Sustained Phase Research Articles

Chitosan Nanoparticles Embedded in In Situ Gel for Nasal Delivery of Imipramine Hydrochloride: Short-Term Stage Development and Controlled Release Evaluation

Imipramine hydrochloride (IMP), a tricyclic antidepressant used for major depression, enuresis, and neuropathic pain, is limited by gastrointestinal complications, low oral bioavailability (44%), and complex dosing requirements. This study aimed to explore a novel non-invasive nasal delivery system using chitosan nanoparticles (Cs NPs) embedded in an in situ gel to address the limitations of oral IMP administration. Cs NPs loaded with IMP were synthesized via ionic gelation and assessed for precision in drug concentration using a validated HPLC method. The particles were integrated into a thermoresponsive polymer, Pluronic F127, to form an in situ gel suitable for nasal administration. The formulation was characterized for gelation temperature, duration, viscosity, mucoadhesive strength, and overall gel robustness. Drug release kinetics and the controlled release mechanism were studied using ex vivo permeation tests with Franz diffusion cells and nasal sheep mucosa. The optimized nanoparticle formulation (F4-50) exhibited a consistent PS of 141.7 ± 2.2 nm, a zeta potential (ZP) of 16.79 ± 2.1 mV, and a high encapsulation efficiency of 67.71 ± 1.9%. The selected in situ gel formulation, F4-50-P1, demonstrated a gelation temperature of 33.6 ± 0.94 °C and a rapid gelation time of 48.1 ± 0.7 s. Transform-attenuated total reflectance infrared spectroscopy (ATR-IR) confirmed the compatibility and effective encapsulation of IMP within the formulation. The release profile of F4-50 included an initial burst release followed by a sustained release phase, with F4-50-P1 showing improved control over the burst release. The flux rates were 0.50 ± 0.01 mg/cm2/h for F4-50 and 0.33 ± 0.06 mg/cm2/h for F4-50-P1, indicating effective permeation. The developed chitosan nanoparticle-based in situ gel formulation provides a promising approach for the controlled release of IMP, enhancing therapeutic efficacy and patient compliance while mitigating the disadvantages associated with oral delivery.

Benefits of cross-border access to human genomes at scale for research and healthcare

Abstract Genomics data will soon be routinely generated and integrated into national healthcare systems. To maximise the potential of genomic medicine, data should be accessible for research where possible. This is the remit of ELIXIR, an intergovernmental organisation that brings together life science resources from across Europe. Innovative solutions are needed to ensure the validated research findings for disease or preventative medicine are then integrated into healthcare. To tackle this, the 1+MG initiative, a joint initiative of 25 EU countries, the UK, and Norway, aims to enable secure access to genomics and the corresponding clinical data across Europe for better research, personalised healthcare and health policy making. In the design and scale-up phase (B1MG project), recommendations and guidelines to advance towards the deployment of personalised medicine at a European scale have been produced, adopted by 1+MG and developed into a 1+MG framework. This includes guidance on data governance, standards, quality and infrastructure, recommendations on how to approach citizen engagement and a tool for countries to self-assess implementation into healthcare. The European Genomic Data Infrastructure (GDI) project supports the scale-up and sustainability phase of the 1+MG initiative, to deploy infrastructure across 24 countries to support the overall ambition. Recommendations are being used to promote governance and technical interoperability across European initiatives including the European Health Data Space (EHDS), and European Cancer Image Initiative (EUCAIM). The 1+MG will be established as a European Data Infrastructure Consortia in 2025 and will act as an Authorised Participant in the EHDS providing access to a permanent high-quality federated data collection of genomic and health data that will accelerate research, innovation and policymaking facilitating the deployment of genomic medicine across Europe.

Evaluating the greenness, blueness, and whiteness of spectroscopic and UPLC techniques for the simultaneous measurement of anti-glaucoma drugs and the preservation agent

