Study on flavor quality formation in green and yellow tea processing by means of UPLC-MS approach

Yellow tea (YT) has an additional process of yellowing before or after rolling than green tea (GT), making YT sweeter. We analyzed the variations of composition and taste throughout the withering, fixing and rolling steps using UPLC-MS/MS and sensory evaluation, and investigated the influence of various yellowing times on flavor profile of YT. 532 non-volatile metabolites were identified. Withering and fixing were the important processes to form the taste quality of GT. Withering, fixing and yellowing were important processes to form flavor profile of YT. Withering mainly regulated bitterness and astringency, and fixing mainly regulated bitterness, astringency and sweetness of YT and GT. Yellowing mainly regulated sweetness of YT. Trans-4-hydroxy-L-proline and glutathione reduced form as the key characteristic components of YT, increased significantly during yellowing mainly through Arginine and proline metabolism and ABC transporters. The paper offers a systematic insight into intrinsic mechanisms of flavor formation in YT and GT.

Cognitive flexibility and resilience measured through a residual approach

BACKGROUND AND OBJECTIVES

Resilience refers to the process through which individuals show better outcomes than what would be expected based on the adversity they experienced. Several theories have proposed that variation in resilience is underpinned by cognitive flexibility, however, no study has investigated this using an outcome-based measure of resilience.

DESIGN

We used a residual-based approach to index resilience, which regresses a measure of mental health difficulties onto a measure of adversity experienced. The residuals obtained from this regression constitute how much better or worse someone is functioning relative to what is predicted by the adversity they have experienced.

METHODS

A total of 463 undergraduate participants completed questionnaires of mental health difficulties and adversity, as well as a number-letter task-switching task to assess cognitive flexibility.

RESULTS

Multiple regression analyses showed that better cognitive flexibility was not associated with greater resilience.

CONCLUSIONS

Our findings do not support theoretical models that propose the existence of a relationship between cognitive flexibility and resilience. Future research may serve to refine the residual-based approach to measure resilience, as well as investigate the contribution of "hot" rather than "cold" cognitive flexibility to individual differences in resilience.

Demystifying Fogging in Lyophilized Products: Impact of Pharmaceutical Processing

A commonly encountered challenge with freeze-dried drug products is glass vial fogging. Fogging is characterized by a thin layer of product deposited upon the inner surface of the vial above the lyophilized cake. While considered to be a routine cosmetic defect in many instances, fogging around the shoulder and neck of the vial may potentially impact container closure integrity and reject rates during inspection. In this work, the influence of processing conditions i.e. vial pre-treatment, lyophilization cycle modifications and filling conditions on fogging was evaluated. A battery of analytical techniques was employed to investigate factors affecting glass vial fogging. A fogging score was used to quantify its severity in freeze-dried products. Additionally, a dye-based method was used to study solution upcreep (Marangoni flow) following product filling. Our lab-scale results indicate measurable improvement in fogging following the addition of an annealing step in the lyophilization cycle. Pre-freeze isothermal holding of the vials (at 5°C on the lyophilizer shelf) for an extended duration indicated a reduction in fogging whereas an increase in the freezing time exhibited no effect on fogging. Vial pre-treatment conditions were critical determinants of fogging for Type 1 vials whereas they had no impact on fogging in TopLyo® vials. The headspace relative humidity (RH) investigation also indicated sufficient increase in the water vapor pressure inside the vial to be conducive to the formulation of a hydration film - the precursor to Marangoni flow.

Impact of reimbursement systems on patient care - a systematic review of systematic reviews

BACKGROUND

There is not yet sufficient scientific evidence to answer the question of the extent to which different reimbursement systems influence patient care and treatment quality. Due to the asymmetry of information between physicians, health insurers and patients, market-based mechanisms are necessary to ensure the best possible patient care. The aim of this study is to investigate how reimbursement systems influence multiple areas of patient care in form of structure, process and outcome indicators.

METHODS

For this purpose, a systematic literature review of systematic reviews is conducted in the databases PubMed, Web of Science and the Cochrane Library. The reimbursement systems of salary, bundled payment, fee-for-service and value-based reimbursement are examined. Patient care is divided according to the three dimensions of structure, process, and outcome and evaluated in eight subcategories.

RESULTS

A total of 34 reviews of 971 underlying primary studies are included in this article. International studies identified the greatest effects in categories resource utilization and quality/health outcomes. Pay-for-performance and bundled payments were the most commonly studied models. Among the systems examined, fee-for-service and value-based reimbursement systems have the most positive impact on patient care.

CONCLUSION

Patient care can be influenced by the choice of reimbursement system. The factors for successful implementation need to be further explored in future research.

Hanford low-activity waste vitrification: A review

This paper summarizes the vast body of literature (over 200 documents) related to vitrification of the low-activity waste (LAW) fraction of the Hanford tank wastes. Details are provided on the origins of the Hanford tank wastes that resulted from nuclear operations conducted between 1944 and 1989 to support nuclear weapons production. Waste treatment processes are described, including the baseline process to separate the tank waste into LAW and high-level waste fractions, and the LAW vitrification facility being started at Hanford. Significant focus is placed on the glass composition development and the property-composition relationships for Hanford LAW glasses. Glass disposal plans and criteria for minimizing long-term environmental impacts are discussed along with research perspectives.

A survey regarding the organizational aspects and quality systems of in-house 3D printing in oral and maxillofacial surgery in Germany

PURPOSE

The aim of the study was to get a cross-sectional overview of the current status of specific organizational procedures, quality control systems, and standard operating procedures for the use of three-dimensional (3D) printing to assist in-house workflow using additive manufacturing in oral and maxillofacial surgery (OMFS) in Germany.

METHODS

An online questionnaire including dynamic components containing 16-29 questions regarding specific organizational aspects, process workflows, quality controls, documentation, and the respective backgrounds in 3D printing was sent to OMF surgeons in university and non-university hospitals as well as private practices with and without inpatient treatment facilities. Participants were recruited from a former study population regarding 3D printing; all participants owned a 3D printer and were registered with the German Association of Oral and Maxillofacial Surgery.

RESULTS

Sixty-seven participants answered the questionnaires. Of those, 20 participants ran a 3D printer in-unit. Quality assurance measures were performed by 13 participants and underlying processes by 8 participants, respectively. Standard operating procedures regarding computer-aided design and manufacturing, post-processing, use, or storage of printed goods were non-existent in most printing units. Data segmentation as well as computer-aided design and manufacturing were conducted by a medical doctor in most cases (n = 19, n = 18, n = 8, respectively). Most participants (n = 8) stated that "medical device regulations did not have any influence yet, but an adaptation of the processes is planned for the future."

CONCLUSION

The findings demonstrated significant differences in 3D printing management in OMFS, especially concerning process workflows, quality control, and documentation. Considering the ever-increasing regulations for medical devices, there might be a necessity for standardized 3D printing recommendations and regulations in OMFS.

Ecological time lags in biodiversity response to habitat changes

The decline of biodiversity can occur with a substantial delay following habitat loss, degradation, and other environmental changes, such as global warming. Considerable time lags may be involved in these responses. However, such time lags typically pose a significant but often unrecognized challenge for biodiversity conservation across a wide range of taxa and ecosystems. Here, we synthesize the current knowledge, categories, manifestations under different scenarios and impacts of ecological time lags. Our work reveals that studies on ecosystem structure lags are far more than ecosystem process and function lags. Due to the presence of these time-lag effects, the 'window phase' typically exists, which is widely recognized as 'relaxation time', providing a particular opportunity for biodiversity conservation. The manifestations of time lags vary under different scenarios. In addition, the different mechanisms that can result in ecological time lags are hierarchically nested, in which mechanisms at the population and metapopulation level have routinely been suggested as explanations for ecological time lags. It generally takes longer time to reach equilibrium at the metapopulation level than it takes for effects to be fully expressed at the level of individuals. Finally, we propose corresponding implications for biodiversity conservation and management. Our research will provide priorities for science and management on how to address the impact of ecological time lags to mitigate future attrition of biodiversity.

