OpenSIMPLe: A real-world implementation feasibility study of a smartphone-based psychoeducation programme for bipolar disorder

BACKGROUND

Few evidence-based mental health apps are widely available to patients and, conversely, many of the available apps have not been appropriately evaluated. Given that the ultimate goal is to scale-up and open internet-based platforms (IBP), it is crucial to appropriately evaluate their real-world feasibility beforehand. We aimed to evaluate the implementation feasibility of a smartphone-based psychoeducational programme for bipolar disorder, exploring its long-term retention, usability, perceived helpfulness and satisfaction, alongside its impact on secondary health outcomes.

METHODS

Participants were recruited via the project website after completing an online screening questionnaire. They were requested to complete web-based questionnaires before using the app and after 6 months of use which included sociodemographic, illness and treatment variables, the world health organisation-five well-being index (WHO-5) and the short form health survey (SF-36). The follow-up questionnaires also contained satisfaction and usefulness questions.

RESULTS

201 participants took part in the study. According to their retention, 66.2% of the participants were classified as noncompleters and 33.8% as completers. The only predictor significantly associated with higher odds of retention was older age (OR = 1.021, p < 0.001). 62% of the users reported they were satisfied with the programme with a higher percentage among completers. Who-5 baseline and follow-up scores showed a significant improvement as well as 6 out of 8 domains of the SF-36.

LIMITATIONS

Screening and outcome measures were administered using exclusively self-reported online methods.

CONCLUSION

The 6-month attrition rate of the programme was high. Positive outcomes regarding satisfaction were found predominantly among completers. The optimal dosage and retention of IBP mental health programmes remain challenging issues that need further research.

Preparation of Bovine Serum Albumin (BSA) nanoparticles by desolvation using a membrane contactor: a new tool for large scale production

Albumin nanoparticles are attractive drug delivery systems as they can be prepared under soft conditions and incorporate several kinds of molecules. The aim of this study was to upscale the desolvation process for preparing Bovine Serum Albumin (BSA) nanoparticles using a membrane contactor. At a first step, the BSA nanoparticles were prepared at small scale using a syringe pump. BSA nanoparticles of 139 nm in size, with a polydispersity index of 0.046, were obtained at the optimal conditions: pH 8.2, 100 mg mL(-1) BSA albumin solution (2 mL), and 1 mL min(-1) flow rate of ethanol addition (8 mL). The upscaling with a membrane contactor was achieved by permeating ethanol through the pores of a Shirasu Porous Glass (SPG Technology Co., Japan) membrane and circulating the aqueous phase tangentially to the membrane surface. By increasing the pressure of the ethanol from 1 to 2.7 bars, a progressive decrease in nanoparticle size was obtained with a high nanoparticles yield (around 94-96%). In addition, the flow rate of the circulating phase did not affect the BSA nanoparticle characteristics. At the optimal conditions (pH 8.2, 100 mg mL(-1) BSA albumin solution, pressure of ethanol 2.7 bars, flow rate of the circulating phase 30.7 mL s(-1)), the BSA nanoparticles showed similar characteristics to those obtained with the syringe pump. Large batches of BSA nanoparticles were prepared up to 10 g BSA. The BSA nanoparticles were stable at least during 2 months at 4 °C, and their characteristics were reproducible. It was then concluded that the membrane contactor technique could be a suitable method for the preparation of albumin nanoparticles at large scale with properties similar to that obtained at small scale.

A description of health care system factors in the implementation of universal weight management services for children with overweight or obesity: case studies from Queensland and New South Wales, Australia

Background

The prevalence of childhood obesity poses an urgent global challenge. The World Health Organization (WHO) Commission on Ending Childhood Obesity recommends the provision of appropriate family-based, lifestyle weight management services through universal health care to support families of children with overweight or obesity; however, there are few examples of their implementation ‘at scale’. The purpose of this research was to compare and contrast the impact of system and organisational factors on the implementation of childhood obesity management services within two Australian States (New South Wales and Queensland) to comprehensively describe their influence on the achievement of the WHO recommendation.

Methods

Purposeful stratified sampling was used to select health service study sites (n = 16) representative of program implementation (none, discontinued, repeated) and geographic location within each State. Within each health service site, staff involved in program delivery, co-ordination and management roles participated (n = 39). An additional 11 staff involved in implementation at State level also participated. The Consolidated Framework for Implementation Research (CFIR) was used to develop interview scripts. Telephone interviews were recorded and transcribed. Transcripts were thematically coded and scored according to CFIR constructs and rating rules to identify enablers and barriers to implementation according to sample characteristics.

Results

New South Wales achieved ongoing implementation; Queensland did not. Enablers included a quality evidence-based program, State government recognition of the urgency of the health issue and a commitment to address it, formally appointed and funded internal implementation leaders, strong communication and reporting at all levels. Barriers included the complexity of the health issue, in particular a lack of clear roles and responsibilities for local health service delivery, inadequate ongoing funding and challenges in meeting the diverse needs of families.

Conclusions

This research is an important progression of the evidence base in relation to the translation of childhood obesity management trials into routine health service delivery. Understanding enablers and barriers to program implementation ‘at scale’ is imperative to inform future planning and investment by Australia and WHO member states to meet their commitment to deliver childhood weight management services as part of universal health coverage.

Electronic supplementary material

The online version of this article (10.1186/s13012-018-0801-2) contains supplementary material, which is available to authorized users.