The pursuit of sustainable solutions is increasingly crucial in contemporary times. We propose inventive research that fulfills the criteria of whiteness and greenness in analytical chemistry. The endeavor aims to advance environmentally conscious techniques for the simultaneous detection of timolol maleate (TIM), dorzolamide HCl (DOR), and benzalkonium Cl (BNZ). The first method employed a sustainable mobile phase consisting of 0.02 M phosphate buffer: ethanol (68:32, v/v), and a flow rate of 0.6 mL/min with retention times 1.274, 1.798, and 2.483 min for DOR, TIM, and BNZ, respectively, with a UV detector at 210 nm. This methodology was easy, fast, and accurate. The approach showed low processing times, peak symmetry, and satisfactory resolution, with correlation values of 0.999. The linearity was between 0.001–0.064, 0.001–0.060 µg mL-1, and 0.001–0.050 µg mL-1for DOR, TIM, and BNZ, respectively. Furthermore, employing water as the solvent, complementary spectrophotometric methods such as Mean Centering of Ratio Spectra (MCR) and Successive Derivative Ratio Spectra (SRDS) were investigated as economical and environmentally friendly substitutes. All procedures demonstrated good linearity (r² > 0.9990), acceptable accuracy, and precision (RSD ≤ 2 %). Furthermore, by proving the superiority of the current work over previously published methods regarding sustainability, analytical performance, economics, and practicality, the real-world implementation of four greenness and whiteness algorithms boosts the approval and overall sustainable development of the proposed methods. The suggested techniques offer low-cost, environmentally friendly substitutes for traditional methods, advancing the field of analytical chemistry towards more sustainable practices and fostering a less destructive future for quality control.

A-193 Optimizing Emergency Laboratory Operations Through Six-Sigma Strategies for Enhanced Efficiency and Effectiveness: A Pilot Study

Abstract Background Quality assurance is vital in laboratory diagnostics to ensure patient safety and accurate results. Laboratories employ internal and external quality control measures, particularly focusing on the analytical phase. Sigma metrics, representing process variation, play a crucial role in assessing accuracy, with Six Sigma setting high standards for operational excellence. This study aims to enhance laboratory testing procedures by analyzing the analytical phase. In 2022, the Emergency laboratory at KFAFH, Jeddah, achieved optimal sigma performance, marking a significant improvement in analytical testing. http://www.westgard.com/sigma-vp-kfafh.htm. In 2023, The study also demonstrated a 30% productivity increase, driven by sustained efforts and Sigma metrics implementation, leading to cost reductions and improved quality. Real-time patient moving averages enhance quality assurance, extending coverage to the total testing process. The primary objectives include redesigning IQC procedures and optimizing resource utilization. This will be accomplished by reducing the frequency of controls, minimizing unnecessary reruns, optimizing resource allocation, and managing total costs, all while ensuring compliance and averting violations. Methods A retrospective-prospective study was conducted at the Emergency Laboratory of King Fahad Armed Forces Hospital in Jeddah, Saudi Arabia, from May 2021 to October 2023. The study assessed 841,558 tests for 131,785 emergency patients. Forty-seven analytes were evaluated for Internal Quality Control and External Quality Control (CAP), with monthly data collection. Chemistry and Hematology parameters were analyzed using Unity Real-Time software on Alinity-ci and Alinity-hq analyzers. Data was collected in three stages: baseline, pre-Sigma verification, post-Sigma implementation, and a sustainability phase. The methodology involved DMAIC model tools like flowcharts, cause & effect analysis, and sigma metric scales. Six Sigma process tools, including DPM and process capability analysis, were used. Interventions included Six Sigma metrics for QC performance, DPM for TAT process improvement, and patient moving average Real-time for proactive risk management in reducing analytical testing variation. Results Excellent performance (> 6 sigma) was achieved for 70% of chemistry test parameters for three control levels.: This indicates a high level of process capability and reliability in laboratory operations, ensuring accuracy and consistency in test results. The study successfully reduced process variation in Emergency Room (ER) laboratory Turnaround times (TATs), leading to an increase in process capability as measured on the Sigma scale, which improved from 1.35 to 3.1, indicating a more robust and efficient laboratory operation. Reducing the cost and efficiency of internal failure controls by 29% and at the same time saving in labor cost/workload marked a decrease in QC frequency from 7.0% to 0.18%, reaching the target goal of TATs and satisfaction. Conclusions The adoption of Six Sigma methodologies resulted in a notable decrease in QC runs, signaling cost savings. These high-quality methods streamline laboratory operations, improve cost-effectiveness for the healthcare system, and ultimately benefit patients and clinicians. Six Sigma methodologies play a crucial role in selecting appropriate QC designs for each parameter, ensuring efficient control while maximizing cost-effectiveness. Emphasizing the importance of suitable QC strategies and continuous technologist training is vital for mitigating analytical errors and enhancing turnaround time through comprehensive automation of the analytical phase.