Content and Process of Adolescent Suicide Ideation: Implications for Risk Assessment

This study examined differences in the content and process of suicide ideation between adolescents presenting with recent suicide ideation or a suicide attempt in clinical settings. Across two combined study samples, adolescents (N = 229; 79% female; 73% Hispanic/Latine), ages 12-19, presenting with a recent suicide attempt, recent suicide ideation with a past suicide attempt history, or recent suicide ideation with no past suicide attempt history were interviewed in detail about the process and content of their suicide ideation. The group with suicide ideation and a past suicide attempt more often reported that their recent ideation lasted greater than 4 h compared to those with suicide ideation but no past suicide attempt history. The suicide attempt group more often considered ingestion as their first method of attempt, compared to the other two suicide ideation groups, and less often considered "other" methods (e.g., jumping from a height or onto train/traffic, hanging). Wish to die was lower in the ideation-only group, compared to both other groups. Separate analyses from Study 2 suggested that the majority of adolescents' suicide ideation contained imagery; however, a higher proportion of adolescents with suicide ideation and a past suicide attempt reported imagery in their ideation than those with ideation but no past attempt. Understanding what adolescents think about when they consider suicide and how they think about it may be informative about risk of a suicide attempt.

Behaviors and mechanisms of microbially-induced corrosion in metal-based water supply pipelines: A review

Microbially-induced corrosion (MIC) is unstoppable and extensively spread throughout drinking water distribution systems (DWDSs) as the cause of pipe leakage and deteriorating water quality. For maintaining drinking water safety and reducing capital inputs in pipe usage, the possible consequences from MIC in DWDSs is still a research hotspot. Although most studies have investigated the effects of changing environmental factors on MIC corrosion, the occurrence of MIC in DWDSs has not been discussed sufficiently. This review aims to fill this gap by proposing that the formation of deposits with microbial capture may be a source of MIC in newly constructed DWDSs. The microbes early attaching to the rough pipe surface, followed by chemically and microbially-induced mineral deposits which confers resistance to disinfectants is ascribed as the first step of MIC occurrence. MIC is then activated in the newly-built, viable, and accessible microenvironment while producing extracellular polymers. With longer pipe service, oligotrophic microbes slowly grow, and metal pipe materials gradually dissolve synchronously with electron release to microbes, resulting in pipe-wall damage. Different corrosive microorganisms using pipe material as a reaction substrate would directly or indirectly cause different types of corrosion. Correspondingly, the formation of scale layers may reflect the distribution of microbial species and possibly biogenic products. It is therefore assumed that the porous and loose layer is an ideal microbial-survival environment, capable of providing diverse and sufficient ecological niches. The usage and chelation of metabolic activities and metabolites, such as acetic, oxalic, citric and glutaric acids, may lead to the formation of a porous scale layer. Therefore, the microbial interactions within the pipe scale reinforce the stability of microbial communities and accelerate MIC. Finally, a schematic model of the MIC process is presented to interpret MIC from its onset to completion.

Is Acceptance and Commitment Therapy Effective for Any Obsessive-Compulsive Symptom Dimensions?

OBJECTIVE

Acceptance and commitment therapy (ACT) has been recently introduced for treating obsessive-compulsive disorder (OCD). Although there are data supporting the efficacy of ACT, only few studies have investigated the effectiveness of ACT against any obsessivecompulsive (OC) symptom dimension or a specific dimension alone.

METHODS

In total, 64 patients with OCD received an 8-session ACT group program. All measures were evaluated before and after treatment. The Dimensional Obsessive-Compulsive Scale was used to assess OCD severity across the four empirically supported symptom dimensions (i.e., contamination, responsibility for harm, unacceptable thoughts, and symmetry). ACT processes were evaluated using the Acceptance and Action Questionnaire-II (AAQ-II), Acceptance and Action Questionnaire for Obsessions and Compulsions (AAQOC), and Cognitive Fusion Questionnaire.

RESULTS

After an 8-week program, there were significant reductions in all four OC symptom dimensions after ACT. The unacceptable thoughts and contamination domains had medium effect size. The responsibility for harm and symmetry dimensions had small effect size. The unacceptable thoughts dimension was significantly correlated with all ACT process measures. The symmetry dimension was significantly correlated with AAQ-OC and AAQ-II scores while the responsibility for harm dimension was correlated with AAQ-II alone. However, the contamination dimension was not associated with any process measures.

CONCLUSION

ACT may be effective for managing all four symptom dimensions with small to moderate effect size. Moreover, depending on the symptom dimension, there may be different relationship patterns between symptom reduction and changes in ACT processes.

[Patient-centered vs. employee-centered radiology : Does this pose a conflict?]

BACKGROUND

Patient-centered radiology and employee-centered radiology are being increasingly discussed as an extension of the established structure- and process-oriented management perspective. Concerning potential conflicts, it is unclear if and how these approaches should best be implemented in a radiology department.

OBJECTIVE

The aim of this narrative review is to identify and critically correlate underlying characteristics of patient-centered and employee-centered approaches including their similarities, conflicts, and synergies as applicable to the radiological work environment.

MATERIALS AND METHODS

Based on a literature search using PubMed, Scopus, Web of Science, and Google Scholar, the current body of knowledge regarding patient- and employee-centered radiology is presented.

RESULTS

Patient- and employee-centered radiology focus on the individual needs of patients and employees, respectively, and promise to improve patient satisfaction, healthcare outcomes, and organizational performance. Conflicts result from an increased organizational complexity and the concurrent utilization of limited resources, such as time, money, and staff. Overall, however, synergies outweigh the potential conflicts.

CONCLUSIONS

Successful implementation of patient- and employee-centered approaches in radiology requires a human-centered leadership approach and an overarching strategy with the execution of specific interventions in the processes. We provide specific recommendations to this effect.

Implementation of PM-JAY in India: a qualitative study exploring the role of competency, organizational and leadership drivers shaping early roll-out of publicly funded health insurance in three Indian states

BACKGROUND

The Pradhan Mantri Jan Arogya Yojana (PM-JAY), a publicly funded health insurance scheme, was launched in India in September 2018 to provide financial access to health services for poor Indians. PM-JAY design enables state-level program adaptations to facilitate implementation in a decentralized health implementation space. This study examines the competency, organizational, and leadership approaches affecting PM-JAY implementation in three contextually different Indian states.

METHODS

We used a framework on implementation drivers (competency, organizational, and leadership) to understand factors facilitating or hampering implementation experiences in three PM-JAY models: third-party administrator in Uttar Pradesh, insurance in Chhattisgarh, and hybrid in Tamil Nadu. We adopted a qualitative exploratory approach and conducted 92 interviews with national, state, district, and hospital stakeholders involved in program design and implementation in Delhi, three state capitals, and two anonymized districts in each state, between February and April 2019. We used a deductive approach to content analysis and interpreted coded material to identify linkages between organizational features, drivers, and contextual elements affecting implementation.

RESULTS AND CONCLUSION

PM-JAY guideline flexibilities enabled implementation in very different states through state-adapted implementation models. These models utilized contextually relevant adaptations for staff and facility competencies and organizational and facilitative administration, which had considerable scope for improvement in terms of recruitment, competency development, programmatic implementation support, and rationalizing the joint needs of the program and implementers. Adaptations also created structural barriers in staff interactions and challenged implicit power asymmetries and organizational culture, indicating a need for aligning staff hierarchies and incentive structures. At the same time, specific adaptations such as decentralizing staff selection and task shifting (all models); sharing of claims processing between the insurer and state agency (insurance and hybrid model); and using stringent empanelment, accreditation, monitoring, and benchmarking criteria for performance assessment, and reserving secondary care benefit packages for public hospitals (both in the hybrid model) contributed to successful implementation. Contextual elements such as institutional memory of previous schemes and underlying state capacities influenced all aspects of implementation, including leadership styles and autonomy. These variations make comparisons across models difficult, yet highlight constraints and opportunities for cross-learning and optimizing implementation to achieve universal health coverage in decentralized contexts.

