Scale-up Efforts Research Articles

Scale-Up Collaboration Model of Village-Owned Enterprises for Increasing Village Economy

BUMDES is a village economic institution that until now has become an important part in realizing village economy independence. In Indonesia nowadays there are almost 50,000 BUMDES with details of 1,000 developed ones, 10,000 developing ones, and 30,000 BUMDES that are still in the pilot stage. One of the efforts that can be done in increasing BUMDES business is BUMDES scale up program. This program can help increase the management of BUMDES in aspects of institutional, innovation, digitalization, and sustainability. BUMDES scale-up must be conducted in collaboration among several parties, including BUMDES, academics, and industry. This research is a formulation of efforts to increase the performance of BUMDES, which aims at developing BUMDES scale-up collaboration model for increasing the village economy. This research uses a qualitative approach using primary data collected using Focus Group Discussion (FGD) technique for BUMDES, academics, and industry. The analysis used are qualitative descriptive and CIPP (Context evaluation, Input evaluation, Process evaluation, and Product evaluation). The results of research have found that BUMDES scale-up collaboration model for increasing the village economy through tripartite cooperation of BUMDES - Academics - Industry has been proven to be able to overcome two problems occurred in BUMDES. Academics are able to help examine the potential and formulate the innovation designs, also provide the training and mentoring. Industry is able to assist in the aspect of technology and market access. The results of research can be a role model in BUMDES scale-up efforts to increase the village economy.

Adoption and scale-up of the cardiovascular Polypill: a realist institutional analysis.

Efforts to promote the adoption and scale-up of health system innovations must contend with the existing institutional context. But there are no commonly used frameworks to ensure that the insights of actors involved in such institutional efforts connect to one another. To test and modify a potential framework-the 'four-by-four' framework-we interviewed researcher-entrepreneurs involved in the unfolding story of the cardiovascular Polypill. The framework has four types/levels of institutions that affect adoption and scale-up: (1) informal institutions (L1, e.g.social norms), (2) formal institutions (L2, e.g.government policies and regulation), (3) organizational structures (L3, e.g.organizational boards and mission) and (4) everyday exchange (L4, e.g.service delivery), vis-à-vis four potential entrepreneurial strategies in response: (1) abide by existing institutions, (2) evade them, (3) alter them and/or (4) exit entrepreneurial action. Using this framework, we conducted a realist-informed analysis to understand how context (i.e. institutions) and mechanism (i.e.entrepreneurial strategies) influence each other to shape outcomes (i.e.adoption and scale-up). We found that researcher-entrepreneurs began with efforts to abide with existing institutions but encountered institutional obstacles at each level. Efforts to abide were followed by seeking to evade and/or alter unfavourable institutions, with greater success evading and/or altering lower (L3 and L4) than upper (L1 and L2) institutions. Exit considerations followed the failure of the evade or alter strategy. Shifts between strategies were propelled by 'learning'. The 'four-by-four' framework can be used as a scaffold to generate narratives of adoption or scale-up efforts, a sensitizing tool to prospectively map out contingencies and a matrix to synthesize narratives and experiences across multiple innovations or settings. Used in these ways, the 'four-by-four' framework can help to optimize the transferability and cumulation of insights on how to promote the adoption and scale-up of health system innovations.

A novel fluidized bed suitable for the hydrolysis step in CuCl hydrogen production cycle

In this paper, a novel design for a hydrolysis reactor step in the Cu–Cl thermochemical hydrogen production cycle is presented and investigated.The core concept of this hydrolysis reactor is recirculation of reaction steam, hence the name “Recirculating Steam Fluidized Bed” (RSFB). This design recirculates steam through the fluidized bed allowing for the unused steam to be consumed by the reaction. This design was found to reduce the total thermal energy requirement of the hydrolysis step by 50% while maintaining favorable reaction kinetics. The recirculating steam has the added benefit of increasing the concentration of product HCl, allowing for a more productive integration with downstream processes. Given the results presented here, it is suggested that the RSFB reactor be considered for adoption in the Cu–Cl cycle scale-up efforts.