Pullulan-DOX/PVA-PDMS Biopolymeric Core-Shell Nanofibers Potential for Drug Delivery Systems

In this research, a novel drug delivery system shell was created by loading doxorubicin hydrochloride (DOX) into Pullulan and integrating the core into a polyvinyl alcohol (PVA) and Polydimethoxysilane (PDMS) composite matrix. The incorporation of DOX into the pullulan solution was carried out to take advantage of Pullulan's biocompatibility, biodegradability and hydrophilic nature. The hydrophilic nature of PVA can result in rapid drug release, while the hydrophobic nature of PDMS allows for slower drug release. The use of PVA-PDMS polymers together in the shell offers an initial rapid release followed by a prolonged and controlled drug release. This combination is superior to PVA or PDMS in terms of safety, mechanical strength, flexibility, controlled drug release and structural stability. This innovative composite system was designed to optimise DOX's controlled release to increase its therapeutic efficacy and reduce systemic toxicity. The kinetics of the drug release was characterised by an initial burst release followed by a sustained release phase, allowing controlled and prolonged release of the chemotherapeutic agent. Our results indicate that the pullulan/PVA-PDMS composite is a promising candidate for practical drug delivery applications, especially in cancer therapy.

Evaluating the tailored implementation of a multisite care navigation service for mental health in rural and remote Australia (The Bridging Study): protocol for a community-engaged hybrid effectiveness-implementation study

BackgroundA dramatic decline in mental health of people worldwide in the early COVID-19 pandemic years has not recovered. In rural and remote Australia, access to appropriate and timely mental health services has been identified as a major barrier to people seeking help for mental ill-health. From 2020 to 2021 a care navigation model, Navicare, was co-designed with rural and remote communities in the Greater Whitsunday Region of Central Queensland in Australia. The Exploration, Preparation, Implementation and Sustainment (EPIS) framework was used to design and guide multiple aspects of a multisite study, The Bridging Study, to evaluate the implementation of Navicare in Australia.MethodsA community-engaged hybrid effectiveness-implementation study design will focus on the tailored implementation of Navicare at three new sites as well as monitoring implementation at an existing site established since 2021. Study outcomes assessed will include sustained access as the co-primary outcome (measured using access to Navicare mental health referral services) and Proctor’s Implementation Outcomes of feasibility, acceptability, appropriateness, adoption, fidelity, implementation cost, and sustainability. Data collection for the implementation evaluation will include service usage data, community consultations, interviews, and workshops; analysed using mixed methods and guided by EPIS and other implementation frameworks. Pre-post effectiveness and cost-consequence study components are embedded in the implementation and sustainment phases, with comparison to pre-implementation data and value assessed for each EPIS phase using hospital, service, and resource allocation data. A scaling up strategy will be co-developed using a national roundtable forum in the final year of the study. Qualitative exploration of other aspects of the study (e.g., mechanisms of action and stakeholder engagement) will be conducted.DiscussionOur study will use tailoring to local sites and a community-engaged approach to drive implementation of a mental health care navigation service in rural and remote Australia, with expected benefits to mental healthcare access. This approach is consistent with policy recommendations nationally and internationally as building blocks for rural health including the World Health Organization Framework for Action on Strengthening Health Systems to Improve Health Outcomes.Trial registrationProspectively registered on April 2, 2024, on the Australian New Zealand Clinical Trials Registry, no. ACTRN12624000382572. https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386665&isReview=true.

Empowering Natural Medicine: Nanocarrier-based Oral Delivery of Vigna Radiata Extract for Effective Diabetes Management

Background: Poor solubility and low oral bioavailability are major challenges associated with the oral delivery of the antidiabetic drug Vigna radiata (VR). Nanostructured lipid carriers (NLCs) have emerged as a promising strategy to overcome these limitations and improve the therapeutic efficacy of VR. This study investigated the potential of NLCs for VR delivery and explored the influence of formulation parameters on NLC properties and drug release behavior. Method: NLCs loaded with VR were prepared using the melt emulsion ultrafiltration technique. The effect of two key formulation variables – the ratio of liquid lipid to solid lipid and the concentration of the surfactant – were investigated in terms of particle size, zeta potential, and drug encapsulation efficiency. The in vitro release profiles of the VR-NLC formulations were evaluated, and the optimal formulation was subjected to further analysis to investigate its release kinetics. Result: The NLCs exhibited particle sizes ranging from 108.9 to 192.3 nm and all formulations possessed a negative zeta potential (-3.68 to -10.9 mV), indicating good stability and potential for resisting aggregation. Interestingly, the lowest solid lipid to liquid lipid ratio and the lowest surfactant concentration yielded the highest drug encapsulation efficiency, highlighting the complex interplay between these factors. All VR-NLC formulations exhibited a biphasic, time-dependent in vitro release pattern, suggesting an initial burst release followed by a sustained release phase. This biphasic profile is promising for achieving both rapid onset of action and long-lasting glycemic control, which are crucial aspects of effective diabetes management. The optimized NLC formulation showed an in vitro release pattern that adhered to the Higuchi diffusion model, suggesting a controlled release mechanism where the drug diffuses steadily out of the NLC matrix. This finding indicates potentially predictable and consistent drug delivery in vivo. Conclusion: This study demonstrates the potential of NLCs as a promising platform for the controlled oral delivery of VR. NLCs can overcome the inherent limitations of VR and provide a convenient and effective oral antidiabetic option for patients. Further research is needed to confirm the efficacy and safety of NLC-encapsulated VR in vivo using relevant animal models. This will pave the way for the development of a novel and potentially transformative treatment option for diabetes.

