Scale-up Evaluation Research Articles

The Secret Sauce? Taking the Mystery Out of Scaling-Up School-Based Physical Activity Interventions.

Over the last 4 decades, physical activity researchers have invested heavily in determining "what works" to promote healthy behaviors in schools. Single and multicomponent school-based interventions that target physical education, active transportation, and/or classroom activity breaks effectively increased physical activity among children and youth. Yet, few of these interventions are ever scaled-up and implemented under real-world conditions and in diverse populations. To achieve population-level health benefits, there is a need to design school-based health-promoting interventions for scalability and to consider key aspects of the scale-up process. In this opinion piece, we aim to identify challenges and advance knowledge and action toward scaling-up school-based physical activity interventions. We highlight the key roles of planning for scale-up at the outset, scale-up pathways, trust among partners and program support, program adaptation, evaluation of scale-up, and barriers and facilitators to scaling-up. We draw upon our experience scaling-up effective school-based interventions and provide a solid foundation from which others can work toward bridging the implementation-to-scale-up gap.

Advanced 3D multiscale modeling of forward osmosis-membrane distillation integrated designs

The development of eco-friendly desalination and water reuse is key to secure water for future generations. The hybridization of emerging membrane technologies such as forward osmosis (FO) and membrane distillation (MD) stand among alternatives that proved sustainable in treating various feeds. As such, in-series integration of MD and FO enabled the simultaneous treatment of challenging streams, with MD producing fresh water while increasing the draw solution concentration before FO treatment. It is within this context that numerical modeling plays a key role by accelerating hybrids process design and scale-up, shedding light on viable directions and shortening development time. This work presents an advanced 3D multiscale modeling approach that integrates FO and MD heat and mass transfer membrane scale calculations to equipment scale computational fluid dynamics, executed on high performance computers. A methodology based on laboratory scale FO-MD integrated module experiments and runtime optimization is proposed for model calibration and process scale-up. The parallelization of the numerical model is shown to be key to efficient integrated modules development, enabling full 3D analysis on fine meshes and the solution of intricately coupled physical phenomena, which leads to a straightforward process scale-up evaluation.

CRADLE-5: a stepped-wedge type 2 hybrid implementation-effectiveness cluster randomised controlled trial to evaluate the real-world scale-up of the CRADLE Vital Signs Alert intervention into routine maternity care in Sierra Leone—study protocol

BackgroundThe CRADLE Vital Signs Alert intervention (an accurate easy-to-use device that measures blood pressure and pulse with inbuilt traffic-light early warning system, and focused training package) was associated with reduced rates of eclampsia and maternal death when trialled in urban areas in Sierra Leone. Subsequently, implementation was successfully piloted as evidenced by measures of fidelity, feasibility and adoption. The CRADLE-5 trial will examine whether national scale-up, including in the most rural areas, will reduce a composite outcome of maternal and fetal mortality and maternal morbidity and will evaluate how the CRADLE package can be embedded sustainably into routine clinical pathways.MethodsCRADLE-5 is a stepped-wedge cluster-randomised controlled trial of the CRADLE intervention compared to routine maternity care across eight rural districts in Sierra Leone (Bonthe, Falaba, Karene, Kailahun, Koinadugu, Kono, Moyamba, Tonkolili). Each district will cross from control to intervention at six-weekly intervals over the course of 1 year (May 2022 to June 2023). All women identified as pregnant or within six-weeks postpartum presenting for maternity care in the district are included. Primary outcome data (composite rate of maternal death, stillbirth, eclampsia and emergency hysterectomy) will be collected. A mixed-methods process and scale-up evaluation (informed by Medical Research Council guidance for complex interventions and the World Health Organization ExpandNet tools) will explore implementation outcomes of fidelity, adoption, adaptation and scale-up outcomes of reach, maintenance, sustainability and integration. Mechanisms of change and contextual factors (barriers and facilitators) will be assessed. A concurrent cost-effectiveness analysis will be undertaken.DiscussionInternational guidance recommends that all pregnant and postpartum women have regular blood pressure assessment, and healthcare staff are adequately trained to respond to abnormalities. Clinical effectiveness to improve maternal and perinatal health in more rural areas, and ease of integration and sustainability of the CRADLE intervention at scale has yet to be investigated. This trial will explore whether national scale-up of the CRADLE intervention reduces maternal and fetal mortality and severe maternal adverse outcomes and understand the strategies for adoption, integration and sustainability in low-resource settings. If successful, the aim is to develop an adaptable, evidence-based scale-up roadmap to improve maternal and infant outcomes.Trial registrationISRCTN 94429427. Registered on 20 April 2022.

