Flexible Implementation Research Articles

Supporting children’s wellbeing through outdoor time: opportunities to integrate consistent outdoor time into the elementary school day

BackgroundTime in nature supports cognitive, psychological, academic, and health benefits. Outdoor time during school can provide young people with equitable access to these benefits, however, there are within-school constraints. Understanding if and how teachers can frequently and consistently incorporate outdoor time in the schoolyard into their classroom activities can inform broader implementation.MethodsA mixed-methods observational study was conducted with 17 teachers from five elementary schools. Teachers reported on how they incorporated outdoor time into their classes over an eight-week period. Data on outdoor time, activities, locations, barriers, motivations, and facilitators were collected through surveys on 15 randomly pre-selected days, and through a post-survey.ResultsOn the 15 randomly selected days surveyed, classes went outside 78% of the time, ranging from 6–15 outdoor days per class, and 0–285 min per day. Time, activities, locations, motivations, barriers, and facilitators varied across classes and days. The most common activities were free play (n = 138) and intentional engagement with nature (n = 57). Health benefits (n = 68) and having time (n = 58) were the most common motivations teachers reported for incorporating outdoor time.Implications for school health, policy, practice, and equityConsistent outdoor time in the school day can support students’ wellbeing and academic success. Encouraging free play, highlighting the health benefits, using a systems approach, and flexible implementation may help teachers increase their use of outdoor time during the school day.ConclusionTeachers consistently incorporated outdoor time, but implementation varied across classes and days. Implementation findings from this district could help inform practices at other schools.

Feasibility of an Obesity Prevention Program for Latino Families from First Trimester of Pregnancy to Child Age 18 Months and Predictors of Program Attendance.

Background: The high prevalence of obesity in Latino families with low income necessitates prevention beginning in pregnancy and continuing through infancy. Due to systemic inequities, adverse social determinants of health (SDoH) and mental health symptoms may limit program efficacy by presenting barriers to attendance. We sought to assess: (1) the feasibility of the Starting Early Program (StEP) Prenatal, a 17-session intervention beginning early in pregnancy and continuing to 18 months postpartum; and (2) the effects of adverse SDoH (material hardship, low social support) and mental health symptoms (depression, anxiety, stress) on program attendance. Methods: We conducted a single-arm feasibility trial of StEP Prenatal, enrolling from December 2018 to February 2020 (n = 231). We assessed feasibility (recruitment, retention, fidelity, attendance) and direct and interactive effects of adverse SDoH and mental health symptoms on attendance. We used zero-inflated Poisson regression, adjusting for maternal age, marital status, nativity, education, and pandemic timing. Results: We recruited 57% of eligible participants, with 213 remaining eligible to receive the full program. Retention was 75%. Median fidelity for group format was 64%; median attendance per session was 69%; median number of program sessions attended was 13. Baseline material hardship and high perceived stress predicted approximately one additional session attended. Similar effects were seen for low social support in the absence of anxiety symptoms. Conclusion: Despite pandemic disruptions, StEP Prenatal was feasible to deliver and participants with adverse SDoH at baseline were particularly motivated to attend. Futures studies should tailor programs to baseline SDoH and test flexible implementation models.

Business Plan for the Creation of an Eco-Recreational Park in Pachuca, Hidalgo, Mexico