Nanoencapsulation of etoposide promotes increased long-term DNA damage, greater induction of senescence and reduces population regrowth of lung cancer cells

Lung cancer is the most common type of cancer and the leading cause of cancer-related deaths worldwide. The nanoencapsulation of etoposide, a topoisomerase II inhibitor and widely used chemotherapeutic drug, may overcome the limitations related to low aqueous solubility and non-specific toxicity, in addition to enabling a sustained release of etoposide and promoting long-term effects. Here we developed etoposide-loaded lipid-core nanocapsules (ETO NC) having unimodal particle size (∼150 nm), drug content of 0.5 mg mL−1 and encapsulation efficiency of ∼99 %. The formulation remained stable for 28 days at 5 °C. The release experiment showed 70 % of drug dialyzed from ETO NC within 72h in a biexponential curve characterized by a burst phase (60 %, t½ = 1.3 h) followed by a sustained phase (33 %, t½ = 173.2 h). Exposure of A549 lung adenocarcinoma cells to 10 μmol L−1 of drug (ETO NC) produced a threefold reduction in cell viability after 48h. Etoposide (ETO or ETO NC) produced DNA double-strand breaks, as indicated by nuclear foci in A549 cells stably expressing 53BP1-mApple. However, ETO NC significantly promoted nuclear damage over the long-term (20 days), consequently enhancing the induction of senescence and significantly reducing the proliferative subpopulation compared to etoposide in solution. Our findings reveal that ETO NC can enhance the long-term effects of etoposide in inducing DNA damage and inducing senescence, being an innovative strategy to overcome the limitations of this treatment, and strongly encouraging future investigations in in vivo models.

Closing the gap: addressing telehealth disparities across specialties in the sustained pandemic era

Missed appointments, or no-shows, disrupt healthcare delivery, exacerbating chronic disease management and leading to worse health outcomes. Telehealth has surged as a viable solution to reduce no-shows and improve healthcare accessibility, especially during the COVID-19 pandemic. However, telehealth disparities and its long-term efficacy across various medical specialties remain understudied. To address this, we performed a retrospective analysis of electronic health records from a heterogenous network of hospitals in Illinois, examining telehealth use and no-shows across among 444,752 adult patients with 1,973,098 outpatient encounters across nine specialties during the sustained pandemic phase (i.e., January 1, 2021 to July 1, 2022). Among them, 84,290 (4.27%) were no-shows, and telehealth constituted 202,933 (10.3%) of the total encounters. Telehealth use during the sustained phase varied significantly by specialty type. Overall, telehealth encounters were associated with reduced no-show odds compared to in-person encounters (OR, 0.28; 95% CI, 0.26–0.29). Black and Hispanic patients, as well as those with Medicaid, had higher no-show odds relative to their counterparts, even when using telehealth. Mental health specialty had the highest telehealth usage rate and the highest no-show odds (OR, 2.99; 95% CI, 2.84–3.14) relative to other specialties included in the study. Moreover, specialty type had differential effects on no-shows for telehealth. These results underscore the variability in telehealth use by specialty type and pervasive disparities telehealth use and no-shows. As we move beyond the pandemic, our findings can inform policymakers to tailor policies and incentives to reach different patient groups as well as specialties, with varying needs, to promote equitable telehealth utilization.

Mixed-mode cationic exchange paper combined with direct infusion mass spectrometry, a sustainable approach to determine opioids in biosamples