From outcome to process: A developmental shift in judgments of good reasoning

What does it mean to reason well? One might argue that good reasoning means that the outcome of the reasoning process is correct: reaching the right belief. Alternatively, good reasoning might refer to the reasoning process itself: following the right epistemic procedures. In a preregistered study, we investigated children's (4-9-year-olds) and adults' judgments of reasoning in China and the US (N = 256). Participants of all age groups evaluated the outcome when the process was kept constant - they favored agents who reached correct over incorrect beliefs, and they evaluated the process when the outcome was kept constant - they preferred agents who formed their beliefs using valid over invalid procedures. Developmental changes emerged when we pitted outcome against process: young children weighed outcome more heavily than process; older children and adults showed the reverse preference. This pattern was constant across the two cultural contexts, with the switch from outcome to process happening earlier in development in China. These results suggest that children initially value what someone believes, but, with development, come to increasingly value how beliefs are formed.

Re-examining so-called 'secondary identifiers' in Disaster Victim Identification (DVI): Why and how are they used?

Disaster victim identification (DVI) refers to the identification of multiple deceased persons following an event that has a catastrophic effect on human lives and living conditions. Identification methods in DVI are typically described as either being primary, which include nuclear genetic markers (DNA), dental radiograph comparisons, and fingerprint comparisons, or secondary, which are all other identifiers and are ordinarily considered insufficient as a sole means of identification. The aim of this paper is to review the concept and definition of so-called 'secondary identifiers" and draw on personal experiences to provide practical recommendations for improved consideration and use. Initially, the concept of secondary identifiers is defined and examples of publications where such identifiers have been used in human rights violation cases and humanitarian emergencies are reviewed. While typically not investigated under a strict DVI framework, the review highlights the idea that non-primary identifiers have proven useful on their own for identifying individuals killed as a result of political, religious, and/or ethnic violence. The use of non-primary identifiers in DVI operations in the published literature is then reviewed. Because there is a plethora of different ways in which secondary identifiers are referenced it was not possible to identify useful search terms. Consequently, a broad literature search (rather than a systematic review) was undertaken. The reviews highlight the potential value of so-called secondary identifiers but more importantly show the need to scrutinise the implied inferior value of non-primary methods which is suggested by the terms "primary" and "secondary". The investigative and evaluative phases of the identification process are examined, and the concept of "uniqueness" is critiqued. The authors suggest that non-primary identifiers may play an important role in providing leads to formulating an identification hypothesis and, using the Bayesian approach of evidence interpretation, may assist in establishing the value of the evidence in guiding the identification effort. A summary of contributions non-primary identifiers may make to DVI efforts is provided. In conclusion, the authors argue that all lines of evidence should be considered because the value of an identifier will depend on the context and the victim population. A series of recommendations are provided for consideration for the use of non-primary identifiers in DVI scenarios.

Machine learning versus crop growth models: an ally, not a rival

The rapid increases of the global population and climate change pose major challenges to a sustainable production of food to meet consumer demands. Process-based models (PBMs) have long been used in agricultural crop production for predicting yield and understanding the environmental regulation of plant physiological processes and its consequences for crop growth and development. In recent years, with the increasing use of sensor and communication technologies for data acquisition in agriculture, machine learning (ML) has become a popular tool in yield prediction (especially on a large scale) and phenotyping. Both PBMs and ML are frequently used in studies on major challenges in crop production and each has its own advantages and drawbacks. We propose to combine PBMs and ML given their intrinsic complementarity, to develop knowledge- and data-driven modelling (KDDM) with high prediction accuracy as well as good interpretability. Parallel, serial and modular structures are three main modes can be adopted to develop KDDM for agricultural applications. The KDDM approach helps to simplify model parameterization by making use of sensor data and improves the accuracy of yield prediction. Furthermore, the KDDM approach has great potential to expand the boundary of current crop models to allow upscaling towards a farm, regional or global level and downscaling to the gene-to-cell level. The KDDM approach is a promising way of combining simulation models in agriculture with the fast developments in data science while mechanisms of many genetic and physiological processes are still under investigation, especially at the nexus of increasing food production, mitigating climate change and achieving sustainability.

Assessment of cobalt recycling potential and environmental impact in China from 1994 to 2020

Cobalt recycling is important for solving environmental problems such as resource shortage and pollution emissions. This paper quantifies the positive significance of cobalt recycling on resource replenishment and pollution emission by using the substance flow analysis and life cycle analysis. The results show that the proportion of recycled cobalt supplied as cobalt raw material is 7.1%, which improves the supply structure of the resource. Meanwhile, the environmental impact of recycling cobalt using the combined treatment process is low. The environmental impact of mining cobalt from mines is about 4.03-41.53 times that of recycling cobalt from cobaltiferous waste materials. However, the overall cobalt recycling is not ideal. First, the cobalt recycling rate is growing slowly. From 1994 to 2020, 245,132 t of cobalt-containing final products entered waste management in China. However, only 79,593 t of cobalt have been recycled, with a recycling rate of 32.47%. Secondly, many recycling enterprises only carry out recycling for a certain type of cobaltiferous waste materials due to the non-uniform cobalt recycling process. Finally, China's cobalt recycling policy does not divide the recycling channels for cobalt waste and does not regulate the specific process. In the future, China should set up separate recycling systems for cobaltiferous waste materials according to different categories and consider adopting combined treatment processes. China can only promote the sustainable use of cobalt if it ensures stable and orderly cobalt recycling in terms of policy and technology.

Double air suctioned carding process: A method for achieving improved quality ring-spun carded yarn

This study aims to maximize yarn realization by minimizing hard waste generation. A new method has been evaluated in a conventional carding machine for this purpose by adding extra air suction units immediately above the doffer and in the brush roller above the stripping roller. Various yarn samples were spun using the double air suction carding (DASC) method and the traditional carding process, and the yarn quality parameters were compared. The results indicated that the DASC yarn had considerable technical improvements in all yarn characteristics (U%, CVm%, thick place, thin place, neps, hairiness) and mechanical properties (breaking strength and elongation). The number of classimat faults in the DASC yarn has also significantly decreased. Even though the DASC technique produced more droppings-1, it generated less pneumafil and hard waste, resulting in improved yarn realization. This research also examined cost analysis, advantages, and limitations. Overall, the findings indicate that the newly introduced DASC yarn has the potential to be a superior product in terms of both quality and cost.

Models of acute care for injured older patients-Australia and New Zealand practice

INTRODUCTION

The epidemiology of injured patients has changed, with an increasing predominance of severe injury and deaths in older (65 years and above) patients after low falls. There is little evidence of the models of care that optimise outcomes for injured older patients. This study aims to describe clinician perspectives of existing models of acute care for injured older patients in Australia and New Zealand.

METHODS

This cross-sectional online survey of healthcare professionals (HCP) managing injured older patients in Australia or New Zealand hospitals was conducted between November 2nd and December 12th, 2020. Recruitment was via survey link and snowball sampling to professional organisations and special interest groups via email and social media. HCP were asked, using a Likert scale, how likely four typical case vignettes were to be admitted to one of twelve options for ongoing care. Additional questions explored usual care components.

RESULTS

Participants (n=157) were predominantly Australian medical professionals in a major trauma service (MTS) or metropolitan hospital. The most common age defining "geriatric" was aged 65 years and older (43%). HCP described variability in the models and components of acute care for older injured patients in Australia and New Zealand. As a component of care, cognitive, delirium and frailty screening are occurring (60%, 61%, 46%) with HCP from non-major trauma services (non-MTS) reporting frailty and cognitive impairment screening more likely to occur in the emergency department (ED). Access to an acute pain service was more likely in a MTS. Participants described poor likelihood of a geriatrician (highest 16%) or physician (highest 12%) review in ED CONCLUSION: Despite a low response rate, HCP in Australia and New Zealand describe variability in acute care pathways for injured older patients. Given the change in epidemiology of injury towards older patients with low force mechanisms, models of acute injury care should be evaluated to define a cost-effective model and components of care that optimise patient-centred outcomes relevant to injured older patients. HCP described some factors they perceive to determine care, and outcomes of variability, offering guidance for future research and resource allocation in the Australia and New Zealand trauma system.

