The ultimate impact of a health innovation depends not only on its effectiveness but also on its reach in the population and the extent to which it is implemented with high levels of completeness and ...fidelity. Implementation science has emerged as the potential solution to the failure to translate evidence from research into effective practice and policy evident in many fields. Implementation scientists have developed many frameworks, theories and models, which describe implementation determinants, processes, or outcomes; yet, there is little guidance about how these can inform the development or selection of implementation strategies (methods or techniques used to improve adoption, implementation, sustainment, and scale-up of interventions) (1, 2). To move the implementation science field forward and to provide a practical tool to apply the knowledge in this field, we describe a systematic process for planning or selecting implementation strategies: Implementation Mapping.
Implementation Mapping is based on Intervention Mapping (a six-step protocol that guides the design of multi-level health promotion interventions and implementation strategies) and expands on Intervention Mapping step 5. It includes insights from both the implementation science field and Intervention Mapping. Implementation Mapping involves five tasks: (1) conduct an implementation needs assessment and identify program adopters and implementers; (2) state adoption and implementation outcomes and performance objectives, identify determinants, and create matrices of change objectives; (3) choose theoretical methods (mechanisms of change) and select or design implementation strategies; (4) produce implementation protocols and materials; and (5) evaluate implementation outcomes. The tasks are iterative with the planner circling back to previous steps throughout this process to ensure all adopters and implementers, outcomes, determinants, and objectives are addressed.
Implementation Mapping provides a systematic process for developing strategies to improve the adoption, implementation, and maintenance of evidence-based interventions in real-world settings.
Dams are important water-resisting structures prone to failure, causing huge economic and environmental losses. Traditionally, a dam failure is identified using the failure mode and effect analysis. ...This approach analyzes both the dam failure path (the specific effect chain of the failure mode) and the damage degree, by identifying and sorting the severity caused by the dam failure path. However, this analysis can be misleading since the relationship among the failure paths is not considered. To account for this, the DEMATEL method is used to modify the evaluation result of the severity of the failure consequence, caused by the dam failure path. Based on the fuzzy mathematics and VIKOR method, a dam failure path identification method is established, and then the dam failure paths are identified and sorted for a case study: gravity dam located at the junction of Yibin County (China). According to results, the two top initial failure paths were insufficient design of upstream anti-seepage (R6) or defective water-tight screen and corrosion (R7).
Multilevel factors impact HPV vaccine series initiation and completion among adolescents in the U.S. Synthesis of these factors is needed to inform intervention development and to direct future ...research. Current frameworks synthesizing factors focus on females only and do not include both series initiation and completion outcomes. We conducted a systematic review of reviews to identify modifiable individual-, provider-, and clinic-level factors associated with HPV vaccination outcomes among U.S. adolescents and developed a multilevel framework illustrating relations between factors to inform intervention development. We searched Medline, PsychInfo, Pubmed, CINAHL, and ERIC databases and included reviews published 2006 to July 2, 2018 describing individual-, provider-, or clinic-level factors quantitatively associated with HPV vaccination among U.S. adolescents. Two coders independently screened reviews, extracted data, and determined quality ratings. Sixteen reviews containing 481 unique primary studies met criteria. Factors synthesized into the multilevel framework included parent psychosocial factors (knowledge, beliefs, outcome expectations, intentions) and behaviors, provider recommendation, and patient-targeted and provider-targeted clinic systems. The scope of our framework and review advances research in two key ways. First, the framework illustrates salient modifiable factors at multiple levels on which to intervene to increase HPV vaccination. Second, the review identified critical gaps in the literature at each level. Future research should link the body of literature on parental intentions to vaccination outcomes, identify provider psychosocial factors associated with recommendation behaviors and subsequent vaccine uptake in their patient population, and understand clinic factors associated with successful implementation of patient- and provider-targeted system-level interventions.