(Invited) Developing Barrier Layer Free Oxygen Electrode for Solid Oxide Cells

High temperature solid oxide cell (SOC) technology is attracting considerable interest in recent decades for clean power generation and hydrogen production (green hydrogen) when combined with low-cost renewable energy. The key driver for such a strong interest is its superior thermodynamic efficiency and high-rate power and hydrogen production. However, the current scale-up and commercialization efforts are hindered by the insufficient durability and high cost, both of which are resulted from the high operating temperature (700-800oC). A further reduction in operation temperature to, e.g. below 700oC, is the best solution to address the durability and cost issues. As the operating temperature is reduced, the resistances of cell components increase correspondingly. To decrease the resistances, one can thin out or use high-conductivity electrolyte membranes, open up microstructure of fuel (or hydrogen) electrodes substrate and employ oxygen electrocatalytically active oxygen electrodes. Unfortunately, a direct use of active oxygen electrodes in SOCs has been proven formidable due to their reaction with electrolytes (ZrO2-based) and very high thermal expansion coefficient. To address the first problem, applying a CeO2-based barrier layer between electrolytes and oxygen electrodes is currently the solution. However, introduction of such a barrier layer considerably increases the ohmic resistance (sometimes as high as 2-3x), thus defeating the purpose of boosting cell performance. To address the second problem, mixing the active oxygen electrode with CeO2-based material or infiltrating it into a thermally compatible skeleton is currently the solution, but CeO2-based barrier layer is still needed.Therefore, a key development for reduced-temperature ZrO2-based SOCs is to find an active oxygen electrode without the need of a barrier layer. Here we show that a composite consisting of La0.8Sr0.2MnO3 (LSM), an excellent electronic conductor, and (Bi0.75Y0.25)0.93Ce0.07O1.5±δ (BYC), an excellent ionic conductor, is a potential barrier layer free oxygen electrode for reduced-temperature SOCs. We also show fabrication of open structured hydrogen electrode substrate to facilitate H2/H2O diffusion and increase the performance of HE.

Machine learning-based ethylene concentration estimation, real-time optimization and feedback control of an experimental electrochemical reactor

With the increase in electricity supply from clean energy sources, electrochemical reduction of carbon dioxide (CO2) has received increasing attention as an alternative source of carbon-based fuels. As CO2 reduction is becoming a stronger alternative for the clean production of chemicals, the need to model, optimize and control the electrochemical reduction of the CO2 process becomes inevitable. However, on one hand, a first-principles model to represent the electrochemical CO2 reduction has not been fully developed yet because of the complexity of its reaction mechanism, which makes it challenging to define a precise state-space model for the control system. On the other hand, the unavailability of efficient concentration measurement sensors continues to challenge our ability to develop feedback control systems. Gas chromatography (GC) is the most common equipment for monitoring the gas product composition, but it requires a period of time to analyze the sample, which means that GC can provide only delayed measurements during the operation. Moreover, the electrochemical CO2 reduction process is catalyzed by a fast-deactivating copper catalyst and undergoes a selectivity shift from the product-of-interest at the later stages of experiments, which can pose a challenge for conventional control methods. To this end, machine learning (ML) techniques provide a potential approach to overcome those difficulties due to their demonstrated ability to capture the dynamic behavior of a chemical process from data. Motivated by the above considerations, we propose a machine learning-based modeling methodology that integrates support vector regression and first-principles modeling to capture the dynamic behavior of an experimental electrochemical reactor; this model, together with limited gas chromatography measurements, is employed to predict the evolution of gas-phase ethylene concentration. The model prediction is directly used in a proportional-integral (PI) controller that manipulates the applied potential to regulate the gas-phase ethylene concentration at energy-optimal set-point values computed by a real-time process optimizer (RTO). Specifically, the RTO calculates the operation set-point by solving an optimization problem to maximize the economic benefit of the reactor. Lastly, suitable compensation methods are introduced to further account for the experimental uncertainties and handle catalyst deactivation. The proposed modeling, optimization, and control approaches are the first demonstration of active control for a CO2 electrolyzer and contribute to the automation and scale-up efforts for electrified manufacturing of fuels and chemicals starting from CO2.