Direct infusion mass spectrometry (DI-MS/MS) allows the rapid analysis of samples and minimizes solvent usage by avoiding chromatographic separation. However, it is prone to ion suppression due to matrix effects, especially when biosamples are processed. In this context, sample preparation appears as the perfect complement to get proper analytical results. In this article, a novel and sustainable planar sorptive phase containing mixed-mode cationic exchange (MCX) particles is presented to overcome the limitations of DI-MS/MS in bioanalysis. The new phase uses cellulose paper as a natural substrate over which the particles can be retained using polyacrylonitrile (PAN) as the chemical binder. The high porosity of the cellulose substrate simplifies the synthesis since a straightforward dip-coating technique can be applied. For this purpose, MCX particles are initially dispersed in a PAN solution prepared in N,N-Dimethylformamide. A segment of paper is later introduced into the slurry, and the evaporation of the solvent leaves a film of PAN-MCX composite over the paper, where the particles are entrapped but accessible for the analyte's isolation. The resulting MCX-paper has been evaluated for the extraction of selected opioids (codeine, methadone, morphine, naloxone, oxycodone, and tramadol) from saliva and urine samples and their determination by direct infusion tandem mass spectrometry. Working at the optimized conditions, the limits of detection were in the low μg L−1 range. The precision, expressed as relative standard deviation, was better than 12 % under intra-day and inter-day conditions. The accuracy, expressed as relative recoveries, provides values in the ranges 89–113 % and 74–121% for saliva and urine, respectively. The method was finally applied to analyze saliva and urine samples collected from patients under codeine treatment.

Enhancing Sustainable Analytical Chemistry in Liquid Chromatography: Guideline for Transferring Classical High-Performance Liquid Chromatography and Ultra-High-Pressure Liquid Chromatography Methods into Greener, Bluer, and Whiter Methods.

This review is dedicated to sustainable practices in liquid chromatography. HPLC and UHPLC methods contribute significantly to routine analytical techniques. Therefore, the transfer of classical liquid chromatographic methods into sustainable ones is of utmost importance in moving toward sustainable development goals. Among other principles to render a liquid chromatographic method green, the substitution of the organic solvent component in the mobile phase with a greener one received great attention. This review concentrates on choosing the best alternative green organic solvent to replace the classical solvent in the mobile phase for easy, rapid transfer to a more sustainable normal phase or reversed-phase liquid chromatography. The main focus of this review will be on describing the transfer of non-green to green and white chromatographic methods in an effort to elevate sustainability best practices in analytical chemistry. The greenness properties and greenness ranking, in addition to the chromatographic suitability of seventeen organic solvents for liquid chromatography, are mentioned to have a clear insight into the issue of rapidly choosing the appropriate solvent to transfer a classical HPLC or UHPLC method into a more sustainable one. A simple guide is proposed for making the liquid chromatographic method more sustainable.

Predictors of the sustainability for an evidence-based eating disorder prevention program delivered by college peer educators

BackgroundDespite ongoing efforts to introduce evidence-based interventions (EBIs) into mental health care settings, little research has focused on the sustainability of EBIs in these settings. College campuses are a natural place to intervene with young adults who are at high risk for mental health disorders, including eating disorders. The current study tested the effect of three levels of implementation support on the sustainability of an evidence-based group eating disorder prevention program, the Body Project, delivered by peer educators. We also tested whether intervention, contextual, or implementation process factors predicted sustainability.MethodsWe recruited 63 colleges with peer educator programs and randomly assigned them to (a) receive a 2-day Train-the-Trainer (TTT) training in which peer educators were trained to implement the Body Project and supervisors were taught how to train future peer educators (TTT), (b) TTT training plus a technical assistance (TA) workshop (TTT + TA), or (c) TTT plus the TA workshop and quality assurance (QA) consultations over 1-year (TTT + TA + QA). We tested whether implementation support strategies, perceived characteristics of the intervention and attitudes towards evidence-based interventions at baseline and the proportion of completed implementation activities during the implementation year predicted three school-level dichotomous sustainability outcomes (offering Body Project groups, training peer educators, training supervisors) over the subsequent two-year sustainability period using logistic regression models.ResultsImplementation support strategies did not significantly predict any sustainability outcomes, although a trend suggested that colleges randomized to the TTT + TA + QA strategy were more likely to train new supervisors (OR = 5.46, 95% CI [0.89–33.38]). Colleges that completed a greater proportion of implementation activities were more likely to offer Body Project groups (OR = 1.53, 95% CI [1.19–1.98]) and train new peer educators during the sustainability phase (OR = 1.39, 95% CI [1.10–1.74]). Perceived positive characteristics of the Body Project predicted training new peer educators (OR = 18.42, 95% CI [1.48–299.66]), which may be critical for sustainability in routine settings with high provider turnover.ConclusionsHelping schools complete more implementation activities and increasing the perceived positive characteristics of a prevention program may result in greater sustainment of prevention program implementation.Trial RegistrationThis study was preregistered on 12/07/17 with ClinicalTrials.gov, ID NCT03409809, https://clinicaltrials.gov/ct2/show/NCT03409809.