•Provider recommendation consistently associated with adolescent HPV vaccine uptake•Provider- and clinic-level factors most important for series completion•Research needed to identify provider-level factors associated with recommendation•Research needed on implementation strategies for effective clinic-level systems
This is a study on the tribological behaviour of ZnO nanoparticles as an additive to a polyalphaolefin (PAO6) and on the influence of dispersing agents (OL100 and OL300). Anti-wear tests were run on ...a Falex Roxana four-ball machine and EP properties were obtained using a Stanhope Seta Shell Four-Ball EP Lubricant Tester. Ensuing SEM and EDS analysis of the worn surface highlighted a number of conclusions: OL300 has better dispersant properties than OL100; OL100 and OL300 are potentially useful as wear reducer additives in PAO6; formation of aggregates was found for 1 and 1.5% of ZnO in PAO6
+
3% OL300 suspension, and these non-coated ZnO nanoparticles had an abrasive behaviour in the AW region, despite their lower hardness compared to steel surfaces; ZnO nanoparticles do not act as anti-wear agent under certain conditions but in EP conditions, from the initial seizure load, they decrease wear; the EP behaviour improvement of PAO6
+
1% OL300
+
ZnO mixtures was related to the increase of ZnO nanoparticle concentration and their surface deposition on the wear scar surface; PAO6
+
3% OL300
+
0.3% ZnO displayed the best EP behaviour in PAO6
+
3% OL300
+
ZnO mixtures, while PAO6
+
3% OL300
+
1% ZnO and PAO6
+
3% OL300
+
3% ZnO were worse, despite Zn deposition on the wear scar surface.
6-Phosphofructo-2-kinase/fructose-2,6-bisphosphatase-3 (PFKFB3) is a master regulator of glycolysis by its ability to synthesize fructose-2,6-bisphosphate, a potent allosteric activator of ...6-phosphofructo-1-kinase. Being a substrate of the E3 ubiquitin ligase anaphase-promoting complex-Cdh1 (APC(Cdh1)), PFKFB3 is targeted to proteasomal degradation in neurons. Here, we show that activation of N-methyl-D-aspartate subtype of glutamate receptors (NMDAR) stabilized PFKFB3 protein in cortical neurons. Expressed PFKFB3 was found to be mainly localized in the nucleus, where it is subjected to degradation; however, expression of PFKFB3 lacking the APC(Cdh1)-targeting KEN motif, or following NMDAR stimulation, promoted accumulation of PFKFB3 and its release from the nucleus to the cytosol through an excess Cdh1-inhibitable process. NMDAR-mediated increase in PFKFB3 yielded neurons having a higher glycolysis and lower pentose-phosphate pathway (PPP); this led to oxidative stress and apoptotic neuronal death that was counteracted by overexpressing glucose-6-phosphate dehydrogenase, the rate-limiting enzyme of the PPP. Furthermore, expression of the mutant form of PFKFB3 lacking the KEN motif was sufficient to trigger oxidative stress and apoptotic death of neurons. These results reveal that, by inhibition of APC(Cdh1), glutamate receptors activation stabilizes PFKFB3 thus switching neuronal metabolism leading to oxidative damage and neurodegeneration.
Introduction
Relapse prevention is a key objetive for patients with a First Episode Psychosis (FEP) and the low adherence to antipsychotic (AP) treatment is the main reason for relapse after a FEP.
...Objectives
There are no clear recommendations about the early use of long-acting injectables (LAIs) in FEP. We review the impact on hospitalization rates of the early use (earlier than 1 year after the inclusion in our Early Intervention Service “Lehenak”) of LAI paliperidone in a FEP sample.
Methods
We evaluated in a naturalistic study a sample (N=384) of patients with a FEP. We carried out a mirror-design study to compare the numer of hospitalizations before and after the introduction of LAI paliperidone (1 and 3 monthly) in early users (<1 year) vs late users (>1 year).
Results
A total of 384 FEP patients with LAI paliperidone were assessed.
Early Paliperidone LAI (n=201)
Late Paliperidone LAI (n=173)
Within groups comparisons t (p)
Hospitalizations pre-LAI mirror period (media, standard deviation)
1.76 (1.97)
2.22 (2.60)
1,87 (0.06)
Days in hospital pre-LAI mirror period
21.42 (28.28)
28.02 (38.27)
1.87 (0.06)
Hospitalizations post-LAI mirror period
0.68 (1.61)
0.80 (1.74)
0.73 (0.46)
Days in hospital post-LAI mirror period
15.17 (40.58)
18.78 (45.24)
0.81 (0.42)
Conclusions
There was no difference between the early and late introduction of LAI Paliperidone in the number of hospitalizations after treatament. There was a trend to present more previous hospitalizations and days in hospital in late users. This could support an earlier use of paliperidone LAI to prevent an excess of hospitalizations due to late introduction.
Disclosure
The presenting author has received honouraria for lectures or advisory boards from Janssen, Otsuka, Lundbeck and Angelini in the last five years.