Exploring skeletal muscle tolerance and whole-body metabolic effects of FDA-approved drugs in a volumetric muscle loss model.

Volumetric muscle loss (VML) is associated with persistent functional impairment due to a lack of de novo muscle regeneration. As mechanisms driving the lack of regeneration continue to be established, adjunctive pharmaceuticals to address the pathophysiology of the remaining muscle may offer partial remediation. Studies were designed to evaluate the tolerance and efficacy of two FDA-approved pharmaceutical modalities to address the pathophysiology of the remaining muscle tissue after VML injury: (1) nintedanib (an anti-fibrotic) and (2) combined formoterol and leucine (myogenic promoters). Tolerance was first established by testing low- and high-dosage effects on uninjured skeletal muscle mass and myofiber cross-sectional area in adult male C57BL/6J mice. Next, tolerated doses of the two pharmaceutical modalities were tested in VML-injured adult male C57BL/6J mice after an 8-week treatment period for their ability to modulate muscle strength and whole-body metabolism. The most salient findings indicate that formoterol plus leucine mitigated the loss in muscle mass, myofiber number, whole-body lipid oxidation, and muscle strength, and resulted in a higher whole-body metabolic rate (p ≤ 0.016); nintedanib did not exacerbate or correct aspects of the muscle pathophysiology after VML. This supports ongoing optimization efforts, including scale-up evaluations of formoterol treatment in large animal models of VML.

Process evaluation of the scale-up of integrated diabetes and hypertension care in Belgium, Cambodia and Slovenia (the SCUBY Project): a study protocol

IntroductionIntegrated care interventions for type 2 diabetes (T2D) and hypertension (HT) are effective, yet challenges exist with regard to their implementation and scale-up. The ‘SCale-Up diaBetes and hYpertension care’ (SCUBY)...

Pelletized SiO2-supported La0.5Ba0.5FeO3 for conversion of CO2 to CO by a reverse water-gas shift chemical looping process

Perovskite oxides, such as La0.5Ba0.5FeO3 (LBF), are promising materials for converting CO2 to CO through low-temperature reverse water–gas shift chemical looping (RWGS-CL). To transition toward industrialization, this study focused on forming perovskite-oxide/silica composite pellets (25 wt% LBF) with sufficiently high crushing strength, with materials prepared by extrusion and tableting methods. X-ray fluorescence (XRF) and diffraction (XRD) confirmed that the resulting material is 26.6 wt% LBF on SiO2 with a combined structure of LBF and SiO2 components. Temperature-programmed reduction (TPR) and oxidation (TPO) experiments revealed that CO2 is converted to CO at 550 °C by LBF/SiO2 pellets, higher than LBF by 50 °C. CO2 chemisorption was determined to be 62.2 μmol/gLBF. DRIFTS-MS experiments confirmed that adsorbed CO2 is dissociated to CO. High material stability is proven by long-term RWGL-CL experiments combined with XRD and XPS. The CO2 to CO yields were 2.21, 2.41, and 2.35 mmol/gLBF of 10 mm tableting pellets, 6 mm tableting pellets, and extrusion pellets, respectively. Deactivated pellets are able to be regenerated by air thermal treatment following intentional reduction. All pellets showed stable redox properties in 50 cycles of semi-batch reactor experiments, indicating that LBF/SiO2 pellets are candidate materials for further scale-up evaluation.