Dielectric study and electrochemical detection of ascorbic acid using modified electrode treated with europium-doped tricalcium aluminate nanoparticles

The current study involved the dielectric, and sensor properties of trivalent europium (Eu3+) doped tricalcium aluminate (Ca3Al2O6) Nanoparticles. These samples were synthesized through the solution combustion method with urea (NH2CO·NH2) as the fuel. Structural analysis confirms that the samples exhibited a sustainable cubic phase with the Pm-3m space group. The irregular spherical morphology and agglomeration of synthesized particles were observed using a scanning electron microscope. The energy bandgap values were calculated using the Kubelka and Munk relation, which ranged from 5.14 to 5.27 eV. To examine the dielectric behavior at different frequencies, electrical impedance spectroscopy was performed which provided insights into the changes in electrical permittivity and revealed the contributions of both grains and grain boundaries in the samples. The synthesized material exhibited higher values of dielectric constant and loss at lower frequencies, which decreased significantly as the frequency increased. This suggests that the samples are suitable for applications in microwave devices. Also, the electrochemical studies demonstrate the sensor's rapid amperometric response to ascorbic acid oxidation. The current constructed sensor has a sensitivity of 0.0065 A for ascorbic acid and the electrode treated with Ca3-xAl2O6:xEu3+ (x = 0.05) is better able to detect the electrochemical behavior of substances like ascorbic acid.

Translating 'proportionate universal healthcare' into meaningful system design to optimize equity in child and family services.

To conduct a child and family health nursing service redesign to improve pathways of access, response and outcomes for all families with children aged 0-5 years. The study was conducted as an iterative, mixed-method study of the process and impact of the service redesign, informed by a participatory action research paradigm and the NSW Agency for Clinical Innovation process for developing a model of care. Diagnostic, solution design, implementation and sustainability phases were undertaken. Quantitative analyses were undertaken of administrative data, and child and family health nurse and client surveys. Qualitative analyses were undertaken of design workshops. The administrative data demonstrated that prior to the redesign service provision was the same for all clients regardless of levels of risk. The design solution, developed through a series of diagnostic and visioning workshops, included multiple new client response pathways. Implementation included development of tools and training. Sustainability of the redistribution of resources to the new pathways was assessed though an evaluation demonstrating a positive impact for families with adversity, with no deleterious effects for families receiving a universal response, and improvements in the emotional labour undertaken by nurses. Despite this, nurse burnout increased post-redesign. The shift from equal services (everyone receives the same) to equitable proportionate universal provision in response to need can be achieved and has positive impacts for nurses and families. This study shows the value of undertaking a systematic and participatory approach to service redesign. A proportionate universalism approach can ensure that early childhood nursing services are available to all in relation to needs. The Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) check-list was used to guide reporting. No patient or public contribution.

Efficient ECCD non-inductive plasma current start-up, ramp-up, and sustainment for an ST fusion reactor

The elimination of the need for an Ohmic heating solenoid may be the most impactful design driver for the realization of economical compact fusion tokamak reactor systems. However, this would require fully non-inductive start-up and current ramp-up from zero plasma current and low electron temperature of sub-keV to the full plasma current of ∼10–15 MA at 20–30 keV electron temperature. To address this challenge, an efficient solenoid-free start-up and ramp-up scenario utilizing a low-field-side-launched extraordinary mode at the fundamental electron cyclotron harmonic frequency (X–I) is proposed, which has more than two orders of magnitude higher electron cyclotron current drive (ECCD) efficiency than the conventional ECCD for the sub-keV start-up regime. A time dependent model was developed to simulate the start-up scenarios. For the Spherical Tokamak Advanced Reactor (STAR) (Menard et al 2023 Next-Step Low-Aspect-Ratio Tokamak Design Studies (IAEA)), it was found that to fully non-inductively ramp-up to 15 MA, it would take about 25 MW of EC power at 170 GHz. Because of the relatively large plasma volume of STAR, radiation losses must be considered. It is important to make sure that high Z impurities are kept sufficiently low during the early current start-up phase where the temperature is sub-keV range. Since the initial current ramp up takes place at a factor of ten lower density compared to the sustained regimes, it is important to transition into a higher bootstrap fraction discharge at lower density to minimize the ECCD power requirement during the densification. For the sustainment phase an array of eight gyrotron launchers with a total of about 60 MW of fundamental O-mode was found to be sufficient to provide the required axis-peaked external current drive. High efficiencies between 19–57 kA MW−1 were found with optimal aiming, and these were resilient to small changes in aiming angles and density and temperature profiles.