Objective: Propose a business plan for the creation of an eco-recreational park in Pachuca, Hidalgo, Mexico, specifically located in Cerro del Lobo for the recovery of the forest, containing the deforestation process, as well as the creation of an ecological park. That provides education and awareness of ecological environmental values to the residents and visitors of the region. Theoretical Framework: As a theoretical reference from the literature, various models and methodologies for the creation of a business plan were consulted, as well as the opinion of experts, including that of a university professor specialized in the subject of business plans. Likewise, primary and secondary sources were consulted to analyze the general characteristics of the region and serve as a guide for the development of the proposed plan. Method: The study adopted for this research is a combination of methodologies proposed for the creation of a business plan and includes the complete process of a general structure, concisely writing each of its parts and proposing instruments that would be useful in the execution of the plan. As well as the different procedures for implementation, the data was collected through documentary research and in-depth interviews with experts in the field. Results and Discussion: The correct implementation of the proposed business plan based on the physical and biological characteristics of Cerro de Lobo and the species that inhabit it, such as its flora and fauna. They allowed the construction of an eco-recreational park that promotes an ecological culture and raises awareness among the inhabitants of the municipality of Pachuca and surrounding places about environmental and ecological values; In addition to this, the recovery of the forest is sought, investing in a reforestation process, which is why the park is currently operating. With this project, benefits are achieved for citizens and the environment. Research Implications: The findings of this research have significant implications for both the government in power, the residents of the area, as well as visitors to the park. It is important to adopt flexible implementation strategies and take advantage of advanced technologies inherent to improve processes and facilitate decision making by adapting to changing weather conditions and dynamic market conditions. Originality/Value: This study contributes to the existing body of knowledge by offering new insights into the proposal and implementation of a business plan for the creation of eco-tourism parks, through the tuning of methodologies. The practical implications derived from this study serve as a valuable resource for government institutions seeking to increase operational efficiency and strategic effectiveness in an increasingly complex panorama that cannot leave aside the care of the environment and the search for benefits for citizens.

Spectral in situ ellipsometer for thin layer measurements in thermonuclear fusion applications.

Ellipsometry is widely used to characterize the thickness and optical parameters of thin films deposited, for example, in industrial processes. It is based on the measurement of polarization change upon reflection of, for example, visible light at a material sample. Commercially available devices are designed for stationary applications and often rely on precise geometric adjustment of the optical setup to maximize the measurement precision. In this work, a simplified spectral ellipsometer is proposed and tested with the aim of flexible implementation in space-limited applications in thermonuclear fusion research: on the one hand, as a hand-held device for large thickness scans of coatings deposited on first-wall components inside the vacuum vessel of fusion experiments and, on the other hand, for in situ monitoring of plasma deposited coatings on diagnostic vacuum windows, reducing their transmission in the optical spectral range, which hampers spectroscopic diagnostics in long-pulse plasma experiments. The simplicity of the hardware setup is partially compensated by complex Bayesian inference of the coating parameters, which incorporates all uncertainties of the measurement and the model and provides a quantitative assessment of the final uncertainties of inferred coating parameters. The Bayesian inference based on synthetic observations is also used to optimize the diagnostic design, identifying the limiting parameters and quantifying their impact on final accuracy. For real-time analysis of layer thickness on first-wall components in fusion devices measured with the hand-held device, a neural network based analysis has been implemented, and promising test results are presented.

Co-designing a blueprint for spreading person-centered, Whole Health care to HIV specialty care settings: a mixed methods protocol

BackgroundSince 2013, the Veterans Health Administration (VHA) has advanced a person-centered, Whole Health (WH) System of Care, a shift from a disease-oriented system to one that prioritizes “what matters most” to patients in their lives. Whole Health is predicated on patient-provider interactions marked by a multi-level understanding of health and trusted relationships that promote well-being. Presently, WH implementation has been focused largely in primary care settings, yet the goal is to effect a system-wide transformation of care so that Veterans receive WH across VHA clinical settings, including specialty care. This sort of system-wide cultural transformation is difficult to implement.MethodsThis three-aim mixed methods study will result in a co-designed implementation blueprint for spreading WH from primary to specialty care settings. Taking HIV specialty care as an illustrative case- because of its diverse models of relationships to primary care - to explore how to spread WH through specialty care settings. We will use the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to organize quantitative and qualitative data and identify key determinants of WH receipt among Veterans living with HIV. Through a co-design process, we develop an adaptable implementation blueprint that identifies and matches implementation strategies to different HIV specialty care configurations.DiscussionThis study will co-design a flexible implementation blueprint for spreading WH from VHA primary care throughout HIV specialty care settings. This protocol contributes to the science of end-user engagement while also answering calls for greater transparency in how implementation strategies are identified, tailored, and spread.

Co-created improvement goals and strategies for implementing SBIRT and MAUDin primary care settings in a facilitator-supported, tailored implementation study.