Biofilm disruption enhances growth rate and carbohydrate-active enzyme production in anaerobic fungi

Anaerobic gut fungi (AGF) are lignocellulose degraders that naturally form biofilms in the rumen of large herbivores and in standard culture techniques. While biofilm formation enhances biomass degradation and carbohydrate-active enzyme (CAZyme) production in some bacteria and aerobic fungi, gene expression and metabolism in AGF biofilms have not been compared to non-biofilm cultures. Here, using the tunable morphology of the non-rhizoidal AGF, Caecomyces churrovis, the impacts of biofilm formation on AGF gene expression, metabolic flux, growth rate, and xylan degradation rate are quantified to inform future industrial scale-up efforts. Contrary to previous findings, C. churrovis upregulated catabolic CAZymes in stirred culture relative to biofilm culture. Using a de novo transcriptome, 197 new transcripts with predicted CAZyme function were identified. Stirred cultures grew and degraded xylan significantly faster than biofilm-forming cultures with negligible differences in primary metabolic flux, offering a way to accelerate AGF biomass valorization without altering the fermentation product profile. The rhizoidal AGF, Neocallimastix lanati, also grew faster with stirring on a solid plant substrate, suggesting that the advantages of stirred C. churrovis cultures may apply broadly to other AGF.

Metagenomics-enabled microbial surveillance.

Lessons learnt from the COVID-19 pandemic include increased awareness of the potential for zoonoses and emerging infectious diseases that can adversely affect human health. Although emergent viruses are currently in the spotlight, we must not forget the ongoing toll of morbidity and mortality owing to antimicrobial resistance in bacterial pathogens and to vector-borne, foodborne and waterborne diseases. Population growth, planetary change, international travel and medical tourism all contribute to the increasing frequency of infectious disease outbreaks. Surveillance is therefore of crucial importance, but the diversity of microbial pathogens, coupled with resource-intensive methods, compromises our ability to scale-up such efforts. Innovative technologies that are both easy to use and able to simultaneously identify diverse microorganisms (viral, bacterial or fungal) with precision are necessary to enable informed public health decisions. Metagenomics-enabled surveillance methods offer the opportunity to improve detection of both known and yet-to-emerge pathogens.

Discovery-to-Clinic Path Smoothed by Open Source Manufacturing

Genetic Engineering & Biotechnology NewsVol. 42, No. 4 DepartmentsDiscovery-to-Clinic Path Smoothed by Open Source ManufacturingWheeler Bio says that its Portable CMC services can help drug developers and CROs streamline scale-up efforts and expedite IND programsGail DuttonGail DuttonSearch for more papers by this authorPublished Online:5 Apr 2022https://doi.org/10.1089/gen.42.04.06AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetails Volume 42Issue 4Apr 2022 Information© 2022 by GEN PublishingTo cite this article:Gail Dutton.Discovery-to-Clinic Path Smoothed by Open Source Manufacturing.Genetic Engineering & Biotechnology News.Apr 2022.16-17.http://doi.org/10.1089/gen.42.04.06Published in Volume: 42 Issue 4: April 5, 2022PDF download

Synthesis Optimization, Scale-Up, and Catalyst Screening Efforts toward the MGAT2 Clinical Candidate, BMS-963272

Synthesis Optimization, Scale-Up, and Catalyst Screening Efforts toward the MGAT2 Clinical Candidate, BMS-963272

A Pilot Sexual and Gender Minority Health Curriculum for the Largest Public Health Care System in the United States.