We report on trends in anaphylaxis admissions in the Spanish hospital system during the period 1998–2011. Data on admissions for anaphylaxis were obtained from the Spanish Information System for ...Hospital Data for the period 1998–2011. Patients were selected using the codes for anaphylaxis in the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM). Poisson regression models were used to estimate incidence rate ratios. We recorded a 1.89‐fold increase in admissions for anaphylaxis in Spanish hospitals during the study period, particularly in patients aged 0–14 years (1.65‐ to 3.22‐fold until 2009 and 4.09‐ to 12.59‐fold until 2011) and in food anaphylaxis in all age groups (2.78‐fold until 2009 and 8.74‐fold until 2011). The incidence of anaphylaxis is perceived as having increased in recent years, especially anaphylaxis caused by food and anaphylaxis affecting the pediatric population.
Summary
This study examines the association of the levels of different airborne pollutants on the incidence of osteoporotic hip fracture in a southern European region. Association was detected ...between SO
2
and NO
2
and hospital admissions due to hip fracture.
Introduction
To examine the short-term effects of outdoor air pollution on the incidence of osteoporotic hip fracture in a southern European region.
Methods
This is an ecological retrospective cohort study based on data obtained from three databases. In a time-series analysis, we examined the association between hip fracture incidence and different outdoor air pollutants (sulfur dioxide (SO
2
), monoxide (NO), nitrogen dioxide (NO
2
), ozone (O
3
), and particulate matter in suspension < 2.5 (PM
2.5
) and < 10-μm (PM
10
) conditions by using general additive models (Poisson distribution). The incidence rate ratio (IRR), crude and adjusted by season and different weather conditions, was estimated for all parameters. Hip incidence was later analyzed by sex and age (under or over age 75) subgroups. The main outcome measure was daily hospital admissions due to fracture.
Results
Hip fracture incidence showed association with SO
2
(IRR 1.11 (95% CI 1.04–1.18)), NO (IRR 1.01 (95% CI 1.01–1.02)), and NO
2
(IRR 1.02 (95% CI 1.01–1.04)). For O
3
levels, this association was negative (IRR 0.97 (95% CI 0.95–0.99)). The association persisted for SO
2
and NO
2
when the models were adjusted by season. After adjusting by season and weather conditions, the association persisted for NO
2
. When participants were stratified by age and sex, associations persisted only in women older than 75 years.
Conclusions
A short-term association was observed with several indicators of air pollution on hip fracture incidence. This is the first study that shows these associations.
► We analyzed the influence aeration on the pectianse and xylanase production. ► Respirometric quotient (RQ) was established according each carbon source consumed. ► RQ is not constant along the ...fermentation due to different carbon source employed. ► Kinetics parameters behavior depends of carbon source consumed from solid matrix. ► Productivities pattern for biomass and both enzymes was established.
Solid-state fermentation (SSF) is defined as the growth of microbes without a free-flowing aqueous phase. The feasibility of using a citrus peel for producing pectinase and xylanase via the SSF process by Aspergillus niger F3 was evaluated in a 2kg bioreactor. Different aeration conditions were tested to optimize the pectinase and xylanase production. The best air flow intensity was 1VkgM (volumetric air flow per kilogram of medium), which allowed a sufficient amount of O2 for the microorganism growth producing 265U/g and 65U/g pectinases and xylanases, respectively. A mathematical model was applied to determine the different kinetic parameters related to SSF. The specific growth rate and biomass oxygen yield decreased during fermentation, whereas an increase in the maintenance coefficient for the different employed carbon sources was concurrently observed.
Background & Aims There is not a consensus on the best irrigation approach for super-high density (SHD) olive orchards. Our aim was to design and test a regulated deficit irrigation (RDI) strategy ...for a sustainable balance between water saving, tree vigour and oil production. Methods We tested our RDI strategy for 3 years in an 'Arbequina' orchard with 1,667 trees ha⁻¹. Two levels of irrigation reduction were applied, 60RDI and 30RDI, scaled to replacing 60 % and 30 %, respectively, of the of irrigation needs (IN). We also had a full irrigation (FI) treatment as control, with IN totalling 4,701 m³ ha⁻¹ Results The 30RDI treatment showed the best balance between water saving, tree vigour and oil production. With a yearly irrigation amount (IA) of 1,366 m³ ha⁻¹, which meant 72 % water saving as compared to FI, the reduction in oil yield was 26 % only. Conclusions Our results, together with recent knowledge on the effect of water stress on fruit development, allowed us to suggest a potentially improved RDI strategy for which a total IA of ca. 2,100 m³ ha⁻¹ was calculated. Both some management details and the benefits of this suggested RDI strategy are still to be tested.
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