Evidence-based approaches to screening and treatment for unhealthy alcohol use have the potential to reduce morbidity and mortality but are currently underutilized in primary care settings. To support implementation of screening, brief intervention, and referral to treatment (SBIRT) and medication-assisted treatment for alcohol use disorder (MAUD) by identifying goals co-developed by clinics and practice facilitators in a flexible implementation study. In a pragmatic implementation study, we used practice facilitation to support the implementation of SBIRT and MAUD in 48 clinical practices across Oregon, Washington, and Idaho. Our study used a tailored approach, in which facilitators and clinics co-identified implementation goals based on clinic needs. We used clinic contact logs, individual interviews, group periodic reflections with practice facilitators, and exit interviews with clinic staff to inform qualitative analysis. With support from practice facilitators, clinics identified goals spanning SBIRT, MAUD, reporting, targeted patient outreach, and quality improvement capacity. Goals addressed both the technical (e.g. data tracking) and social (e.g. staff training) aspects of SBIRT and MAUD. A decision tree summarizes emergent findings into a tool to support future implementation of SBIRT in primary care settings. A facilitator-supported, tailored approach to SBIRT implementation enabled clinics to identify a variety of goals to improve SBIRT and MAUD implementation. These identified priorities, along with a decision tree describing the hierarchical structure of these goals, could support future implementation efforts.

QCManyBody: A flexible implementation of the many-body expansion.

While the many-body expansion (MBE) and counterpoise treatments are commonly used to mitigate the high scaling of accurate abinitio methods, researchers may need to piece together tools and scripts if their primary chosen software does not support targeted features. To further modular software in quantum chemistry, the arbitrary-order, multiple-model-chemistry, counterpoise-enabled MBE implementation from Psi4 has been extracted into an independent, lightweight, and open-source Python module, QCManyBody, with new schema underpinning, application programming interface, and software integrations. The package caters to direct users by facilitating single-point and geometry optimization MBE calculations backed by popular quantum chemistry codes through the QCEngine runner and by defining a schema for requesting and reporting many-body computations. It also serves developers and integrators by providing minimal, composable, and extensible interfaces. The design and flexibility of QCManyBody are demonstrated via integrations with geomeTRIC, OptKing, Psi4, QCEngine, and the QCArchive project.

Adapting a Preparatory Skills-Building Programme for Carers of People With Cancer Through Co-Design: The iCanSupport Project.

Health services rely upon carers to provide care for loved ones with cancer, yet many carers often feel ill-prepared for this role. Despite a multitude of programmes to support carer mental health, programmes that help carers feel better equipped to support a person with cancer are lacking. This study aimed to address this need by adapting an evidence-based intervention to be suitable for carers of people with cancer. This study used an exploratory, qualitative design consisting of experienced-based co-design and an in-depth stakeholder engagement strategy. An existing evidence-based programme to promote resilience in the context of providing care was adapted for relevance to carers for people with cancer via two co-design workshops with carers and healthcare professionals (n = 8). The resulting prototype programme was refined based on stakeholder consultations with staff and consumer members of cancer and carer support organisations across Australia (n = 16). Transcripts of the workshops, meetings and written feedback from carers were thematically analysed. Major programme developments were guided by three themes that emerged from the co-design workshops: 'creating value for carers', 'multiple contributors to carer distress' and 'the need for flexible implementation'. Analysis of the stakeholder consultation data showed that the themes of 'diversity in carer journeys' and 'creating impact for carers' were key to further tailoring the programme for applicability to practice. An adapted programme called 'iCanSupport' resulted from the process, with key adaptations being more relevant case study scenarios for carers and greater flexibility in accessing and engaging with the intervention to accommodate a range of carer circumstances. Programmes to build skills for becoming a carer for someone with cancer are absent, yet they are desired by carers. Using co-design provided a user-centric approach to adapt an existing evidence-based programme. Programme evaluation is required to determine the effectiveness of the co-designed approach in improving carer preparedness among a range of cohorts. Carers and consumers with lived experience and others involved in supporting consumers made valuable contributions to co-designing and refining the programme in addition to providing ongoing guidance in the unfolding analysis and reporting of this research.

Early integration of palliative care and oncology (EIPCO): A low-maintenance, easy-to-implement program to address palliative care shortages in oncology.