Sexual and gender minority (SGM) people face multiple health disparities. Clinicians often lack adequate training to address health needs of SGM people. In this setting, some health care organizations have sought to develop system-wide curricula to build clinician knowledge and capacity around SGM health. NYC Health + Hospitals partnered with the National LGBTQIA+ [lesbian, gay, bisexual, transgender, queer, intersex, asexual] Health Education Center at The Fenway Institute to design and implement a novel SGM health care curriculum, offered from 2017 to 2020. The pilot program featured a 90-minute live introductory session, a pretest, a post-test, and six 45-minute online modules focusing on a range of topics in SGM health care. Of approximately 35,000 employees from a range of settings and professional roles across NYC Health + Hospitals, 792 participated in the pilot program; most were clinicians at acute care hospitals, with the single largest group being attending clinicians. The proportion of eligible employees completing each component of the curriculum varied: 544 of 792 (68.7%) completed the online pretest, while 373 of 792 (47.1%) completed the module on behavioral health. Of 373 participants who completed both the pre- and post-tests, mean scores rose significantly from 60.9 on the pretest to 81.9 on the post-test ( P < .001). Future efforts should focus on increasing staff participation in the curriculum through scale-up efforts across the health care system, as well as measuring patient outcomes to assess the clinical impact of the initiative.

Biocatalysis of precursors to new-generation SB-T-taxanes effective against paclitaxel-resistant cancer cells

A 10-O-deacetylbaccatin III 10-O-acetyltransferase biocatalyst from Taxus plants was expressed in bacteria whole-cells that were fed 10-O-deacetylbaccatin III and cyclopropane carboxylic acid. Product analysis by qualitative LC/ESI-MS suggested that the C10-acylated products baccatin III, 10-O-n-propionyl-10-O-deacetylbaccatin III, and 10-O-cyclopropanecarbonyl-10-O-deacetylbaccatin III were made in vivo. The results implied that the cells provided non-natural cyclopropanecarbonyl CoA, from a broad-specificity CoA ligase, and natural products, acetyl CoA and n-propionyl CoA, from reserves in the bacteria for use by acyltransferase to acylate 10-O-deacetylbaccatin III in vivo. The 10-acyl-10-O-deacetylbaccatin III are precursors used to synthesize new-generation paclitaxel analogs SB-T-1214 and SB-T-121303, which are effective against cancer cells resistant to paclitaxel and its drug derivatives. The kcat and KM of the acyltransferase for cyclopropanecarbonyl CoA (0.83 s−1, 0.15 M) and n-propionyl CoA (1.2 s−1, 0.15 M) guided scale-up efforts. The 10-acyl-10-O-deacetylbaccatin III analogs (∼45 mg each) were made in vitro by the acyltransferase when incubated with the commercial taxane 10-O-deacetylbaccatin III and synthesized cyclopropanecarbonyl or n-propionyl CoA. The structures of the 10-acyl products were verified by NMR analyses that confirmed C10 acylation of the taxane substrate. LC/ESI-MS/MS analysis also supported the identities of the biocatalyzed products. This effort provides a biocatalysis framework to produce new-generation taxane precursors.

Implementation of a diabetes prevention program within two community sites: a qualitative assessment

BackgroundDespite numerous translations of diabetes prevention programs, implementation evaluations are rarely conducted. The purpose of this study was to examine the implementation process and multilevel contextual factors as an evidence-based diabetes prevention program was implemented into two local community organization sites to inform future scale-up. To build the science of implementation, context and strategies must be identified and explored to understand their impact.MethodsThe program was a brief-counseling diet and exercise modification program for individuals at risk of developing type 2 diabetes. A 1-year collaborative planning process with a local not-for-profit community organization co-developed an implementation plan to translate the program. A pragmatic epistemology guided this research. Semi-structured interviews were conducted with staff who delivered the program (n = 8), and a focus group was completed with implementation support staff (n = 5) at both community sites. Interviews were transcribed verbatim and thematically analyzed using a template approach. The consolidated framework for implementation research (CFIR) is a well-researched multilevel implementation determinant framework and was used to guide the analysis of this study. Within the template approach, salient themes were first inductively identified, then identified themes were deductively linked to CFIR constructs.ResultsImplementation strategies used were appropriate, well-received, and promoted effective implementation. The implementation plan had an impact on multiple levels as several CFIR constructs were identified from all five domains of the framework: (a) process, (b) intervention characteristics, (c) outer setting, (d) inner setting, and (e) individual characteristics. Specifically, results revealed the collaborative 1-year planning process, program components and structure, level of support, and synergy between program and context were important factors in the implementation.ConclusionThis study offers insights into the process of implementing a community-based diabetes prevention program in two local sites. Successful implementation benefited from a fully engaged, partnered approach to planning, and subsequently executing, an implementation effort. The CFIR was a useful and thorough framework to evaluate and identify multilevel contextual factors impacting implementation. Results can be used to inform future implementation and scale-up efforts.