Temporal and spatial variations of eco-environment in Association of Southeast Asian Nations from 2000 to 2021 based on information granulation

As a multinational organization with rapid economic development, the eco-environment of Association of Southeast Asian Nations (ASEAN) will be an important factor in determining the success or failure of the future development of the region. This study uses information granulation based on granular computing and spatial distribution characteristics of the remote sensing ecological index (RSEI) to granulate indicator. According to the different influences of different countries in ASEAN, a new scale-up evaluation method of RSEI is proposed, which considers the influence of countries and establishes the weight by scale transformation knowledge granularity entropy. The RSEI research results of ASEAN from 2000 to 2021 show that 1) from 2000 to 2021, the eco-environmental quality of ASEAN was good. The areas with better RSEI accounted for 40.3566%, while the poor areas accounted for 32.6194%. The areas with extremely poor and excellent remote sensing ecology accounted for less. 2) From 2000 to 2021, the remote sensing eco-environment of ASEAN showed a certain volatility, the quality of the remote sensing eco-environment was declining, and the spatial differentiation was increasing. 3) The spatial distribution of the remote sensing eco-environmental quality of the Malay Peninsula is better than that of the Indochina Peninsula. 4) The order of impact of ASEAN remote sensing eco-environmental indicators is heat, dryness, greenness and humidity.

Planning implementation and scale-up of physical activity interventions for people with walking difficulties: study protocol for the process evaluation of the ComeBACK trial

BackgroundThere is currently little evidence of planning for real-world implementation of physical activity interventions. We are undertaking the ComeBACK (Coaching and Exercise for Better Walking) study, a 3-arm hybrid Type 1 randomised controlled trial evaluating a health coaching intervention and a text messaging intervention. We used an implementation planning framework, the PRACTical planning for Implementation and Scale-up (PRACTIS), to guide the process evaluation for the trial. The aim of this paper is to describe the protocol for the process evaluation of the ComeBACK trial using the framework of the PRACTIS guide.MethodsA mixed methods process evaluation protocol was developed informed by the Medical Research Council (MRC) guidance on process evaluations for complex interventions and the PRACTIS guide. Quantitative data, including participant questionnaires, health coach and administrative logbooks, and website and text message usage data, is being collected over the trial period. Semi-structured interviews and focus groups with trial participants, health coaches and health service stakeholders will explore expectations, factors influencing the delivery of the ComeBACK interventions and potential scalability within existing health services. These data will be mapped against the steps of the PRACTIS guide, with reporting at the level of the individual, provider, organisational and community/systems. Quantitative and qualitative data will elicit potential contextual barriers and facilitators to implementation and scale-up. Quantitative data will be reported descriptively, and qualitative data analysed thematically.DiscussionThis process evaluation integrates an evaluation of prospective implementation and scale-up. It is envisaged this will inform barriers and enablers to future delivery, implementation and scale-up of physical activity interventions. To our knowledge, this is the first paper to describe the application of PRACTIS to guide the process evaluation of physical activity interventions.Trial registrationAustralian and New Zealand Clinical Trials Registry (ANZCTR) Registration date: 10/12/2018.

Process evaluation of care scale up for hypertension in diabetes in Belgium, Slovenia and Cambodia

Abstract Background Effective integrated care interventions for hypertension (HT) and type 2 diabetes (T2D) exist and need to be scaled-up. The ‘SCale-Up diaBetes and hYpertension care' SCUBY project aims to facilitate scale-up of integrated care for HT and T2D through the implementation of contextualised scale-up roadmaps in Cambodia, Slovenia and Belgium and co-creation in policy dialogues. We herewith describe the plan for the process and scale-up evaluation of the SCUBY project, including the development, adoption and implementation of the roadmaps. The specific goals of the process evaluation are to (i) analyse how the reality of scale-up adheres to the developed roadmaps and (ii) assess how the different contexts can influence the implementation process of the scale-up strategies. Methods A comprehensive framework was developed to include context, process, scale-up and impact evaluation that is embedded in implementation and political theory. A diverse range of mostly qualitative tools - including a policy dialogue reporting form, a stakeholder follow-up interview and survey, project diaries and policy mapping - will be used to assess how stakeholders perceive the scale-up implementation process and adaptations to the roadmap. Key implementation outcomes include acceptability, feasibility relevance, adaptation, adoption and cost of roadmap activities. The role of context is relevant, and barriers and facilitators to scale-up will be continuously assessed. Conclusions The SCUBY project presents a comprehensive framework to guide the evaluation of scale-up of complex interventions. We describe three contextualised roadmaps, for Belgium, Slovenia and Cambodia, each adopting their own (horizontal/diversification/vertical) scale-up strategy(ies) as a basis to monitor adaptations through a co-creation process. This study protocol will be a guide for other scale-up interventions making use of knowledge translation and co-creation activities. Key messages Process evaluation is needed to keep track of complex interventions including scale up. The SCUBY project developed an evaluation plan to comprehensively monitor the scale-up of HT and T2D care.