192 Background: With demand for palliative care rising and increasing cancer survival rates, there is an urgent need to train future healthcare professionals in palliative care principles, especially for oncology. Prior work has focused on adding modules or rotations to medical school curriculums. However, this approach provides insufficient or late exposure to specific trainees, such as undergraduate and medical students that are less aware of palliative care. Here, we report on the successful development and implementation of a program that educates early trainees in palliative care and oncology topics while immediately benefiting patients and healthcare teams. Methods: The pilot version of the EIPCO (Early Integration of Palliative Care and Oncology) program was initiated at Stanford in 2021 by a single medical student and faculty advisor. Recruited medical, graduate, and undergraduate student trainees first complete an online, didactic course as a self-paced, safe introduction to palliative care and oncology. A member of EIPCO leadership (officer) then interviews trainees one-on-one to discuss course takeaways, remaining questions, and what follow-up opportunities are most relevant for each trainee. Next, EIPCO facilitates trainee boarding into their respective opportunities, such as shadowing, volunteering, talks, or research projects, to stimulate further learning and excitement. Involved trainees may then also apply to become officers. EIPCO was reliably maintained and expanded by a small team, even when all officers had significant time constraints. Results: EIPCO was received positively by trainees, especially for providing access to rare opportunities where they could directly help patients. Trainees reported the most interest in shadowing (88% of trainees, e.g. inpatient or at tumor boards), providing companionship (96% of trainees, e.g. spiritual care visits or for actively dying patients), and helping patients complete advanced care directives (85% of trainees). These experiences solidified crucial concepts and cultivated interest in palliative care and oncology. Resources have also been developed for the flexible implementation of EIPCO at other institutions. Conclusions: EIPCO serves as a low-maintenance and easy-to-implement model to address a growing need in medical education. EIPCO benefits healthcare teams and patients while exposing early trainees to how palliative and cancer care can be integrated. Further work has begun to expand the program to other institutions to enhance training on a broader scale.

“It’s Good to Have a Voice”: What Do Students Think about the Impact of a Flexible Curricular Implementation of Student-Centered Pedagogies on Their Own Learning Experiences?

While there is extensive evidence that student-centered pedagogies (SCPs) develop multidimensional (motor, cognitive, social) outcomes in students, the coalesced use of some of the core pedagogies of student-centered models (SCMs) can facilitate the achievement of more than one educational theme in the same intervention and may facilitate student engagement in more representative physical education (PE) experiences. In this study, students’ voices are explored concerning the impact of a flexible and coalesced curricular implementation of SCPs on their own PE learning experiences. An insider action-research design was implemented for one entire school year (50 lessons of 90 min each) with 25 students aged 16–17 years, enrolled in the 12th grade at a high school in Portugal. A qualitative data collection source was used (semi-structured focus-group interviews), analyzed through a mixed inductive–deductive thematic analysis. The findings emphasize that a flexible and coalesced curricular implementation of various SCPs over an extended period of time, considering the sport content, the context, and the skill level of students, seems to contribute to the development of more positive learning experiences for students. In summary, these learning experiences require that teachers learn to listen and respond to students’ voices.

One policy, two implementations: probing policy specifications in two EMI courses in a Macao university

ABSTRACT Despite growing literature on EMI policy implementation in higher education contexts, there is a lack of research on how these policies are enacted at the micro-level, particularly in the classroom settings. The present study explores the language beliefs and practices of a psychology professor in two English-medium instruction (EMI) courses which differed in course types and students’ preparedness, in an effort to understand how language policy was enacted in nuanced EMI settings. Drawing on semi-structured interviews, classroom observation, and course artifacts, the study reveals that the non-native English speaking participant held a consistent belief in enforcing a strict English-only policy within the classroom, yet she managed students’ and her own language practices slightly differently (e.g. speak time, pace, vocabulary, L1 proportion) based on specific course objectives. The findings highlight the importance of consistent and mindful language policies that allow for flexible implementation where unique features of individual EMI contexts are accommodated. Through highlighting the agency of EMI teachers as language policy arbiters, we reimagined the original ROAD-MAPPING framework [Dafouz, E., & Smit, U. (2016). Toward a dynamic conceptual framework for English-medium education in multilingual university settings. Applied Linguistics, 37(3), 397–415] to capture the granular and dynamic process of EMI policy enactment and implementation in authentic classrooms. Practical implications are drawn accordingly.