A pragmatic approach to identifying implementation barriers and facilitators for a novel pre-exposure prophylaxis (PrEP) delivery model at public facilities in urban Uganda

BackgroundScalable HIV pre-exposure prophylaxis (PrEP) delivery models for resource-limited settings are critical for improving PrEP coverage and interrupting HIV transmission. This research uses technical assistance (TA) reports to evaluate implementation barriers and facilitators for a novel delivery model integrating PrEP and antiretroviral therapy (ART) delivery for HIV sero-different couples in public health facilities in Kampala, Uganda.MethodsWe used data from the Partners PrEP Program (PPP)—a stepped-wedge cluster randomized trial that is launching PrEP delivery through an integrated model of oral PrEP and antiretroviral therapy (ART) delivery for HIV sero-different couples at public health facilities in Kampala and Wakiso, Uganda (NCT03586128). Technical assistance teams, comprised of PPP program staff, conducted monthly TA visits to implementing facilities where they identified and addressed implementation challenges in collaboration with health facility staff. Findings were recorded in TA reports, a standardized form structured using the Consolidated Framework for Implementation Research (CFIR). We used a conceptual content analysis approach to evaluate TA reports completed from January to December 2019 and identify implementation barriers and facilitators.ResultsAmong 39 reports from the 8 implementing facilities (~ 5 per facility), we identified 11 CFIR constructs. Key implementation facilitators included sensitizing and educating facility staff about PrEP (knowledge and beliefs about the innovation); establishing formal and informal feedback and accountability mechanisms (reflecting and evaluating); and empowering facility staff to address implementation challenges (self-efficacy). Key implementation barriers were related to ineffective recruitment and referral of sero-different couples to and from nearby facilities (cosmopolitanism) as well as stockouts of laboratory resources and testing supplies (available resources).ConclusionsThis analysis featured a robust implementation science framework to assess the relationship between early implementation determinants and outcomes of this innovative PrEP delivery model. Further, we have provided important descriptions of early implementation barriers and facilitators that will inform scale-up efforts for PrEP delivery within and beyond Uganda. Future work will refine the analysis of pragmatic program data, qualitatively investigate the identified key themes, and explore strategies for addressing implementation barriers.

Implementation Approaches for Introducing and Overcoming Barriers to Hepatitis B Birth-Dose Vaccine in sub-Saharan Africa.

In sub-Saharan Africa (SSA), chronic viral hepatitis B (HBV) affects more than 60 million people. Mother-to-child transmission is a major contributor to the ongoing HBV epidemic and yet only 11 of 54 (20.3%) SSA countries have introduced the birth dose of HBV vaccine (HepB-BD) into their regular immunization schedule. As more African countries adopt HepB-BD, implementation approaches must be targeted to ensure effective and timely HepB-BD delivery, especially in rural and under-resourced settings. We conducted a systematic literature review of published literature using PubMed. We included 39 articles published from January 2010 to August 2020, as well as gray literature, case studies, and research performed in SSA. We describe barriers to the uptake of HepB-BD in SSA at the policy, facility, and community levels and propose solutions that are relevant to stakeholders wishing to introduce HepB-BD. We highlight the importance and challenge of reaching infants who are born outside of health care facilities (i.e., home deliveries) with HepB-BD in partnership with community health workers. We also discuss the critical role of maternal education and community engagement in future HepB-BD scale-up efforts in SSA.

