Letting Go: Conceptualizing intervention de-implementation in public health and social service settings

The discontinuation of interventions that should be stopped, or de-implementation, has emerged as a novel line of inquiry within dissemination and implementation science. As this area grows in human services research, like public health and social work, theory is needed to help guide scientific endeavors. Given the infancy of de-implementation, this conceptual narrative provides a definition and criteria for determining if an intervention should be de-implemented. We identify three criteria for identifying interventions appropriate for de-implementation: (a) interventions that are not effective or harmful, (b) interventions that are not the most effective or efficient to provide, and (c) interventions that are no longer necessary. Detailed, well-documented examples illustrate each of the criteria. We describe de-implementation frameworks, but also demonstrate how other existing implementation frameworks might be applied to de-implementation research as a supplement. Finally, we conclude with a discussion of de-implementation in the context of other stages of implementation, like sustainability and adoption; next steps for de-implementation research, especially identifying interventions appropriate for de-implementation in a systematic manner; and highlight special ethical considerations to advance the field of de-implementation research

Statistical Modeling of the Number of Deaths of Children in Bangladesh

Efforts to reduce the number of children’s death in developing countries through health care programs focus more to the prevention and control of diseases than to determining the underlying risk factors/predictors and addressing these through proper interventions. This study aims to identify socioeconomic and demographic predictors of the number of children’s death to women aged 12-49 from the Bangladesh Health and Demographic Survey (BDHS) administered in 2011. The number of children’s death in a family is a non-negative count response variable. The average number of children’s death is found to be 28 per 100 women with a variance of 44per 100 women. Thus Poisson regression model is not a proper choice to predict the mean response from the BDHS data due to the presence of over-dispersion. In order to address over-dispersion, we fit a Negative Binomial Regression (NBR), a Zero-Inflated Negative Binomial Regression (ZINBR) and a Hurdle Regression (HR) model. Among these models, ZINBR fits the data best. We identify respondent’s age, respondent’s age at 1st birth, gap between 1st birth and marriage, number of family members, region, religion, respondent’s education, husband’s education, incidence of twins, source of water, and wealth index as significant predictors for the number of children’s death in a family from the best fitted model. Identification of the risk factors of the number of children’s death is an important public health issue and should be carried out correctly for the much needed intervention

Lease based addressing for event-driven wireless sensor networks

Sensor Networks have applications in diverse fields. They can be deployed for habitat modeling, temperature monitoring and industrial sensing. They also find applications in battlefield awareness and emergency (first) response situations. While unique addressing is not a requirement of many data collecting applications of wireless sensor networks it is vital for the success of applications such as emergency response. Data that cannot be associated with a specific node becomes useless in such situations. In this work we propose an addressing mechanism for event-driven wireless sensor networks. The proposed scheme eliminates the need for network wide Duplicate Address Detection (DAD) and enables reuse of addresses. <br /

Central Nervous System Depressant, Analgesic and Antidiarrheal Effects of the Seed Extracts of Dimocarpus longan Lour in Rats

Purpose: To assess the central nervous system (CNS) depressant, analgesic and antidiarrheal activities of the dried seed crude extracts of Dimocarpus longan Lour in rodents.Methods: Selected pharmacological effects of the ethanol (ENLS), petroleum ether (PELS), chloroform (CHLS) and ethyl acetate (EALS) extracts of D. longan fruit seeds were investigated. CNS depressant activity was evaluated by open field and hole cross tests; analgesic activity by acetic acid-induced writhing test and formalin-induced licking test; and anti-diarrheal activity was assessed in castor oil and magnesium-induced diarrhea rat model. The extracts were given orally in a rat model at doses of 200 and 300 mg/kg body weight. Normal saline served as control in all experiment. In CNS depressant test, diazepam (1 mg/kg) was used as reference drug while indomethacin (10 mg/kg) and loperamide(2 mg/kg) were used as standard drugs in analgesic and antidiarrheal tests, respectively.Results: In hole cross method, EALS showed the most effective depressant effect, viz, 1.17±0.17 for 200 mg/kg dose and 0.83±0.31 number of movements for 300 mg/kg dose after 120 min (p &lt; 0.01), whereas in the open field test, all the extracts exhibited significant (p &lt; 0.01) depressant effect in relation to positive control, diazepam. In acetic acid-induced pain test, PELS gave the lowest number of writhing (2.83±0.307) and the highest inhibition (88.45 %, 300 mg/kg dose) which was statistically significant. All the extracts also significantly (p &lt; 0.01) suppressed licking activity in both phases of the formalin-induced licking test, in contrast to indomethacin. In the antidiarrheal tests, diarrheal suppression was highest at 300 mg/kg dose for all the extracts, compared with loperamide in both castor oil and magnesium sulphate induced diarrhea model.Conclusion: The extracts of Dimocarpus longan tested demonstrated significant CNS depressant, analgesic and antidiarrheal activities in a rodent model.Keywords: Dimocarpus longan Lour, CNS depressant, Analgesic, Anti-diarrheal