Model-based workflow for scale-up of process strategies developed in miniaturized bioreactor systems.

Miniaturized bioreactor (MBR) systems are routinely used in the development of mammalian cell culture processes. However, scale-up of process strategies obtained in MBR- to larger scale is challenging due to mainly non-holistic scale-up approaches. In this study, a model-based workflow is introduced to quantify differences in the process dynamics between bioreactor scales and thus enable a more knowledge-driven scale-up. The workflow is applied to two case studies with antibody-producing Chinese hamster ovary cell lines. With the workflow, model parameter distributions are estimated first under consideration of experimental variability for different scales. Second, the obtained individual model parameter distributions are tested for statistical differences. In case of significant differences, model parametric distributions are transferred between the scales. In case study I, a fed-batch process in a microtiter plate (4ml working volume) and lab-scale bioreactor (3750 ml working volume) was mathematically modeled and evaluated. No significant differences were identified for model parameter distributions reflecting process dynamics. Therefore, the microtiter plate can be applied as scale-down tool for the lab-scale bioreactor. In case study II, a fed-batch process in a 24-Deep-Well-Plate (2ml working volume) and shake flask (40 ml working volume) with two feed media was investigated. Model parameter distributions showed significant differences. Thus, process strategies were mathematically transferred, and model predictions were simulated for a new shake flask culture setup and confirmed in validation experiments. Overall, the workflow enables a knowledge-driven evaluation of scale-up for a more efficient bioprocess design and optimization.

Integrated Multiproduct Biorefinery for Furfural Production with Acetic Acid and Lignin Recovery: Design, Scale-Up Evaluation, and Technoeconomic Analysis

Furfural is a versatile platform and multipurpose chemical that can be produced with no carbon efficiency loss from pentose sugars present in prehydrolysate streams. Existing processes for the prod...

9.G. Workshop: Evaluation of scale-up of health systems interventions: what and how? Lessons for scale-up projects

Abstract Objectives Non-communicable diseases (NCD) are a major challenge for health systems across the globe. Although effective interventions for prevention, detection and control exist, these do not reach all people in need, especially the poor and most vulnerable. Scale-up strategies are developed to increase universal access to those interventions, addressing demand-side and supply-side barriers and to facilitate integration in the health system. While there are useful frameworks to conceptualise and operationalise scale-up of NCD interventions, there is a knowledge gap on what and how to evaluate. This session addresses that knowledge gap, presenting evaluation methods for scale-up from four large multi-country research projects. The objectives are: To increase knowledge on four dimensions of scale-up evaluation: 1) contextualisation of methods; 2) implementation evaluation; 3) cost-evaluation and 4) use of health information systemsTo present methods and results of implementation research on NCDs as an example for other chronic diseasesTo illustrate how contextualisation, implementation and evaluation varies across different stages of scale-upTo stimulate learning by experience through small-group discussion with session participants This workshop provides added value through the four coherent presentations combined with small group interactions on the same topics. It allows the audience to link the case study lessons to their own research and wider application. Format Four different elements of scale-up evaluation are addressed: 1) Contextualisation of evaluation methods from a common framework; 2) Implementation evaluation at operational level; 3) Cost-evaluation of NCD interventions; and 4) Large-scale evaluation through routine health information systems (HIS). Case studies from four large-scale Horizon2020 funded research projects in 14 countries in Europe, Africa and Asia will be presented, each case focusing on one dimension. Cross-cutting themes of adaptation and transferability of methods will also be addressed. After the presentations, there will be an interactive session to promote experience-based learning in small-group discussions. Presentations Self-Management Approach and Reciprocal Learning for Type 2 Diabetes (SMART2D)Scaling-up Packages of Interventions for cardiovascular disease prevention in Europe and Sub-Saharan Africa (SPICES)Scaling-Up NCD Interventions in South-East Asia (SUNI-SEA)The Scale-Up of Diabetes and Hypertension Care (SCUBY) The presentations will provide the introduction to subsequent small-table discussions, around the following questions: How to measure and monitor implementation and outcome of intervention scale-up?How to generate transferrable lessons from cross-country studies?How to conduct cross-setting evaluation of the effect and cost of NCD interventions? Key messages The global scale-up of NCD interventions calls for robust evaluation methods of effect, implementation and cost. Evaluation methods need to be fit to the country context and health information systems.