Practical two-party SM2 signing using multiplicative-to-additive functionality

Threshold signatures are important tools for addressing issues related to key management, certificate management, and cryptocurrencies. Among them, two-party SM2 signatures have received considerable interest recently. In this paper, we propose a fast and secure online/offline two-party SM2. By employing the re-sharing technique, we have successfully made the online phase of the signing process non-interactive while achieving nearly optimal computational efficiency. Additionally, in the offline phase, there is just a single call to the multiplicative-to-additive functionality based on Paillier encryption. Our protocol is existentially unforgeable under adaptive chosen message attacks in the random oracle model in the presence of a static adversary. Experimental results demonstrate that our proposed scheme outperforms previous similar schemes by approximately a factor of 2 in online computation and a factor of 3 in online communication. Our scheme can be applied in scenarios such as Certificate Authority (CA) and the signing of blockchain transactions to provide them with a more secure and flexible implementation method, enhancing the security and reliability of the systems.

Reconfigurable flexible assembly model and implementation for cross-category products

As the production orders are becoming multi-category and small-batch in the era of product personalization, these require frequent reconfiguration of reconfigurable flexible assembly system for cross-category products (RFAS-CCP). However, there is no suitable theoretical assembly model and systematic implementation framework. We first propose a five-element assembly model (FAM) for RFAS-CCP, i.e. product, process, resource, knowledge, and decision. The product, process, and resource element describe the objects, steps to be assembled, and the tools, fixtures, and other equipment used for assembly, respectively. The knowledge element is a form representation of various heterogeneous data, such as a knowledge graph. The decision element includes various assembly methods to achieve assembly automation, flexibility, and intelligence. Then, in order to standardize and easy the frequent reconfiguration process, we reorganize various decision methods into a three-phase systematic implementation framework according to which stage they are used: design, configuration, and operation phases. The design phase methods primarily design various assembly modules for a product family, forming an assembly resource library. The configuration phase methods primarily configure suitable assembly lines for a specific product in the product family. The operation phase methods monitor the status of the assembly line and ensures its stable operation through health management. Finally, the effectiveness and practicality of the proposed five-element assembly model and three-phase systematic implementation framework are experimented with a pressure reducing valve product.

An enhanced Moth-Flame optimizer with quality enhancement and directional crossover: optimizing classic engineering problems

As a popular meta-heuristic algorithm, the Moth-Flame Optimization (MFO) algorithm has garnered significant interest owing to its high flexibility and straightforward implementation. However, when addressing engineering constraint problems with specific parameters, MFO also exhibits limitations such as fast convergence and a tendency to converge to local optima. In order to address these challenges, this paper introduces an enhanced version of the MFO, EQDXMFO. EQDXMFO integrates a Quality Enhancement (EQ) strategy and a Directional Crossover (DX) mechanism, fortifying the algorithm’s search dynamics. Specifically, the DX mechanism is designed to augment the population’s diversity, enhancing the algorithm’s exploratory potential. Concurrently, the EQ strategy is employed to elevate the solution quality, which in turn refines the convergence precision of the algorithm. To verify the effectiveness of EQDXMFO, experiments are carried out on the test set of the IEEE CEC2017. A total of 5 classical algorithms, five excellent MFO variants, and seven state-of-the-art algorithms are selected for comparison, which confirm the significant advantages of EQDXMFO. Next, EQDXMFO is applied to five complex engineering constraint problems, demonstrating that EQDXMFO can optimize realistic problems. The comprehensive analysis shows that EQDXMFO has strong optimization capabilities and provides methods for research on other complex real-world problems.

Evaluation of an E-Learning Training Package by Nurses of Various Designations for Developing Clinical Skills and Knowledge

Education helps nurses maintain, improve and broaden their professional knowledge to meet their obligations to provide ethical, safe and competent care. Globally, electronic learning (e-learning) has emerged in the last decade as a flexible mechanism to provide education for nurses. However, not enough is known about how nurses view e-learning as continuing education and whether the skills and knowledge gained are transferable to daily practice. A descriptive correlational design applying a non-experimental quantitative approach was employed to evaluate an e-learning training package used by nurses of various designations for developing clinical skills and knowledge at a private hospital in Perth, Western Australia. Data were collected via a survey method over 3 years. Findings suggest an e-learning training package effectiveness is mainly dependent on the implementation process, the way learning is packaged and sequenced, and the instructional design of the package. When the e-learning training package uses materials participants can apply with patients in the clinical setting, there is higher active engagement and application of content to practice. This study’s findings reveal more flexible implementation approaches might be considered in the future, including blended learning.