ASSISTING OF NUANSA GEMBIRA COFFEE PRODUCTS TOWARDS HALAL CERTIFICATIONS WITH THE SI-HALAL APPLICATION IN DELES VILLAGE, BATANG DISTRICT, CENTRAL JAVA

A halal certificate is a legal requirement that must be fulfilled for every Micro, Small, and Medium Enterprise. Kopi Nuansa Gembira is a pure, original ground coffee business without any mixtures which still does not have halal certification. The problems faced will result in distrust and sales volumes that continue to decline if this is still ignored. This service is carried out to help Nuansa Gembira Coffee to obtain a halal certificate. The lack of understanding regarding halal products makes it necessary to provide assistance and knowledge to Kopi Nuansa Gembira. The solution offered is in the form of aid related to halal certificates and obtaining halal certificates. The stages of halal product assistance are: The preparation stage is surveying the service location to explore the problems faced by Nuansa Gembira coffee. Phase 1, the service team and the owner of Nuansa Gembira Coffee went to the Ministry of Religion office to consult regarding halal products. Stage 2 prepares all the necessary documents. 4. Sustainability Phase of issuing a halal certificate for Kopi Nuansa Gembira. The assistance results will start from January 2023, namely when the initial assistance starts from preparations for verifying problems with partners to convincing the owner of Kopi Nuansa Gembira to apply for halal certification through the halal application. The business actor then fills it out and submits it after filing and filling in the complete documents. After going through all the processes, including the verification, validation, and return processes, both by the companion and by BPJPH, on June 9, 2023, the halal certificate for Kopi Nuansa Gembira was issued.

Leveraging Lean Six Sigma principles in an Indian tertiary care hospital: a case study

PurposeWorkflow optimisation is crucial for establishing a viable acute stroke (AS) intervention programme in a large tertiary care centre. This study aims to utilise Lean Six Sigma (LSS) principles to enhance the hospital's workflow.Design/methodology/approachThe Action Research methodology was used to implement the project and develop the case study. The study took place in a large tertiary care academic hospital in India. The Define-Measure-Analyse-Improve-Control approach optimised the workflow within 6 months. Lean tools such as value stream mapping (VSM), waste audits and Gemba were utilised to identify issues involving various stakeholders in the workflow. Sigma-level calculations were used to compare baseline, improvement and sustainment status. Additionally, statistical techniques were effectively employed to draw meaningful inferences.FindingsLSS tools and techniques can be effectively utilised in large tertiary care hospitals to optimise workflow through a structured approach. Sigma ratings of the processes showed substantial improvement, resulting in a five-fold increase in clinical outcomes. Specifically, there was a 43% improvement in outcome for patients who underwent acute stroke revascularisation. However, certain sigma ratings deteriorated during the control and extended control (sustainment) phases. This indicates that ensuring the sustainability of quality control interventions in healthcare is challenging and requires continuous auditing.Research limitations/implicationsThe article presents a single case study deployed in a hospital in India. Thus, the generalisation of outcomes has a significant limitation. Also, the study encounters the challenge of not having a parallel control group, which is a common limitation in quality improvement studies in healthcare. Many studies in healthcare quality improvement, including this one, are limited by minimal data on long-term follow-up and the sustainability of achieved results.Originality/valueThis study pioneers the integration of LSS methodologies in a large Indian tertiary care hospital, specifically targeting AS intervention. It represents the first LSS case study applied in the stroke department of any hospital in India. Whilst most case studies discuss only the positive aspects, this article fills a critical gap by unearthing the challenges of applying LSS in a complex healthcare setting, offering insights into sustainable quality improvement and operational efficiency. This case study contributes to the theoretical understanding of LSS in healthcare. It showcases its real-world impact on patient outcomes and process optimisation.

Utility of the Leadership and Organizational Change for Implementation-Systems Level (LOCI-SL) strategy for a statewide substance use treatment implementation effort