Eukaryotic plankton community assembly and influencing factors between continental shelf and slope sites in the northern South China Sea

Eukaryotic plankton are pivotal members of marine ecosystems playing crucial roles in marine food webs and biogeochemical cycles. However, understanding the patterns and drivers of their community assembly remains a grand challenge. A study was conducted in the northern South China Sea (SCS) to address this issue. Here, 49 samples were collected and size-fractionated from discrete depths at continental shelf and continental slope in the northern SCS over a diel cycle. From high throughput sequencing of the 18S rDNA gene V4 region, 2463 operational taxonomic units (OTUs) were retrieved. Alveolata and Opisthokonta overwhelmingly dominated the assemblages in the abundance (44.76%, 31.08%) and species richness (59%, 12%). Biodiversity was higher in the slope than the shelf and increased with depth. Temperature and salinity appeared to be the most important deterministic drivers of taxon composition. Community structure was influenced by multiple factors in the importance order of: environmental factors (temperature + salinity) > spatial factor > water depth > sampling time. Furthermore, the neutral model explained more variations in the smaller-sized (0.22-3 μm) community (24%) than larger-sized (3-200 μm) community (16%) but generally explained less variations than did deterministic processes. Additionally, our data indicated that the larger plankton might be more environmentally filtered and less plastic whereas the smaller plankton had stronger dispersal ability. This study sheds light on the differential contributions of the deterministic process and stochastic process and complexities of assembly mechanisms in shaping the community assembly of micro-nano and pico-eukaryotic biospheres in a subtropical ocean.

An integrated approach to address the temporal variation of geochemistry in groundwater of an arid region

Kuwait is characterized with an arid climate and scarce freshwater sources. Variation in groundwater quality with space and time leads to sustainable development of the region. Evaluating the chemical properties of groundwater is of prime importance to ensure the longevity of this important source of water. In this study, the geochemical data for the years 2004 and 2018 were examined for 6 wells in the freshwater zones of Northern Kuwait. The aim of this study is to examine the geochemical variations, if any that occurred on the only existing freshwater aquifer in Kuwait. The chemical properties examined in this study include total dissolved solids, chloride, nitrate, bicarbonate, calcium, electric conductivity, sulfate, sodium, potassium, magnesium, and pH. The variation of the electrical conductivity in this region indicates an improvement in three wells located in the northern to central region of the study area as values decreased from 1210 to 956 (μS/cm); however, the electrical conductivity has deteriorated in the remaining three wells located in the central to southern part of the study area as values increased from 791 to 1401 (μS/cm). The geochemical facies of the groundwater were determined, indicating a migration of the groundwater facies towards more chloride dominant field in 2018. The saturation states of carbonates like aragonite, calcite, dolomite, and magnesite and those of sulfates like gypsum and anhydrite were determined. The increase in calcium in most of the wells facilitated the saturation index of calcium sulfates relatively more than calcium carbonate minerals. The principal component analysis was conducted for the data of 2004 and 2018; it extracted two main components accounting for the variability of the data; the main components indicate geogenic influences and anthropogenic pollution such as agriculture. The study indicates that there is no major variation observed in groundwater chemistry during the 15 years, as the chemical changes which occurred are minimal and do not require immediate remediation measures. Hence, if the current groundwater extraction rate remained with no extensive land use development, it would sustain the water quality of the region.

Shaping a research agenda to ensure a successful European health technology assessment: insights generated during the inaugural convention of the European access academy

OBJECTIVES

Key challenges for a joint European Health Technology Assessment (HTA) include consolidated approaches towards the choice of adequate comparator(s), selection of endpoints that are relevant to patients with a given disease, dealing with remaining uncertainties as well as transparent and consistent management of related processes. We aimed to further crystallize related core domains within these four areas that warrant further research and scrutiny.

METHODS

Building on the outcomes of a previously conducted questionnaire survey, four key areas, processes, uncertainty, comparator choice and endpoint selection, were identified. At the inaugural convention of the European Access Academy dedicated working groups were established defining and prioritizing core domains for each of the four areas. The working groups consisted of ~ 10 participants each, representing all relevant stakeholder groups (patients/ clinicians/ regulators/ HTA & payers/ academia/ industry). Story books identifying the work assignments were shared in advance. Two leads and one note taker per working group facilitated the process. All rankings were conducted on an ordinal Likert Response Scale scoring from 1 (low priority) to 7 (high priority).

RESULTS

Identified key domains include for processes: i) address (resource-) challenge of multiple PICOs (Patient/ Intervention/ Comparator/ Outcomes), ii) time and capacity challenges, iii) integrating all involved stakeholders, iv) conflicts and aligning between different multi-national stakeholders, v) interaction with health technology developer; for uncertainty: i) early and inclusive collaboration, ii) agreement on feasibility of RCT and acceptance of uncertainty, iii) alignment on closing evidence gaps, iv) capacity gaps; for comparator choice: i) criteria for the choice of comparator in an increasingly fragmented treatment landscape, ii) reasonable number of comparators in PICOs, iii) shape Early Advice so that comparator fulfils both regulatory and HTA needs, iv) acceptability of Indirect Treatment Comparisons (ITC), v) ensure broad stakeholder involvement in comparator selection; for endpoint selection: i) approaching new endpoints; ii) patient preferences on endpoints; iii) position of HTA and other stakeholders; iv) long-term generation and secondary use of data; v) endpoint challenges in RCTs.

CONCLUSIONS

The implementation of a joint European HTA assessment is a unique opportunity for a stronger European Health Union. We identified 19 domains related to the four key areas, processes, uncertainty, comparator choice and endpoint selection that urgently need to be addressed for this regulation to become a success.

Strategic directions in the what and how of learning and teaching innovation-a fifty-year synopsis

Student learning experiences at university are constantly evolving; new disciplinary discoveries, new knowledge, interdisciplinary synergies and new exigencies make learning a dynamic experience for students, teachers and researchers alike; and that is just the what of learning. Add to this, changes in the how of learning, new pedagogies and new technologies, new partners in the provision of learning, as well as new configurations of where learning takes place, such as on campus, at home, in the workplace and online; and it is not hard to make the case that learning experiences of students enrolled in a degree are relatively more complex today than they were even 20 years ago. Much of this change has been captured over the last five decades in the journal Higher Education. The ongoing challenge of these changes is the complexity that accompanies them. How do we improve the student experience of learning in a complex context? What should the outcomes of a higher education degree be? What learning processes are likely to lead better outcomes? How do you assess the quality of learning that may occur in small groups on campus or online, or in large groups in both places, or in laboratories or the workplace? What is the role of material objects in these experiences and do they contribute to outcomes? This manuscript will consider such questions and where the journal is pointing researchers towards new avenues that are developing in learning and teaching internationally.

The value of mass-produced COVID-19 scenarios: A quality evaluation of development processes and scenario content

Hundreds of scenarios were developed across the world in 2020, aimed at generating forward-looking conversations, better understanding for COVID-19 transmission rates, trialling economic outcomes, and stress-testing existing systems in light of the developing pandemic. In response, Cairns & Wright (2020) questioned the value of these mass-produced scenarios created retroactively to existing crises. We address their concerns by evaluating 213 COVID-19 scenarios developed in the first wave of the pandemic. We use two yardsticks as guiding maps against which we plot each scenario's profile and test for values of high-quality process and content. Our analyses reveal various points of high and low qualities, in both process and content. Though most reported processes fell towards lower quality standards, and content largely carried generic applications, the prolific levels of exploratory narratives reflected a mixture of high and low-quality values. Together, our papers develop and reinforce the message that scenario interventions, especially in times of crisis, should reflect more proactive efforts and ensure powerful stakeholders, decision-makers, and affected community members are included in the development of scenarios.

Analyzing implementation of public health interventions : a need for rigor, and the challenges of stakeholder involvement

OBJECTIVES

This article shows how conceptual models can help to develop and evaluate public health interventions. It also reports on the challenges of getting stakeholders involved.

METHOD

The analysis is based on the reflexive approach applied by the authors during their participation in two public health intervention research (PHIR) projects, in France and in Burkina Faso.