Techno-Economic assessment of natural gas pyrolysis in molten salts

Steam methane reforming with CO2 capture (blue hydrogen) and water electrolysis based on renewable electricity (green hydrogen) are commonly assumed to be the main supply options in a future hydrogen economy. However, another promising method is emerging in the form of natural gas pyrolysis (turquoise hydrogen) with pure carbon as a valuable by-product. To better understand the potential of turquoise hydrogen, this study presents a techno-economic assessment of a molten salt pyrolysis process. Results show that moderate reactor pressures around 12 bar are optimal, and that reactor size must be limited by accepting reactor performance well below the thermodynamic equilibrium. Despite this challenge stemming from slow reaction rates, the simplicity of the molten salt pyrolysis process delivers high efficiencies and promising economics. In the long-term, carbon could be produced for 200–300 €/ton, granting access to high-volume markets in the metallurgical and chemical process industries. Such a scenario makes turquoise hydrogen a promising alternative to blue hydrogen in regions with public resistance to CO2 transport and storage. In the medium-term, expensive first-of-a-kind plants could produce carbon around 400 €/ton if hydrogen prices are set by conventional blue hydrogen production. Pure carbon at this cost level can access smaller high-value markets such as carbon anodes and graphite, ensuring profitable operation even for first movers. In conclusion, the economic potential of molten salt pyrolysis is high and further demonstration and scale-up efforts are strongly recommended.

Caught between HIV exceptionalism and health service integration: Making visible the role of public health policy in the scale-up of novel sexual health services.

The role of contextual factors for program implementation is well-documented; however, their changing function throughout implementation phases is less established. We conducted an institutional ethnography to understand how structural conditions for scaling up initiatives are shaped by public health policy. We conducted 25 interviews with implementers of a comprehensive sexual health testing service in Canada, 21 meeting observations, and textual analyses of key policies and reports. Our analysis revealed a disjuncture between implementers' task of scaling up programming and the actualities of working within the discursive and material confines of policies premised on HIV exceptionalism and underfunded integrated health services.

Value of integrated mandatory national surveillance data and literature reviews to inform public health policy in the child care sector

Abstract Background Epidemiological properties of children have been a matter of debate during the entire duration of the SARS-CoV-2-pandemic. To inform public health policy two instruments were used that stemmed from mandatory national surveillance data as well as continuous, up-to-date literature screening. We report how these two instruments complemented each other in the first/second (before the advent of the VOC Alpha (B.1.1.7)) and the 3rd wave (dominated by VOC Alpha (B.1.1.7)) in Germany. Methods We monitored and analysed continuously data reported from local health departments via state health departments to the Robert Koch Institute. In addition, we reviewed peer-reviewed, pre-prints and grey literature on key epidemiological parameters in children, such as susceptibility, infectiousness and viral load. Results After the 1st wave in March-May 2020 the 2nd wave started in early autumn and lasted until the first weeks in 2021. The proportion of cases among 0-5 year old children stayed mostly below the corresponding population proportion, and was always lower than that of older age groups. Reported outbreaks in child care centres were small (median 4 cases). Primary cases were mainly adults. Among the cases reported from child care centre outbreaks the proportion of 0-5 year old children was only 35%. Information from the literature indicated lower susceptibility of children, lower viral load, but provided equivocal information about infectiousness. In the 3rd, B.1.1.7-dominated wave the number of outbreaks increased rapidly and exceeded the highest number in the 2nd wave. In addition, the proportion of 0-5 year old children involved in the outbreaks increased to 45%. Conclusions During the 1st and 2nd wave susceptibility and likely also infectiousness of 0-5 year old children was limited allowing broad opening of child care centres. In contrast, in the 3rd wave affectedness of children increased leading to recommendations to scale-up prevention efforts in child care centres.