IntroductionMulti-level and cross-context implementation strategies are needed to support health systems, healthcare delivery organizations, and providers to adopt evidence-based practice (EBP) for substance use disorder (SUD) treatment. However, misalignment between state oversight agencies and healthcare organizations about which services to prioritize and which outcomes are reasonable to expect can hinder implementation success and widespread access to high-quality care. This study investigated the utility of the Leadership and Organizational Change for Implementation-System Level (LOCI-SL) strategy for supporting statewide EBP implementation for SUD treatment. MethodsNine community mental health centers (CMHCs) contracted by a state agency participated in a combined motivational-enhancement therapy and cognitive behavioral therapy (MET/CBT) implementation effort. Five of the CMHCs also received the LOCI-SL strategy to obtain ongoing implementation support. We conducted 21 individual interviews and three small group interviews with 30 participants across CMHCs and state health agencies to investigate the utility of LOCI-SL in supporting their EBP implementation efforts. Deductive thematic analysis was guided by the Exploration, Preparation, Implementation, Sustainment Framework. ResultsFive themes described CMHCs' LOCI-SL and broader contextual experiences implementing EBPs: (1) LOCI-SL supported executives in Preparation phase activities that holistically considered organizational needs and capacity to implement and sustain EBPs; (2) LOCI-SL facilitated trust and communication processes across Preparation, Implementation, and Sustainment phases to improve EBP uptake; (3) LOCI-SL increased CMHCs' use of implementation climate strengthening activities throughout the Implementation phase; (4) state contracts did not emphasize quality and thus were not sufficient bridging factors to enforce EBP fidelity during Implementation; and, (5) limited funding and low Medicaid reimbursement rates hindered EBP use throughout the Implementation and Sustainment phases. ConclusionsLOCI-SL was viewed as a favorable and useful implementation strategy for supporting statewide adoption of EBPs. However, outer context barriers, including limited financial investments in the treatment system, impeded implementation and sustainment efforts. While previous research suggests that contracts are viable alignment-promoting bridging factors, this study demonstrates the importance of articulating implementation outcome expectations to aid state-contracted organizations in achieving EBP implementation success. This study also highlights the need for multi-level implementation strategies to effectively align implementation expectations between outer- and inner-context entities.

Professionals’ Fidelity-Adaptation Attitudes: Relation to Implementation Determinants and Work-Life Consequences – A Cluster Analysis

Evidence-based interventions have the potential to improve health and well-being, but their effectiveness depends, among other things, on the challenging act of balancing between fidelity and adaptation, referred to as the fidelity-adaptation dilemma. After initial implementation, it is primarily professionals delivering evidence-based interventions to end users that face the dilemma, but research about how professionals relate to and perceive it is limited. This study aims to describe professionals’ attitudes towards the dilemma and investigate the associations between professional attitudes and individual and organisational implementation determinants, individual characteristics, and work-life consequences for the professionals. Using a cross-sectional design, 103 professionals working with an evidence-based parental support programme ABC (All Children in Focus) were surveyed on attitudes towards the fidelity-adaptation dilemma, implementation determinants, and work-life consequences. Data were analysed using two-step cluster analysis. Three profile groups summarize professionals’ attitudes: one preferring fidelity (the adherers, n = 31), one preferring adaptations (the adapters, n = 50), and one with a dual view on fidelity and adaptation (the double-minded, n = 18). The adherers, the ones preferring fidelity, reported higher levels of skills, knowledge, openness, work-related self-efficacy, meaning of work, and possibilities for development, and a lower level of role conflict and unreasonable tasks compared to the adapters. Professionals with a positive attitude towards fidelity reports experiencing more job resources and a lower level of job demands compared to professionals who are more positive towards adaptation. The study shows that the fidelity-adaptation dilemma is at play during the sustainment phase of implementation and suggest that it has consequences for professionals working life.

Multiscale Porous Architecture Consisting of Graphene Aerogels and Metastructures Enabling Robust Thermal and Mechanical Functionalities of Phase Change Materials

AbstractPassive thermal energy storage systems using phase change materials (PCMs) are promising for resolving temporal‐spatial overheating issues from small‐ to large‐scale platforms, yet their poor shape stability due to solid–liquid transition incurs PCM leakage and weak resistance against mechanical disturbance, limiting practical applications. While foam‐stable templates for PCMs have shown complement, they reveal massive leakage and collapse of liquefied PCMs under external loads or impacts. Herein, a multiscale porous architecture consisting of graphene aerogels (GAs) and meta structures enabling robust thermal‐mechanical functionalities of PCMs (3D‐MPGA) toward sustainable phase change thermal energy storage composites is reported. 3D‐printed mechanical metamaterials employing octet‐truss cells provide supportive strength and directionally‐assisted leakage reduction, while GAs serve as porous templates with surface‐interfacial contacts, thereby fixing paraffin wax as PCM inside their nano/micropores. The 3D‐MPGA shows intrinsic thermal characteristics of bulk PCMs, and improved thermal‐mechanical‐chemical stability, confirmed by long‐term heating‐cooling cycle tests over 10 h. Moreover, it exhibits highly reinforced strength (200–5000%) within a low density across ambient and melting temperatures, and maintains original shapes in the liquefied PCMs without severe leakage, against external loads. This work inspires rational strategies for advancing robust thermal‐mechanical functionalities for PCM‐based thermal energy storage systems.