RESULTS

In Paris, PHIR aimed to enable sub-Saharan immigrants to appropriate the existing means of prevention and sexual health care and to strengthen their empowerment in view of preserving their health. Evaluation was carried out using mixed methods. The intervention process theory is based on Ninacs' conceptual model of individual empowerment. The Consolidated Framework For Implementation Research (CFIR) was mobilized a posteriori to analyze the process. PHIR stemmed from collaboration between a research team and two associations. The different stakeholders were involved in the evaluation process, as were, at certain times, persons in highly precarious situations. In Ouagadougou, a community-based dengue vector control intervention was deployed to address an essential but neglected need. As regards evaluation, we opted for a holistic, mixed method approach (effectiveness and process). The contents of the intervention were determined based on tacit knowledge, a community preference survey and solid evidence. The theoretical framework of the intervention consisted in an eco-biological model of vector control. The implementation analysis combined an internal assessment of implementation fidelity with an external CFIR process analysis. All stakeholders were involved in the evaluation process.

DISCUSSION

Analysis confirmed not only the value of process evaluations in PHIR, but also the primordial importance of a rigorous approach. Stakeholder involvement is a major challenge to be addressed early in the planning of RISPs; with this in mind, effective and ethically sound assessment mechanisms need to be drawn up. Interdisciplinary evaluative approaches should be preferred, and the use of justified, relevant, and flexible frameworks is highly recommended.

CONCLUSION

Lessons learned for those wishing to engage in the process evaluation of a public health intervention are hereby presented.

Recentering neuroscience on behavior: The interface between brain and environment is a privileged level of control of neural activity

Despite the huge and constant progress in the molecular and cellular neuroscience fields, our capability to understand brain alterations and treat mental illness is still limited. Therefore, a paradigm shift able to overcome such limitation is warranted. Behavior and the associated mental states are the interface between the central nervous system and the living environment. Since, in any system, the interface is a key regulator of system organization, behavior is proposed here as a unique and privileged level of control and orchestration of brain structure and activity. This view has relevant scientific and clinical implications. First, the study of behavior represents a singular starting point for the investigation of neural activity in an integrated and comprehensive fashion. Second, behavioral changes, accomplished through psychotherapy or environmental interventions, are expected to have the highest impact to specifically reorganize the complexity of the human mind and thus achieve a solid and long-lasting improvement in mental health.

Evaluation of an ultrasound program in nationwide Continuing Professional Development (CPD) in Korean public health and medical institutions

BACKGROUND

The Education and Training Centre for Public Healthcare of the National Medical Centre plays a key role in providing continuing professional development (CPD) to 221 public health and medical institutions in South Korea. To assess the realization of the Centre's core value and the intended changes, program evaluations are required. The context, input, process, and product (CIPP) model is particularly suitable for evaluating CPD in the public sector, as it allows for recognizing the dynamic nature of the program environment.

METHODS

This research applied the CIPP model to the evaluation of CPD programs, particularly abdominal and thoracic ultrasound programs implemented in 2017 and 2018. Data were collected from 2017 to 2019. The program and its feedback were reviewed in the context evaluation. Based on this, a subsequent program strategy was established for the input evaluation. Observing the program in real time and recording its progress was followed in process evaluation. Finally, the outcomes and impacts of the program were reviewed and compared with baseline data in the product evaluation.

RESULTS

In context evaluation, the educational needs of the Centre's CPD program recipients, impediments that inhibit participation in education, and resources that the Centre can utilize were identified through an online survey, focus group interviews and expert consultation. Through input evaluation, we identified the best alternative that satisfied all pre-selected criteria, which were responsiveness to priority system needs, potential effectiveness, fit with existing services, affordability, and administrative feasibility. Observing the program in real time and recording its progress were conducted in process evaluation, demonstrating that the augmented program went as planned, and even had to be expanded due to increased demand. The impact of the program was measured, interpreted, and assessed in the product evaluation. The review committee decided that the intended change had been occurred, thus the Centre decided to maintain the program.

CONCLUSION

A thorough evaluation is necessary to determine the potential benefits of CPD. The CIPP methodology is valuable for executing formative and summative evaluations. The CIPP model is particularly useful for securing accountability data for large-scale nationwide educational programs supplied by public funds.

Response surface optimization and modeling in heavy metal removal from wastewater-a critical review

The existence of hazardous heavy metals in aquatic settings causes health risks to humans, prompting researchers to devise effective methods for removing these pollutants from drinking water and wastewater. To obtain optimum removal efficiencies and sorption capacities of the contaminants on the sorbent materials, it is normally necessary to optimize the purification technology to attain the optimum value of the independent process variables. This review discusses the most current advancements in using various adsorbents for heavy metal remediation, as well as the modeling and optimization of the adsorption process independent factors by response surface methodology. The remarkable efficiency of the response surface methodology for the extraction of the various heavy metal ions from aqueous systems by various types of adsorbents is confirmed in this critical review. For the first time, this review also identifies several gaps in the optimization of adsorption process factors that need to be addressed. The comprehensive analysis and conclusions in this review should also be useful to industry players, engineers, environmentalists, scientists, and other motivated researchers interested in the use of the various adsorbents and optimization methods or tools in environmental pollution cleanup.

[German-language translation of the PANELVIEW instrument to evaluate the guideline development process from the perspective of the guideline group]

INTRODUCTION

The development process for clinical guidelines is influenced by factors that are relevant to the validity of a guideline but often are not captured sufficiently in the final guideline documents. PANELVIEW is an English-language tool that can be used to explore the guideline development process from the perspective of guideline group members. Our aim was to translate the PANELVIEW tool into German, taking into account national contexts and linguistic differences.

METHODS

The PANELVIEW tool was initially translated by a core team, then refined and approved by a group of experts in a consensus-based Delphi process. The experts were selected on the basis of their experience in guideline development covering different fields (clinical, methodological, organisational, health professional, patient perspective) and geographical regions (Germany, Austria, Switzerland). A representative of the original PANELVIEW team was also involved. The Delphi steps included an online survey, an online consensus conference and final approval by circulating the results via email. Individual items were seen as generally agreed upon if the level of agreement in the respective steps was 75 % or more.

RESULTS

The expert group consisted of 12 persons. Of these, 11 (92 %) participated in the online survey and 10 (83 %) in the subsequent consensus conference. After the first Delphi step, sufficient agreement was achieved for 19 of 34 items (56 %). The remaining 15 items were discussed in the consensus conference and finally obtained 100 % agreement. The discussion focused on clarifying and adapting terms whose meaning was ambiguous or inadequate in the German context, which led to a deviation from the original wording in some instances.

DISCUSSION

The PANELVIEW tool was translated into German by means of a Delphi process. PANELVIEW complements existing instruments for assessing the methodological quality of guidelines by capturing the perspective of the guideline group. This will enable guideline developers and organisations to identify problems in the drafting process and avoid them in future projects. User testing and validation of the German-language PANELVIEW tool are planned for the future.

CONCLUSION

The German-language translation of PANELVIEW will enable guideline developers in German-speaking countries to continuously evaluate and, where necessary, improve the process and methods of guideline development.

Reducing infantile anemia: insight on patterns of process and outcome indicators by ethnicity and socioeconomic class during a 10-year intervention program and 5 years after

Background

In 2005, Clalit Health Services (CHS), the largest health maintenance organization in Israel, initiated an intervention program aimed at reducing the prevalence rate of infantile anemia (IA). This study evaluated the progress made during the intervention (2005–2014) and its yield 5 years after it ended (2019).

Methods

The CHS database was retrospectively reviewed twice yearly from 2005 to 2014 for repetitive samples of children aged 9 to 18 months regarding the previous half-year interval, and a single sample in 2019. Data were collected on gender, ethnicity (Jewish/non-Jewish), socioeconomic class (SEC; low/intermediate/high), hemoglobin testing (yes/no), and hemoglobin level (if tested). Excluded were infants with documented or suspected hemoglobinopathy.