Precision Electrochemical Fabrication of Corrugated Waveguides

Advancements in high energy physics require continuous innovations in hardware to support the generation, amplification, transmission, modulation, and detection of radio frequency (RF) electromagnetic waves. One particular hardware component, waveguides, have garnered increasing interest due to their integral function in the transmission, amplification, and/or manipulation of electromagnetic waves. Waveguides are typically high-purity hollow metal structures that require precision fabrication. Waveguides operating in higher than conventional frequency ranges, e.g., 30 to 300 GHz, are of particular interest to the high energy physics community given the scaling of gradient and shunt impedance with frequency. These higher frequencies necessitate waveguides exhibiting features, such as corrugations, with significantly smaller dimensions. However, traditional manufacturing approaches are inadequate, in terms of manufacturing precision and cost, to meet these requirements. Thus, to satisfy the purity and dimensional tolerance requirements of waveguides operating at high frequencies, novel fabrication techniques are required.Faraday Technology, in consultation with Argonne Wakefield Accelerator (AWA) group, addressed this need by developing an economic fabrication process and apparatus for electroforming high-purity cylindrical copper waveguides with internal corrugations. Aluminum alloy mandrels with corresponding corrugations served as the substrate for copper electroforming. The electroforming approach was achieved within a custom electrolyte solution that was formulated by eliminating or minimizing conventional chemical additives – which is typically required to achieve uniform, conformal, and/or void-free deposits with direct current (DC) electroforming strategies. The custom, low-additive electrolyte was employed to mitigate any possibility of impurity (i.e. additive) inclusion within the copper electroform and thus, ensure high-purity copper waveguides. The low-additive electrolyte consisted of a high-purity copper sulfate solution consisting of 95–100 g/L CuSO4•5H2O, 210–215 g/L H2SO4, 60–70 ppm Cl− and 350 ppm polyethylene glycol. To compensate for the absence of traditional additives, pulse-modulated waveforms were employed during copper electrodeposition to selectively control ionic transport as well as the subsequent deposit morphology and thus facilitate complete copper filling of the corrugation valleys, as seen in the accompanying figure. Preliminary scale-up efforts from ~2-inch to ~6-inch copper electroformed waveguides were demonstrated and confirm the versatility of the pulse-modulated electroforming strategy. Upon mandrel removal, a cold test of the ~2-inch copper waveguide using a vector network analyzer (VNA) was conducted. The results of the S-parameter measurements and the bead-pull test indicate reasonable agreement with the design by CST simulation, which validates the novel pulse-modulated electroforming approach.Acknowledgements: The U.S. Department of Energy (DOE) provided financial support for this work under the contract award number: DE-SC0020782. Figure 1

Increasing Disability Inclusion in Health Programming Using NCHPAD's inclusive Community Implementation Process: a Case Study

<h3>Research Objectives</h3> To examine the feasibility of using NCHPAD's inclusive Community Implementation Process (NiCIP) to select and implement disability inclusion solutions to increase inclusion of people with disabilities in an evidence-based nutrition education program. <h3>Design</h3> This case study follows the NiCIP to select and implement disability inclusion solutions related to implementing an inclusive evidence-based nutrition education program within the community. <h3>Setting</h3> A community in South Carolina. <h3>Participants</h3> A local inclusive health coalition (IHC) of stakeholders (n=12) representing public health, disability-serving organizations, community organizations, self-advocates with disability, healthcare, and local government. <h3>Interventions</h3> The NiCIP aims to increase disability inclusion by providing a framework to identify and address gaps to disability inclusion. The process was led by local stakeholders, is data-driven, and guides planning and implementation processes to select and implement disability inclusion solutions. <h3>Main Outcome Measures</h3> Selection of data-driven inclusion solutions and evaluation of a pilot test of selected inclusion solutions. <h3>Results</h3> Results from accessibility assessments led the IHC to implement the following inclusion solutions: creation of disability inclusive promotional materials, disability etiquette training for program staff, creation of an accessibility checklist, and additional program adaptations to ensure inclusivity of the evidence-based curriculum. Inclusion solutions were pilot tested through a 6-week class which included Participants with disability and support persons (n=30). Key findings from the pilot test indicated that with the inclusion solutions, a disability inclusive program was completed within a community setting. However, additional training for instructors, limited class sizes, and more concise and understandable participant follow-up are needed within scale-up efforts to ensure program effectiveness. <h3>Conclusions</h3> Using the NiCIP process led by local stakeholders to select and implement data-driven disability inclusion solutions can result in inclusive community-based health programming. <h3>Author(s) Disclosuress</h3> None.