Securing the IoT ecosystem: ASIC-based hardware realization of Ascon lightweight cipher

The Internet of Things (IoT) nodes consist of sensors that collect environmental data and then perform data exchange with surrounding nodes and gateways. Cybersecurity attacks pose a threat to the data security that is being transmitted in any IoT network. Cryptographic primitives are widely adopted to address these threats; however, the substantial computation demands limit their applicability in the IoT ecosystem. In addition, each IoT node varies with respect to the area and throughput (TP) requirements, thus demanding flexible implementation for encryption/decryption processes. To solve these issues, this work implements the NIST lightweight cryptography standard, Ascon, on a SAED 32 nm process design kit (PDK) library by employing loop folded, loop unrolled and fully unrolled architectures. The fully unrolled architecture can achieve the highest TP but at the cost of higher area utilisation. Unrolling by a lower factor results in lower area implementations, enabling the exploration of design space to tackle the trade-off between area and TP performance of the design. The implementation results show that, for loop folded architecture, Ascon-128 and Ascon-128a require 36.7k μm2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\upmu \ extrm{m}^{2}$$\\end{document} and 38.5k μm2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\upmu \ extrm{m}^{2}$$\\end{document} chip area, respectively compared to 277.1k μm2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\upmu \ extrm{m}^{2}$$\\end{document} and 306.6k μm2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\upmu \ extrm{m}^{2}$$\\end{document} required by their fully unrolled implementations. The proposed implementation strategies can adjust the number of rounds to accommodate the varied requirements of IoT ecosystems. An implementation with an open-source 45 nm PDK library is also undertaken for enhanced generalization and reproducibility of the results.

3D-printed devices for optimized generation of cold atmospheric plasma to improve decontamination of surfaces from respiratory pathogens

Three-dimensional (3D)-printing technology is instrumental in creating devices for biological applications, including the exploitation of cold atmospheric plasma (CAP). CAP, a partially ionized gas that functions at ambient temperatures, serves as a safe, inexpensive, and effective tool for the inactivation of various pathogens on different surfaces. In this study, we compared three different 3D-printed devices with respect to their ability to provide optimized CAP compositions effective against select respiratory viruses (SARS-CoV-2, influenza virus, adenovirus, and rhinovirus) and the bacterium Pseudomonas aeruginosa, which is associated with serious lung diseases. The transmission of respiratory pathogens via surface contamination may pose a serious health threat, thus highlighting the biological importance of the current study. The properties of a prototype 3D-printed CAP-generating device and two optimized versions were characterized by detecting reactive oxygen and nitrogen species (RONS) in a gaseous environment via infrared spectroscopy and analyzing the composition of the reactive compounds. The virucidal effects of CAP were examined by determining virus infectivity and particle integrity. The bactericidal effect was documented by viability testing and visualization via transmission electron microscopy. The findings indicate that optimization of the 3D-printed devices for CAP production yielded an environment with relatively high amounts of RONS (O3, N2O, NO2, and H2O2), reducing the exposure time required for inactivation of respiratory pathogens by approximately 50%. In addition to reducing infectivity and viability, CAP treatment led to the destruction of viral nucleic acids and physical damage to bacterial cells. Owing to its flexibility and easy implementation, optimized CAP generated by 3D-printed devices provides an attractive inactivation method adaptable for different biological applications, including surface decontamination from viral and bacterial pathogens.   

CuO nanoparticles embedded in laser-induced graphene for flexible planar micro-supercapacitors

Utilizing predefined electrode geometries, laser direct writing technology is employed to intricately inscribe flexible polyimide (PI) films, thereby inducing porous graphene patterned electrodes for flexible planar micro-supercapacitors (MSCs), which greatly facilitates the integration of MSCs into functional devices for power supply. Nevertheless, prevailing challenges confront current flexible MSCs relying on laser-induced graphene (LIG), including the constrained electrochemical functionality of pure LIG electrodes and the uneven incorporation of heterogeneous constituents within LIG electrodes. In light of these challenges, this study delves into the fundamental mechanism underlying the formation of polyimide (PI) films and introduces an innovative approach to uniformly integrate CuO nanoparticles into the poly (acrylic acid) (PAA) precursor solution. The subsequent imidization process culminates in the synthesis of a CuO-embedded PI film. The research progresses to the fabrication of shape-controllable CuO/LIG patterned electrodes utilizing a precision laser direct writing technique, and the subsequent construction of flexible planar MSCs. Harnessing the synergistic interactions between the dual components within the electrode, the resulting MSC possesses an impressive areal capacitance of 6.45 mF·cm-2, coupled with an energy density of 0.896 mWh·cm-2 and a power density of 0.081 mW·cm-2, thus illustrating the potential of this innovative material integration for high-performance flexible energy storage implementations.