Results

At study initiation, the rate of performance of hemoglobin testing was 54.7%, and the IA prevalence rate was 7.8%. The performance rate was lower in the Jewish than the non-Jewish subpopulation. The low-SEC subpopulation had a similar hemoglobin testing rate to the high-SEC subpopulation but double the IA prevalence rate. Overall, by the end of the intervention (2014), the performance rate increased to 87.5%, and the AI prevalence rate decreased to 3.4%. In 2019, there was little change in the performance rate from the end of the intervention (88%) and the IA prevalence was further reduced to 2.7%. The non-Jewish and low-SEC subpopulations showed the most improvement which was maintained and even bettered 5 years after the intervention ended.

Conclusions

The 10-year IA intervention program introduced by CHS in 2005 led to a reduction in IA prevalence rate to about 3.5% in all sub-populations evaluated. By program end, the results in the weaker subpopulations, which had the highest prevalence of IA at baseline, were not inferior to those in the stronger subpopulations. We recommended to the Israel Ministry of Health to adopt the intervention countrywide, and we challenge other countries to consider similar interventions.

Organic Codes: A Unifying Concept for Life

Although the knowledge about biological systems has advanced exponentially in recent decades, it is surprising to realize that the very definition of Life keeps presenting theoretical challenges. Even if several lines of reasoning seek to identify the essence of life phenomenon, most of these thoughts contain fundamental problem in their basic conceptual structure. Most concepts fail to identify either necessary or sufficient features to define life. Here, we analyzed the main conceptual frameworks regarding theoretical aspects that have been supporting the most accepted concepts of life, such as (i) the physical, (ii) the cellular and (iii) the molecular approaches. Based on an ontological analysis, we propose that Life should not be positioned under the ontological category of Matter. Yet, life should be better understood under the top-level ontology of "Process". Exercising an epistemological approach, we propose that the essential characteristic that pervades each and every living being is the presence of organic codes. Therefore, we explore theories in biosemiotics and code biology in order to propose a clear concept of life as a macrocode composed by multiple inter-related coding layers. This way, as life is a sort of metaphysical process of encoding, the living beings became the molecular materialization of that process. From the proposed concept, we show that the evolutionary process is a fundamental characteristic for life's maintenance but it is not necessary to define life, as many organisms are clearly alive but they do not participate in the evolutionary process (such as infertile hybrids). The current proposition opens a fertile field of debate in astrobiology, epistemology, biosemiotics, code biology and robotics.

Cognitive and affective processes of prosociality

One piece of the puzzle to prosocial behavior is understanding its underlying cognitive and affective processes. We discuss how modeling behavior in social dilemmas can be expanded by integrating cognitive theories and attention-based models of decision processes, and models of affective influences on prosocial decision-making. We review theories speaking to the interconnections of cognition and affect, identifying the need for further theory development regarding modeling moment-by-moment decision-making processes. We discuss how these theoretical perspectives are mirrored in empirical evidence, drawn from classical outcome-oriented as well as contemporary process-tracing research. Finally, we develop perspectives for future research trajectories aiming to further elucidate the processes by which prosocial decisions are formed, by linking process measures to usually unobservable cognitive and affective reactions.

Examining the challenges of hospital discharge for patients with a urinary catheter

BACKGROUND

Patient discharge between acute and secondary care will be viewed differently based on the stakeholder groups involved. Examining these different perceptions may help improve the discharge process and the patient journey from hospital to home.

AIMS

To determine the perceptions of community and hospital nursing staff regarding the challenges that exist with the general hospital discharge process for patients with a urinary catheter.

METHODS

A survey was created and sent to a wide range of acute and community nurses and the subscriber list of Journal of Community Nursing, Journal of General Practice Nursing and Wound Care Today.

FINDINGS

Compared with hospital staff, the opinions of community staff were more negative around the discharge process and post-discharge care and materials.

CONCLUSIONS

Results of this survey provide insight into the perceptions of nursing staff into general patient discharge for those with a urinary catheter and help identify the challenges that exist on the patient journey from hospital to home.

Case Examples and Process-Oriented Questions in Teletherapy with Couples and Families

This paper shares learned experiences in teletherapy (also called tele-mental-health, remote video therapy, and virtual therapy) with couples and families. It aims to enhance teletherapy practice with couples and families by providing tools for screening and coaching. The paper describes common pitfalls in teletherapy with couples and families and how to avoid or address them, describes the opportunities for added insight when engaging couples and families in teletherapy from their homes, provides concrete interventions in the form of process-focused questions which therapists can draw from, and provides case examples. The case examples and process-oriented questions focus on four areas: screening, logistical coaching of technology, using the family's meeting place to learn about the family, and avoiding pitfalls.

Is the Mind a Network? Maps, Vehicles, and Skyhooks in Cognitive Network Science

Cognitive researchers often carve cognition up into structures and processes. Cognitive processes operate on structures, like vehicles driving over a map. Language alongside semantic and episodic memory are proposed to have structure, as are perceptual systems. Over these structures, processes operate to construct memory and solve problems by retrieving and manipulating information. Network science offers an approach to representing cognitive structures and has made tremendous inroads into understanding the nature of cognitive structure and process. But is the mind a network? If so, what kind? In this article, we briefly review the main metaphors, assumptions, and pitfalls prevalent in cognitive network science (maps and vehicles; one network/process to rule them all), highlight the need for new metaphors that elaborate on the map-and-vehicle framework (wormholes, skyhooks, and generators), and present open questions in studying the mind as a network (the challenge of capturing network change, what should the edges of cognitive networks be made of, and aggregated vs. individual-based networks). One critical lesson of this exercise is that the richness of the mind as network approach makes it a powerful tool in its own right; it has helped to make our assumptions more visible, generating new and fascinating questions, and enriching the prospects for future research. A second lesson is that the mind as a network-though useful-is incomplete. The mind is not a network, but it may contain them.

Enhancement of Cell-based Vaccine Manufacturing Through Process Intensification

There are many drivers to intensify the manufacturing of vaccines. The emergence of SARS-CoV-2 has only added to them. Since the pandemic began, we are seeing an acceleration of vaccine development and approval, including application of novel prophylactic vaccine modalities. We have also seen an increase in the appreciation and general understanding of what had been a somewhat obscure discipline. Concurrently, there has been great interest in the application of new understandings and technology to the intensification of biopharmaceutical processes in general. The marriage of these developments defines the field of vaccine manufacturing process intensification. Difficulties in its implementation include the many disparate vaccine types- from conjugate to hybrid to nucleic-acid based. Then, there are the respective and developing manufacturing methods, modes, and platforms- from fermentation of transformed bacteria to the bioreactor culture of recombinant animal cells to production of virus-like particles in transgenic plants. Advances are occurring throughout the biomanufacturing arena, from process development (PD) techniques to manufacturing platforms, materials, equipment, and facilities. Bioprocess intensification refers to systems for producing more product per cell, time, volume, footprint, or cost. The need for vaccine manufacturing process intensification is being driven by desires for cost control, process efficiency, and the heightened pressures of pandemic response. We are seeing great interest in the power of such disciplines as synthetic biology, process simplification, continuous bioprocessing, and digital techniques in the optimization of vaccine PD and manufacturing. Other powerful disciplines here include process automation, improved monitoring, optimized culture materials, and facility design. The intent of this short commentary is to provide a brief review, and a few examples of the exciting advances in the equipment, technology and processes supporting this activity.

Quality of maternal and newborn health care in Ethiopia: a cross-sectional study

Background

Despite reports of universal access to and modest utilization of maternal and newborn health services in Ethiopia, mothers and newborns continue to die from preventable causes. Studies indicate this could be due to poor quality of care provided in health systems. Evidences show that high quality health care prevents more than half of all maternal deaths. In Ethiopia, there is limited knowledge surrounding the status of the quality of maternal and newborn health care in health facilities. This study aims to assess the quality of maternal and neonatal health care provision at the health facility level in four regions in Ethiopia.

Methodology

This study employed a facility-based cross-sectional study design. It included 32 health facilities which were part of the facilities for prototyping maternal and neonatal health quality improvement interventions. Data was collected using a structured questionnaire, key informant interviews and record reviews. Data was entered in Microsoft Excel and exported to STATA for analysis. Descriptive analysis results are presented in texts, tables and graphs. Quality of maternal and neonatal health care was measured by input, process and outputs components. The components were developed by computing scores using standards used to measure the three components of the quality of maternal and neonatal health care.