Derivation and external validation of a risk score for predicting HIV-associated tuberculosis to support case finding and preventive therapy scale-up: A cohort study.

Among people living with HIV (PLHIV), more flexible and sensitive tuberculosis (TB) screening tools capable of detecting both symptomatic and subclinical active TB are needed to (1) reduce morbidity and mortality from undiagnosed TB; (2) facilitate scale-up of tuberculosis preventive therapy (TPT) while reducing inappropriate prescription of TPT to PLHIV with subclinical active TB; and (3) allow for differentiated HIV-TB care. We used Botswana XPRES trial data for adult HIV clinic enrollees collected during 2012 to 2015 to develop a parsimonious multivariable prognostic model for active prevalent TB using both logistic regression and random forest machine learning approaches. A clinical score was derived by rescaling final model coefficients. The clinical score was developed using southern Botswana XPRES data and its accuracy validated internally, using northern Botswana data, and externally using 3 diverse cohorts of antiretroviral therapy (ART)-naive and ART-experienced PLHIV enrolled in XPHACTOR, TB Fast Track (TBFT), and Gugulethu studies from South Africa (SA). Predictive accuracy of the clinical score was compared with the World Health Organization (WHO) 4-symptom TB screen. Among 5,418 XPRES enrollees, 2,771 were included in the derivation dataset; 67% were female, median age was 34 years, median CD4 was 240 cells/μL, 189 (7%) had undiagnosed prevalent TB, and characteristics were similar between internal derivation and validation datasets. Among XPHACTOR, TBFT, and Gugulethu cohorts, median CD4 was 400, 73, and 167 cells/μL, and prevalence of TB was 5%, 10%, and 18%, respectively. Factors predictive of TB in the derivation dataset and selected for the clinical score included male sex (1 point), ≥1 WHO TB symptom (7 points), smoking history (1 point), temperature >37.5°C (6 points), body mass index (BMI) <18.5kg/m2 (2 points), and severe anemia (hemoglobin <8g/dL) (3 points). Sensitivity using WHO 4-symptom TB screen was 73%, 80%, 94%, and 94% in XPRES, XPHACTOR, TBFT, and Gugulethu cohorts, respectively, but increased to 88%, 87%, 97%, and 97%, when a clinical score of ≥2 was used. Negative predictive value (NPV) also increased 1%, 0.3%, 1.6%, and 1.7% in XPRES, XPHACTOR, TBFT, and Gugulethu cohorts, respectively, when the clinical score of ≥2 replaced WHO 4-symptom TB screen. Categorizing risk scores into low (<2), moderate (2 to 10), and high-risk categories (>10) yielded TB prevalence of 1%, 1%, 2%, and 6% in the lowest risk group and 33%, 22%, 26%, and 32% in the highest risk group for XPRES, XPHACTOR, TBFT, and Gugulethu cohorts, respectively. At clinical score ≥2, the number needed to screen (NNS) ranged from 5.0 in Gugulethu to 11.0 in XPHACTOR. Limitations include that the risk score has not been validated in resource-rich settings and needs further evaluation and validation in contemporary cohorts in Africa and other resource-constrained settings. The simple and feasible clinical score allowed for prioritization of sensitivity and NPV, which could facilitate reductions in mortality from undiagnosed TB and safer administration of TPT during proposed global scale-up efforts. Differentiation of risk by clinical score cutoff allows flexibility in designing differentiated HIV-TB care to maximize impact of available resources.