initiatives.

METHODS

As part of a national overdose prevention strategy, widespread OPEND was implemented throughout multiple low-threshold facilities in Norway. Following a two-hour 'train-the trainer course' staff were able to distribute naloxone in their facility. The course was open to all staff, regardless of educational background. To measure the effectiveness of the course, a questionnaire was given to participants immediately before and after the session, assessing knowledge on overdoses and naloxone, as well as attitudes towards the training session and distributing naloxone.

RESULTS

In total, 511 staff were trained during 41 trainer sessions. During a two-month survey period, 54 staff participated in a questionnaire study. Knowledge scores significantly improved in all areas following the training (p<0.001). Attitude scores improved, and the majority of staff found the training useful and intended to distribute naloxone to their clients.

CONCLUSION

Large-scale naloxone distribution programs are likely to continue growing, and will require competent trainers to carry out training sessions. The train-the-trainer model appears to be effective in efficiently training a high volume of trainers, improving trainers' knowledge and intentions to distribute naloxone. Further research is needed to assess the long term effects of the training session, staffs' subsequent involvement following the trainer session, and knowledge transferred to the clients.

Scaling-up of a novel, simplified MFC stack based on a self-stratifying urine column

BACKGROUND

The microbial fuel cell (MFC) is a technology in which microorganisms employ an electrode (anode) as a solid electron acceptor for anaerobic respiration. This results in direct transformation of chemical energy into electrical energy, which in essence, renders organic wastewater into fuel. Amongst the various types of organic waste, urine is particularly interesting since it is the source of 75 % of the nitrogen present in domestic wastewater despite only accounting for 1 % of the total volume. However, there is a persistent problem for efficient MFC scale-up, since the higher the surface area of electrode to volume ratio, the higher the volumetric power density. Hence, to reach usable power levels for practical applications, a plurality of MFC units could be connected together to produce higher voltage and current outputs; this can be done by combinations of series/parallel connections implemented both horizontally and vertically as a stack. This plurality implies that the units have a simple design for the whole system to be cost-effective. The goal of this work was to address the built configuration of these multiple MFCs into stacks used for treating human urine.

RESULTS

We report a novel, membraneless stack design using ceramic plates, with fully submerged anodes and partially submerged cathodes in the same urine solution. The cathodes covered the top of each ceramic plate whilst the anodes, were on the lower half of each plate, and this would constitute a module. The MFC elements within each module (anode, ceramic, and cathode) were connected in parallel, and the different modules connected in series. This allowed for the self-stratification of the collective environment (urine column) under the natural activity of the microbial consortia thriving in the system. Two different module sizes were investigated, where one module (or box) had a footprint of 900 mL and a larger module (or box) had a footprint of 5000 mL. This scaling-up increased power but did not negatively affect power density (≈12 W/m(3)), a factor that has proven to be an obstacle in previous studies.

CONCLUSION

The scaling-up approach, with limited power-density losses, was achieved by maintaining a plurality of microenvironments within the module, and resulted in a simple and robust system fuelled by urine. This scaling-up approach, within the tested range, was successful in converting chemical energy in urine into electricity.

A review of pharmaceutical extrusion: critical process parameters and scaling-up

Hot melt extrusion has been a widely used process in the pharmaceutical area for three decades. In this field, it is important to optimize the formulation in order to meet specific requirements. However, the process parameters of the extruder should be as much investigated as the formulation since they have a major impact on the final product characteristics. Moreover, a design space should be defined in order to obtain the expected product within the defined limits. This gives some freedom to operate as long as the processing parameters stay within the limits of the design space. Those limits can be investigated by varying randomly the process parameters but it is recommended to use design of experiments. An examination of the literature is reported in this review to summarize the impact of the variation of the process parameters on the final product properties. Indeed, the homogeneity of the mixing, the state of the drug (crystalline or amorphous), the dissolution rate, the residence time, can be influenced by variations in the process parameters. In particular, the impact of the following process parameters: temperature, screw design, screw speed and feeding, on the final product, has been reviewed.