Result

The study was done in a total of 32 health facilities: 5 hospitals and 27 health centers in four regions. The study revealed that the average value of the quality of the maternal and neonatal health care input component among health facilities was 62%, while the quality of the process component was 43%. The quality of the maternal and neonatal health output component was 48%. According to the standard cut-off point for MNH quality of care, only 5 (15.6%), 3 (9.3%) and 3 (10.7%) of health facilities met the expected input, process and output maternal and neonatal health care quality standards, respectively.

Conclusion

This study revealed that the majority of health facilities did not meet the national MNH quality of care standards. Focus should be directed towards improving the input, process and output standards of the maternal and neonatal health care quality, with the strongest focus on process improvement.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06680-1.

RADIAL: leveraging a learning management system to support radiology education

Increasing volume and complexity of cases in academic radiology and the drive toward pediatric sub-specialization have threatened knowledge assimilation for radiologists. There is a clear need for a system that retrieves vetted information from the excess available on the internet. Partnered with an interdisciplinary team from the Graduate School of Education, the authors created the first comprehensive learning management system (LMS) for radiology, implemented in the reading room to augment image interpretation and point-of-care education. The LMS supports quantitative analysis using a robust analytics platform to evaluate user statistics, facilitating improved quality of patient care by revolutionizing the way radiologists assimilate knowledge. This integration promises to enhance workflow and point-of-care teaching and to support the highest quality of care.

Treatment processes for microplastics and nanoplastics in waters: State-of-the-art review

In this work, established treatment processes for microplastics (MPs) and nanoplastics (NPs) in water as well as developed analytical techniques for evaluation of the operation of these processes were reviewed. In this regard, the strengths and limitations of different qualitative and quantitative techniques for the analysis of MPs and NPs in water treatment processes were first discussed. Afterward, the MPs and NPs treatment processes were categorized into the separation and degradation processes and the challenges and opportunities in their performance were analyzed. The evaluation of these processes revealed that the MPs or NPs removal efficiency of the separation and degradation processes could reach up to 99% and 90%, respectively. It can be concluded from this work that the combination of separation and degradation processes could be a promising approach to mineralize MPs and NPs in water with high efficiency.

A validated strategy to design efficient fermentation-industrial processes: agave spirit production

An industrial process is profitable when its individual unit operations are efficient and thus, this work shows a guideline for designing efficient fermentation-industrial processes for agave distilled production based on a sequential approach of optimization, beginning in the laboratory and followed by the adjustment of the variable values using the evolutionary operation method for successful process scaling. The results at the laboratory showed that a starter inoculum containing a 5 × 10⁶ cells/mL mixture of Kluyveromyces marxianus, Clavispora lusitaniae, and Kluyveromyces marxianus var. drosophilarum strains in a bioreactor containing agave syrup with 120 g/L fermented sugar, processed at a constant temperature of 33 °C and 1.0 VVM aeration for 1.6 h, led to a fermented product with a 4.18% (v/v) alcohol content after 72 h of processing time. The scale-up process results showed that the best operating conditions at the pilot-plant level were a temperature of 35 °C and aeration at 1.0 VVM for 1.2 h, which led to a fermented product with a 4.22% (v/v) total alcohol content after 72 h of processing time. These represent similar performance values for both production processes, but each one worked with their specific values of process variables, which demonstrates that each level of production had its own specific values for process variables. The volatile compound analysis shows that both distilled products contained a similar profile of volatile components that provide fruity and ethereal aromatic notes pleasant to the palate. Therefore, the process design for agave spirit production at the semi-industrial level was successfully achieved.

Inequitable access to healthcare in Africa: reconceptualising the "accountability for reasonableness framework" to reflect indigenous principles

Background

The “Accountability for Reasonableness” (A4R) framework has been widely adopted in working towards equity in health for sub-Saharan Africa (SAA). Its suitability for equitable health policy in Africa hinges, at least in part, on its considerable successes in the United States and it being among the most comprehensive ethical approaches in addressing inequitable access to healthcare. Yet, the conceptual match is yet to be examined between A4R and communal responsibility as a common fundamental ethic in SAA.

Methodology

A4R and its applications toward health equity in sub-Saharan Africa were conceptually examined by considering the WHO’s “3-by-5” and the REACT projects for their accounting for the communal responsibility ethic in pursuit of health equity.

Results

Some of the challenges that these projects encountered may be ascribed to an incongruity between the underpinning ethical principle of A4R and the communitarian ethical principle dominant in sub-Saharan Africa. These are respectively the fair equality of opportunity principle derived from John Rawls’ theory, and the African communal responsibility principle.

Conclusion

A health equity framework informed by the African communal responsibility principle should enhance suitability for SAA contexts, generating impetus from within Africa alongside the affordances of A4R.

Development of an Implementation Process Model: a Delphi study

Background

There is general scarcity of research on key elements of implementation processes and the factors which impact implementation success. Implementation of healthcare interventions is a complex process. Tools to support implementation can facilitate this process and improve effectiveness of the interventions and clinical outcomes. Understanding the impact of implementation support tools is a critical aspect of this process. The objective of this study was to solicit knowledge and agreement from relevant implementation science and knowledge translation healthcare experts in order to develop a process model of key elements in the implementation process.

Methods

A two round, modified Delphi study involving international experts in knowledge translation and implementation (researchers, scientists, professors, decision-makers) was conducted. Participants rated and commented on all aspects of the process model, including the organization, content, scope, and structure. Delphi questions rated at 75% agreement or lower were reviewed and revised. Qualitative comments supported the restructuring and refinement. A second-round survey followed the same process as Round 1.

Results

Fifty-four experts participated in Round 1, and 32 experts participated in Round 2. Twelve percent (n = 6) of the Round 1 questions did not reach agreement. Key themes for revision and refinement were: stakeholder engagement throughout the process, iterative nature of the implementation process; importance of context; and importance of using guiding theories or frameworks. The process model was revised and refined based on the quantitative and qualitative data and reassessed by the experts in Round 2. Agreement was achieved on all items in Round 2 and the Delphi concluded. Additional feedback was obtained regarding terminology, target users and definition of the implementation process.

Conclusions

High levels of agreement were attained for all sub-domains, elements, and sub-elements of the Implementation Process Model. This model will be used to develop an Implementation Support Tool to be used by healthcare providers to facilitate effective implementation and improved clinical outcomes.

Freeze-drying of nanoparticles: How to overcome colloidal instability by formulation and process optimization

Lyophilization of nanoparticle (NP) suspensions is a promising technology to improve stability, especially during long-term storage, and offers new routes of administration in solid state. Although considered as a gentle drying process, freeze-drying is also known to cause several stresses leading to physical instability, e.g. aggregation, fusion, or content leakage. NPs are heterogeneous regarding their physico-chemical properties which renders them different in their sensitivity to lyophilization stress and upon storage. But still basic concepts can be deducted. We summarize basic colloidal stabilization mechanisms of NPs in the liquid and the dried state. Furthermore, we give information about stresses occurring during the freezing and the drying step of lyophilization. Subsequently, we review the most commonly investigated NP types including lipophilic, polymeric, or vesicular NPs regarding their particle properties, stabilization mechanisms in the liquid state, and important freeze-drying process, formulation and storage strategies. Finally, practical advice is provided to facilitate purposeful formulation and process development to achieve NP lyophilizates with high colloidal stability.

Milk microfiltration process dataset annotated from a collection of scientific papers

Milk microfiltration process plays a key role in the dairy industry. Crossflow microfiltration of skimmed milk using a membrane with 0.1 µm mean pore size is widely used to fractionate the two main groups of dairy proteins: casein micelles (~150 nm) and serum proteins (~2-15 nm). Retentate, containing mainly casein micelles, is generally used to enrich vat milk for cheese making. Permeate, containing serum proteins, lactose and minerals, is usually ultrafiltered in order to produce protein-rich concentrate with a high nutritional value dedicated to specific populations such as infants and seniors. The great interest in these protein fractions explains the increasing number of microfiltration equipments in the dairy industry. This data article contains data associated with milk microfiltration process experiments and properties of the resulting dairy fractions annotated from a collection of scientific documents. These data are stored in INRAE public repository (see Data accessibility in the Specification Table for direct links to data). They have been structured using MILK MICROFILTRATION ontology and are replicated in @Web data warehouse providing additional querying tools (https://www6.inrae.fr/cati-icat-atweb/).