Anaerobic membrane bioreactor (AnMBR) scale-up from laboratory to pilot-scale for microalgae and primary sludge co-digestion: Biological and filtration assessment

This research work proposes the scale-up evaluation in terms of biological and filtration performance from laboratory to pilot-scale of an anaerobic membrane bioreactor (AnMBR) co-digesting raw microalgae and primary sludge. Best operating conditions for this scale-up were energetically and economically assessed based on laboratory results. Economic balance showed 3% higher annual costs when operating a reactor at 100 d solids retention time (SRT) compared to 70 d SRT. Energetic balance showed a 5.5-fold increase in heat demand working at thermophilic temperature comparing to mesophilic. The AnMBR operating conditions were set at 70 d SRT and 35 °C. The pilot-scale and lab-scale co-digesters performed similarly in terms of biogas production and system stability. 154 mLbiogas·d−1·L−1reactor were produced at pilot-scale, corresponding to methane yield of 215 mLCH4·gCODinf−1. AnMBR filtration at both laboratory and pilot-scale showed stability working at permeate fluxes of 4.2–5.8 L·m−2·h−1.

Testing and scaling-up of a novel Ti/Ru0.7Ti0.3O2 mesh anode in a microfluidic flow-through reactor

This work investigates the scale-up of the electrolysis and photo-electrolysis of water polluted with clopyralid using a novel Ti/Ru0.3Ti0.7O2 mesh anode produced by CO2 laser. Two different cells were used: a mixed tank cell (MT) and a microfluidic flow-through reactor (MF-FT). The main advantages of the MF-FT reactor are the simultaneous reduction of the ohmic resistance and mass transfer limitations, which are two critical factors in electrochemical oxidation. Thus, the goal is the scale-up evaluation and the study of the effects of the kind of water matrix towards practical application of the laser-made anode in water treatment. Aqueous solutions of clopyralid and groundwater intensified with this pollutant were studied in the context of the scale-up evaluation to clarify the effects of the water matrix. Single photolysis was also studied for comparison purposes. It was demonstrated that photo-electrolysis results in a faster clopyralid and TOC removal in both the MF-FT reactor and mixed tank cells as compared to single electrolysis. This work also focuses on the synergy coefficient to evaluate the effect of the coupling of different processes on system performance. Higher synergistic effects occur on clopyralid removal in the MF-FT reactor (110% and 358%, for natural groundwater and synthetic water, respectively) and TOC (233.3% and 15396% for natural groundwater and synthetic water, respectively). The best performance was obtained in the MF-FT reactor, which was attributed to the more uniform potential/current distribution associated with the reduced interelectrode gap (few microns) in comparison with the MT cell (gap of one centimeter), which also results in reduced energy consumption.