Cross-Site Evaluation of Alcohol Screening and Brief Intervention Implementation Programs in Healthcare Systems Serving Individuals of Reproductive Age.

With US Centers for Disease Control and Prevention funding, from 2018 to 2022, 4 large healthcare systems (n = 53 health centers across 7 states) serving people of reproductive age trained staff and provided implementation support for alcohol screening and brief intervention (SBI). This cross-site evaluation explores each healthcare system's implementation approach to implement SBI, reduce excessive alcohol use, and prevent prenatal alcohol exposure (PAE) and fetal alcohol spectrum disorders. The SBIRT (Screening, Brief Intervention, and Referral to Treatment) Program Matrix framed the multilevel strategies to implement alcohol SBI programs from 2018 to 2022. Qualitative and quantitative data sources examined outcomes, guided by one logic model, through systems-level process data and provider-level performance metrics. Data analyses utilized frequencies and means for quantitative data and themes for qualitative data according to an established framework. Successful approaches within systems included using electronic health records, flexible implementation and workflow protocols, customized training and technical assistance programs, quality assurance feedback loops, and stakeholder buy-in. Centralized management structures were efficient in standardizing implementation across health centers. Decentralized management structures used tailored approaches, enhancing provider/staff SBI acceptance. Across systems, 1259 staff (eg, clinicians, medical assistants) were trained to provide alcohol SBI services and reported pre-post training increases in self-efficacy in performing brief intervention; skills in PAE counseling; and confidence in screening. Fifty-three (48 providing data) health centers implemented alcohol SBI, screening 106 826 patients over the study period with most of the 10 087 patients who screened positive for excessive alcohol use receiving a BI. Maximizing the use of technology, employing flexibility in program delivery, and institutionalizing processes and protocols improved workflow, efficiency, and program reach. Ongoing partnership and stakeholder communication identify areas for ongoing improvement, engagement, and best practices for sustainability around substance use screening, which are essential with increases in substance use since the pandemic.

Site-initiated adaptations in the implementation of an evidence-based inpatient walking program.

There is increasing recognition of the importance of maximizing program-setting fit in scaling and spreading effective programs. However, in the context of hospital-based mobility programs, there is limited information on how settings could consider local context and modify program characteristics or implementation activities to enhance fit. To fill this gap, we examined site-initiated adaptations to STRIDE, a hospital-based mobility program for older Veterans, at eight Veterans Affairs facilities across the United States. STRIDE was implemented at eight hospitals in a stepped-wedge cluster randomized trial. During the pre-implementation phase, sites were encouraged to adapt program characteristics to optimize implementation and align with their hospital's resources, needs, and culture. Recommended adaptations included those related to staffing models, marketing, and documentation. To assess the number and types of adaptations, multiple data sources were reviewed, including implementation support notes from site-level support calls and group-based learning collaborative sessions. Adaptations were classified based on the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME), including attention to what was adapted, when, why, and by whom. We reviewed the number and types of adaptations across sites that did and did not sustain STRIDE, defined as continued program delivery during the post-implementation period. A total of 25 adaptations were reported and classified across seven of the eight sites. Adaptations were reported across five areas: program documentation (n = 13), patient eligibility criteria (n = 5), program enhancements (n = 3), staffing model (n = 2), and marketing and recruitment (n = 2). More than one-half of adaptations were planned. Adaptations were common in both sustaining and non-sustaining sites. Adaptations were common within a program designed with flexible implementation in mind. Identifying common areas of planned and unplanned adaptations within a flexible program such as STRIDE may contribute to more efficient and effective national scaling. Future research should evaluate the relationship between adaptations and program implementation.