Executing Distributed Healthcare and Research Processes - The HiGHmed Data Sharing Framework

Several standards and frameworks have been described in existing literature and technical manuals that contribute to solving the interoperability problem. Their data models usually focus on clinical data and only support healthcare delivery processes. Research processes including cross organizational cohort size estimation, approvals and reviews of research proposals, consent checks, record linkage and pseudonymization need to be supported within the HiGHmed medical informatics consortium. The open source HiGHmed Data Sharing Framework implements a distributed business process engine for executing arbitrary biomedical research and healthcare processes modeled and executed using BPMN 2.0 while exchanging information using FHIR R4 resources. The proposed reference implementation is currently being rolled out to eight university hospitals in Germany as well as a trusted third party and available open source under the Apache 2.0 license.

Patient and family views of team functioning in primary healthcare teams with nurse practitioners: a survey of patient-reported experience and outcomes

BACKGROUND

Nurse practitioners (NPs) have been added to primary healthcare teams to improve access to care. Team processes, including communication and decision-making, explicate how patients and families view team functioning. Yet, important gaps exist in our understanding of patient-reported experience and outcomes at the level of the healthcare team. We aimed to examine the influence of individual, team, and organizational characteristics, and role clarity on outcomes of care mediated by team processes in primary healthcare teams that include NPs.

METHODS

A cross-sectional survey across six sites representing practices with NPs in Québec, Canada, was conducted between March 2018 and April 2019 as part of a multiple-case study. Patients and families (n = 485; response rate: 53%) completed a validated questionnaire, which included a patient-reported experience measure (PREM) and a patient-reported outcome measure (PROM) of team functioning (Cronbach alpha: 0.771 (PROM) to 0.877 (PREM)). We performed logistic regression and mediation analyses to examine relationships between the individual, team, and organizational characteristics, role clarity, and outcomes of care mediated by team processes.

RESULTS

Patients and families expressed positive perceptions of team functioning (mean 4.97/6 [SD 0.68]) and outcomes of care (5.08/6 [0.74]). Also, high team processes (adjusted odds ratio [AOR] 14.92 [95% CI 8.11 to 27.44]) was a significant predictor of high outcomes of care. Role clarity (indirect effect coefficient ab = 6.48 [95% CI 3.79 to 9.56]), living in an urban area (-1.32 [-2.59 to -0.13]), patient as respondent (-1.43 [-2.80 to -0.14]), and income (1.73 [0.14 to 3.45]) were significant predictors of outcomes of care mediated by team processes.

CONCLUSIONS

This study provides key insights on how primary healthcare teams with NPs contribute to team functioning, using a validated instrument consistent with a conceptual framework. Results highlight that high role clarity, living in a non urban area, family as respondent, and adequate income were significant predictors of high outcomes of care mediated by high team processes. Additional research is needed to compare teams with and without NPs in different settings, to further explicate the relationships identified in our study.

Process mapping in healthcare: a systematic review

INTRODUCTION

Process mapping (PM) supports better understanding of complex systems and adaptation of improvement interventions to their local context. However, there is little research on its use in healthcare. This study (i) proposes a conceptual framework outlining quality criteria to guide the effective implementation, evaluation and reporting of PM in healthcare; (ii) reviews published PM cases to identify context and quality of PM application, and the reported benefits of using PM in healthcare.

METHODS

We developed the conceptual framework by reviewing methodological guidance on PM and empirical literature on its use in healthcare improvement interventions. We conducted a systematic review of empirical literature using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. Inclusion criteria were: full text empirical study; describing the process through which PM has been applied in a healthcare setting; published in English. Databases searched are: Medline, Embase, HMIC-Health Management Information Consortium, CINAHL-Cumulative Index to Nursing and Allied Health Literature, Scopus. Two independent reviewers extracted and analysed data. Each manuscript underwent line by line coding. The conceptual framework was used to evaluate adherence of empirical studies to the identified PM quality criteria. Context in which PM is used and benefits of using PM were coded using an inductive thematic analysis approach.

RESULTS

The framework outlines quality criteria for each PM phase: (i) preparation, planning and process identification, (ii) data and information gathering, (iii) process map generation, (iv) analysis, (v) taking it forward. PM is used in a variety of settings and approaches to improvement. None of the reviewed studies (N = 105) met all ten quality criteria; 7% were compliant with 8/10 or 9/10 criteria. 45% of studies reported that PM was generated through multi-professional meetings and 15% reported patient involvement. Studies highlighted the value of PM in navigating the complexity characterising healthcare improvement interventions.

CONCLUSION

The full potential of PM is inhibited by variance in reporting and poor adherence to underpinning principles. Greater rigour in the application of the method is required. We encourage the use and further development of the proposed framework to support training, application and reporting of PM.

TRIAL REGISTRATION

Prospero ID: CRD42017082140.

Stewardship as process: A paradox perspective

Long-term stewardship is usually represented as a stable structural condition and portrayed as a source of competitive advantage to firms (including family businesses) that use it as a mode of governance. Less is known about how organizations engage with stewardship as a process. We embrace a process approach to report a case study about the unfolding of stewardship in a multi-business family group. We conclude that stewardship is a process marked by critical tensions and paradoxes; by exploring the nature of these we uncover further dimensions and responses to the paradoxes of stewardship.

A comprehensive review of the recent development and challenges of a solar-assisted biodigester system

The extensive use of fossil fuels and the environmental effect of their combustion products have attracted researchers to look into renewable energy sources. In addition, global mass production of waste has motivated communities to recycle and reuse the waste in a sustainable way to lower landfill waste and associated problems. The development of waste to energy (WtE) technology including the production of bioenergy, e.g. biogas produced from various waste through Anaerobic Digestion (AD), is considered one of the potential measures to achieve the sustainable development goals of the United Nations (UN). Therefore, this study reviews the most recent studies from relevant academic literature on WtE technology (particularly AD technology) for biogas production and the application of a solar-assisted biodigester (SAB) system aimed at improving performance. In addition, socio-economic factors, challenges, and perspectives have been reported. From the analysis of different technologies, further work on effective low-cost technologies is recommended, especially using SAB system upgrading and leveraging the opportunities of this system. The study found that the performance of the AD system is affected by a variety of factors and that different approaches can be applied to improve performance. It has also been found that solar energy systems efficiently raise the biogas digester temperature and through this, they maximize the biogas yield under optimum conditions. The study revealed that the solar-assisted AD system produces less pollution and improves performance compared to the conventional AD system.

Remediation of Cu-phenanthrene co-contaminated soil by soil washing and subsequent photoelectrochemical process in presence of persulfate

A promising technology was proposed for the remediation of Cu and phenanthrene (PHE) co-contaminated soil. Firstly, Cu and PHE were simultaneously removed from soil using an extraction agent containing ethylenediaminetetraacetic acid (EDTA) and Tween 80 (TW80). Specifically, Cu was mobilized by the chelation of EDTA while PHE was desorpted from soil by TW80 micelles. At 20 mL g^-1 of liquid to soil ratio, 10 g L^-1 TW80 and 1 mM EDTA, 73.5% Cu and 68.1% PHE were removed by soil washing. The extraction agent was then recovered from effluent by photoelectro-persulfate (PE/PS) process after soil washing. Under the conditions of 10 mM PS, 4 mA cm^-2 current density, natural pH of 3.5 and 150 min treatment, 83.6% Cu was reduced to elemental copper but only 36.8% EDTA was recovered, while 99.6% PHE was eliminated and 94.0% TW80 was recovered. The result of quenching experiments indicated PHE was predominantly oxidized by sulfate radical, though hydroxyl radical and singlet oxygen were also identified by electron paramagnetic resonance technique. The recovered extracting agent could be reused for further three washing cycles. The results demonstrated that soil washing followed by PE/PS process could be a cost-effective remediation technology for heavy metal and organic co-contaminated soil.