A re-usable wave bioreactor for protein production in insect cells

Wave-mixed bioreactors have increasingly replaced stainless steel stirred tank reactors in seed inoculum productions and mammalian cell-based process developments. Pre-sterilized, single-use plastic bags are used for cultivation, eliminating the risk of cross-contamination and cleaning procedures. However, these advantages come with high consumable costs which is the main barrier to more uptakes of the technology by academic institutions. As an academic Core Facility that faces high demand in protein production from insect cells, we have therefore developed a cost-effective alternative to disposable wave bags. In our study we identified: •A re-usable wave shaken polycarbonate bioreactor for protein production in insect cells achieves protein yields comparable to disposable bags.•The advantages of this re-usable bioreactor are low costs, long life cycle, flexible configuration of accessories and convenient handling due to its rigid shape.

Cloning and upscale production of monoamine oxidase N (MAO-N D5) by Pichia pastoris

OBJECTIVE

To clone monoamine oxidase N, that catalyses the selective oxidative deamination or deracemisation of amines into imines, in Pichia pastoris and prove the importance of choosing the proper expression system for its recombinant production.

RESULTS

Monoamine oxidase, originating from Aspergillus niger and subjected to directed evolution (MAO-N D5), was cloned and expressed in Pichia pastoris CBS7435 Mut^S strain for the first time. Various transformants were screened at microscale level. The production of the clone expressing the most active enzyme was scaled-up to a 1.5 l fermenter and preparation of MAO-N D5 as a crude enzyme extract was optimised. The obstacles in the production of the enzyme in both expression systems, Escherichia coli and P. pastoris, are discussed and demonstrated.

CONCLUSIONS

There was an improvement in specific productivity, which was 83 times higher in P. pastoris, clearly proving the importance of choosing the right expression host system for the specific enzymes.

Incremental high pressure torsion as a novel severe plastic deformation process: Processing features and application to copper

High pressure torsion is known as one of the most popular severe plastic deformation processes. However, it has certain size limitations, especially regarding the thickness of the processed samples. In this contribution incremental high pressure torsion is introduced as a novel severe plastic deformation process. This further development of conventional high pressure torsion is capable of delivering specimens having an extraordinarily high aspect-ratio of thickness to diameter. The features of this process combined with a case-study on a pure copper specimen with a deformed diameter of 50 mm and a thickness of 40 mm is presented.

Upscaling irradiation protocols of Aedes albopictus pupae within an SIT program in Reunion Island

The implementation of the sterile insect technique against Aedes albopictus relies on many parameters, in particular on the success of the sterilization of males to be released into the target area in overflooding numbers to mate with wild females. Achieving consistent sterility levels requires efficient and standardized irradiation protocols. Here, we assessed the effects of exposure environment, density of pupae, irradiation dose, quantity of water and location in the canister on the induced sterility of male pupae. We found that the irradiation of 2000 pupae in 130 ml of water and with a dose of 40 Gy was the best combination of factors to reliably sterilize male pupae with the specific irradiator used in our control program, allowing the sterilization of 14000 pupae per exposure cycle. The location in the canister had no effect on induced sterility. The results reported here allowed the standardization and optimization of irradiation protocols for a Sterile Insect Technique program to control Ae. albopictus on Reunion Island, which required the production of more than 300,000 sterile males per week.

Enhanced nutrient removal in agro-industrial wastes-amended hybrid floating treatment wetlands treating real sewage: Laboratory microcosms to field-scale studies

The use of natural agro-industrial materials as suspended fillers (SFs) in floating treatment wetlands (FTWs) to enhance nutrient removal performance has recently been gaining significant attention. However, the knowledge concerning the nutrient removal performance enhancement by different SFs (alone and in mixtures) and the major removal pathways is so far inadequate. The current research, for the first time, carried out a critical analysis using five different natural agro-industrial materials (biochar, zeolite, alum sludge, woodchip, flexible solid packing) as SFs in various FTWs of 20 L microcosm tanks, 450 L outdoor mesocosms, and a field-scale urban pond treating real wastewater over 180 d. The findings demonstrated that the incorporation of SFs in FTWs enhanced the removal performance of total nitrogen (TN) by 20-57% and total phosphorus (TP) by 23-63%. SFs further enhanced macrophyte growth and biomass production, leading to considerable increases in nutrient standing stocks. Although all the hybrid FTWs showed acceptable treatment performances, FTWs set up with mixtures of all five SFs significantly enhanced biofilm formation and enriched the abundances of the microbial community related to nitrification and denitrification processes, supporting the detected excellent N retention. N mass balance assessment demonstrated that nitrification-denitrification was the major N removal pathway in reinforced FTWs, and the high removal efficiency of TP was attributable to the incorporation of SFs into the FTWs. Nutrient removal efficiencies ranked in the following order among the various trials: microcosm scale (TN: 99.3% and TP: 98.4%) > mesocosm scale (TN: 84.0% and TP: 95.0%) > field scale (TN: -15.0-73.7% and TP: -31.5-77.1%). These findings demonstrate that hybrid FTWs could be easily scaled up for the removal of pollutants from eutrophic freshwater systems over the medium term in an environmentally-friendly way in regions with similar environmental conditions. Moreover, it demonstrates hybrid FTW as a novel way of disposing of significant quantities of wastes, showing a win-win means with a huge potential for large-scale application.