Big data analytics for retail industry using MapReduce-Apriori framework

Presently, retailing has changed its face from unordered stacked traditional stores to beautifully decorated and appropriately managed merchandise stores or shopping malls with excellent ambiance and comfort. Therefore, these stores try to accommodate all needed items for daily use or rarely required items under the same roof. However, the primary challenge for today’s retailer is that the modern customer is quality and brands conscious as well as compare for services provided to them by different outlets at the comfort of home with a single click. Therefore, customers prefer to purchase from E-Commerce websites instead of physically visiting a retail store, which leads to the downfall in the sales of retailers which become a serious threat to them. Therefore, retailers are required to work sincerely towards their customer expectations by providing all their needed goods under the same roof. Therefore, the objective of this paper is to assist retail business owners to recognize the purchasing needs of their customers and hence to entice customers to physical retail stores away from competitor E-Commerce websites. This paper employs a systematic research methodology based on association rule mining deployed over Map-Reduce based Apriori association mining and Hadoop based intelligent cloud architecture to determine useful buying patterns from purchase history of previous customers, in order to assist retail business owners. The finding acknowledges that the traditional mining algorithms have not progressed to support big data analysis as required by current retail businesses owners. The job of finding unknown association rules from big data requires a lot of resources such as memory and processing engines. Moreover, traditional mining systems are inadequate to provide support for partial failure support, extensibility, scalability etc. Therefore, this study aims to implement and develop MapReduce based Apriori (MR-Apriori) algorithm in the form of Intelligent Retail Mining Tool i.e. IRM Tool to recognize all these concerns in an efficient manner. The proposed system adequately satisfy all significant requisites anticipated from modern Big Data processing systems such as scalability, fault tolerance, partial failure support etc. Finally, this study experimentally verifies the effectiveness of the proposed algorithm i.e. MR-Apriori by speed-up, size-up, and scale-up evaluation parameters.

Implementation and scale-up of physical activity and behavioural nutrition interventions: an evaluation roadmap

BackgroundInterventions that work must be effectively delivered at scale to achieve population level benefits. Researchers must choose among a vast array of implementation frameworks (> 60) that guide design and evaluation of implementation and scale-up processes. Therefore, we sought to recommend conceptual frameworks that can be used to design, inform, and evaluate implementation of physical activity (PA) and nutrition interventions at different stages of the program life cycle. We also sought to recommend a minimum data set of implementation outcome and determinant variables (indicators) as well as measures and tools deemed most relevant for PA and nutrition researchers.MethodsWe adopted a five-round modified Delphi methodology. For rounds 1, 2, and 3 we administered online surveys to PA and nutrition implementation scientists to generate a rank order list of most commonly used; i) implementation and scale-up frameworks, ii) implementation indicators, and iii) implementation and scale-up measures and tools. Measures and tools were excluded after round 2 as input from participants was very limited. For rounds 4 and 5, we conducted two in-person meetings with an expert group to create a shortlist of implementation and scale-up frameworks, identify a minimum data set of indicators and to discuss application and relevance of frameworks and indicators to the field of PA and nutrition.ResultsThe two most commonly referenced implementation frameworks were the Framework for Effective Implementation and the Consolidated Framework for Implementation Research. We provide the 25 most highly ranked implementation indicators reported by those who participated in rounds 1–3 of the survey. From these, the expert group created a recommended minimum data set of implementation determinants (n = 10) and implementation outcomes (n = 5) and reconciled differences in commonly used terms and definitions.ConclusionsResearchers are confronted with myriad options when conducting implementation and scale-up evaluations. Thus, we identified and prioritized a list of frameworks and a minimum data set of indicators that have potential to improve the quality and consistency of evaluating implementation and scale-up of PA and nutrition interventions. Advancing our science is predicated upon increased efforts to develop a common ‘language’ and adaptable measures and tools.

A scale-up evaluation of a semicontinuous culture of Scenedesmus sp. in a raceway under greenhouse conditions using a commercial fertilizer as culture medium

In the present work, Scenedesmus sp. was grown under a semicontinuous regime in fertilizer (Bayfolan® Forte, 1 mL L−1) medium, and Bold’s Basal Medium (BBM) as control, in raceways of 200 and 2000 L under greenhouse conditions. The biomass, lipid, protein, carbohydrate and total pigment production was determined. The culture under the semicontinuous regime allowed an increase in the productivities in each consecutive cycle, reaching a lipid productivity of 20.00 ± 6.29 mg L−1 d−1 in Bayfolan medium. The biomass productivity in the medium supplemented with fertilizer was significantly higher than in the BBM. The protein productivity was significantly higher in Bayfolan (1.93 ± 0.28 L−1 d−1). The average carbohydrate productivity of the cycles was 10.10 ± 2.01 mg L−1 d−1. The fertilizer allowed an increase of up to 3-fold in total pigment productivity compared to the BBM. The fatty acids obtained were mainly composed of C16:0, C18:3n3 (α-linolenic) and C18:0. Palmitic acid (C16:0) was the main fatty acids methyl ester accumulated along with stearic (C18:0) and myristic (C14:0) acids. It was shown that the utilization of the liquid fertilizer Bayfolan is a potential alternative to replace conventional media.

Implementation and evaluation of nationwide scale-up of the Surgical Safety Checklist.

BackgroundThe WHO Surgical Safety Checklist improves surgical outcomes, but evidence and theoretical frameworks for successful implementation in low‐income countries remain lacking. Based on previous research in Madagascar, a nationwide checklist implementation in Benin was designed and evaluated longitudinally.MethodsThis study had a longitudinal embedded mixed‐methods design. The well validated Consolidated Framework for Implementation Research (CFIR) was used to structure the approach and evaluate the implementation. Thirty‐six hospitals received 3‐day multidisciplinary training and 4‐month follow‐up. Seventeen hospitals were sampled purposively for evaluation at 12–18 months. The primary outcome was sustainability of checklist use at 12–18 months measured by questionnaire. Secondary outcomes were CFIR‐derived implementation outcomes, measured using the WHO Behaviourally Anchored Rating Scale (WHOBARS), safety questionnaires and focus groups.ResultsAt 12–18 months, 86·0 per cent of participants (86 of 100) reported checklist use compared with 31·1 per cent (169 of 543) before training and 88·8 per cent (158 of 178) at 4 months. There was high‐fidelity use (median WHOBARS score 5·0 of 7; use of basic safety processes ranged from 85·0 to 99·0 per cent), and high penetration shown by a significant improvement in hospital safety culture (adapted Human Factors Attitude Questionnaire scores of 76·7, 81·1 and 82·2 per cent before, and at 4 and 12–18 months after training respectively; P < 0·001). Acceptability, adoption, appropriateness and feasibility scored 9·6–9·8 of 10. This approach incorporated 31 of 36 CFIR implementation constructs successfully.ConclusionThis study shows successfully sustained nationwide checklist implementation using a validated implementation framework.

Scale-up evaluation of anaerobic degradation of linear alkylbenzene sulfonate from sanitary sewage in expanded granular sludge bed reactor

Sanitary sewage composed of 6.2 ± 3.2 mgLAS L−1, low diversity of organic acids (21.4 ± 18.9 and 2.1 ± 3.9 mg L−1, for acetic and propionic, respectively), metals (Fe, Zn, Pb, Mn, Ni, Cr, Cu) and xenobiotic compounds (limonene, terpinene, phenol, indolizine) were used in the pilot-scale EGSB reactor feed (69 L). For influent load of 1.4 ± 0.7 mgLAS gVS−1d−1 and 50 ± 15 mgCOD gVS−1 d−1, removal efficiencies were 60 ± 30% and 77 ± 28% for LAS and COD, respectively. According to the alpha diversity indices (Shannon, Chao-1and Simpson), the sanitary sewage composition did not negatively affect the microbial richness throughout the 314 days of EGSB reactor operation. Bacteria related to LAS degradation such as Synergistes, Syntrophus, Clostridium and Geobacter were identified. For the Archaea Domain, Methanosaeta was the dominant genus. Therefore, in the present study the application of a pilot-scale EGSB reactor was considered viable for the LAS bioremediation in sanitary sewage.

Capture and electro-splitting of CO2 in molten salts

Due to the serious greenhouse gas effects caused by the increasing concentration of atmospheric CO2, carbon capture and storage (CCS) has been an important area of research and many technologies are developed within this field. Molten salt CO2 capture and electrochemical transformation (MSCC-ET) process is a desirable method due to a high CO2 solubility, a wide potential window of molten salts and easily-controlled electrode reactions. Generally, electro-splitting CO2 in molten salts begins with CO2 absorption reactions to form CO32−, which is then followed by the carbon deposition at the cathode and O2 evolution at the anode. As a result, CO2 is electro-converted to O2 and carbon with different morphologies, compositions, microstructures and functional properties. This report introduces the MSCC-ET process, summarizes the reactions occurring in the molten salts and at the electrode surfaces, as well as the morphological variations of the cathodic products. The inert anode materials, cost estimation and scale-up evaluation of the process are then discussed. It is presumed that with a comprehensive understanding of the electrode reactions during electrolysis and the functional properties of carbon materials obtained during CO2 electro-splitting can provide a foundation for further developing this environmentally friendly process.