Delayed-onset disseminated BCG disease causing a multi-system illness with fatal mycotic aortic aneurysm

CASE: We report a case of disseminated BCG infection, diagnosed two years after BCG infusion for bladder cancer. Our patient, a 74-year-old male, was referred with an 18-month history of fevers, weight loss and intermittent confusion. Prior to referral, the patient had multiple hospital admissions for evaluation of fever of unknown origin, confusion, and fatigue. He was treated for several acute infections, whilst extensive investigations did not identify a focal cause of the persistent fever. During this period two aneurysms, iliac and aortic, were found and stented. Both were presumed mycotic, but no positive microbiology arose from either. He presented again with fever and confusion and was found to have a left sided pleural effusion, which was drained, and broad-spectrum antibiotics started, but his fever and inflammatory markers did not settle. Mycobacterium tuberculosis PCR on a pleural fluid sample returned a positive result, and later cultures from the same fluid grew Mycobacterium species which whole genome sequencing identified as Mycobacterium Bacillus Calmette-Guérin (BCG). Despite a number of adverse events with anti-BCG medications, the patient was established on four medications (rifampicin/isoniazid/ethambutol/levofloxacin) with symptomatic improvement. He re-presented four months later with abdominal pain and was found to have an inoperable leaking thoracic aortic sac from deterioration of his mycotic aneurysm. Following discussion with the patient and his family he was managed palliatively and died two days later. DISCUSSION: The learning points from this case are to consider disseminated BCG in patients presenting with pyrexia of unknown origin following reported intravesical BCG treatment for bladder malignancy in the years prior to presentation. Mycotic aneurysms are a rare but serious complication of disseminated BCG with a high mortality

A scoping review of de-implementation frameworks and models

BACKGROUND: Reduction or elimination of inappropriate, ineffective, or potentially harmful healthcare services and public health programs can help to ensure limited resources are used effectively. Frameworks and models (FM) are valuable tools in conceptualizing and guiding the study of de-implementation. This scoping review sought to identify and characterize FM that can be used to study de-implementation as a phenomenon and identify gaps in the literature to inform future model development and application for research. METHODS: We searched nine databases and eleven journals from a broad array of disciplines (e.g., healthcare, public health, public policy) for de-implementation studies published between 1990 and June 2020. Two raters independently screened titles and abstracts, and then a pair of raters screened all full text records. We extracted information related to setting, discipline, study design, methodology, and FM characteristics from included studies. RESULTS: The final search yielded 1860 records, from which we screened 126 full text records. We extracted data from 27 articles containing 27 unique FM. Most FM (n = 21) were applicable to two or more levels of the Socio-Ecological Framework, and most commonly assessed constructs were at the organization level (n = 18). Most FM (n = 18) depicted a linear relationship between constructs, few depicted a more complex structure, such as a nested or cyclical relationship. Thirteen studies applied FM in empirical investigations of de-implementation, while 14 articles were commentary or review papers that included FM. CONCLUSION: De-implementation is a process studied in a broad array of disciplines, yet implementation science has thus far been limited in the integration of learnings from other fields. This review offers an overview of visual representations of FM that implementation researchers and practitioners can use to inform their work. Additional work is needed to test and refine existing FM and to determine the extent to which FM developed in one setting or for a particular topic can be applied to other contexts. Given the extensive availability of FM in implementation science, we suggest researchers build from existing FM rather than recreating novel FM. REGISTRATION: Not registered

Hierarchically Porous Gd3+-Doped CeO2 Nanostructures for the Remarkable Enhancement of Optical and Magnetic Properties

Rare earth ion-doped CeO2 has attracted more and more attention because of its special electrical, optical, magnetic, or catalytic properties. In this paper, a facile electrochemical deposition route was reported for the direct growth of the porous Gd-doped CeO2. The formation process of Gd-doped CeO2 composites was investigated. The obtained deposits were characterized by SEM, EDS, XRD, and XPS. The porous Gd3+- doped CeO2 (10 at% Gd) displays a typical type I adsorption isotherm and yields a large specific surface area of 135 m2/g. As Gd3+ ions were doped into CeO2 lattice, the absorption spectrum of Gd3+-doped CeO2 nanocrystals exhibited a red shift compared with porous CeO2 nanocrystals and bulk CeO2, and the luminescence of Gd3+-doped CeO2 deposits was remarkably enhanced due to the presence of more oxygen vacancies. In addition, the strong magnetic properties of Gd-doped CeO2 (10 at% Gd) were observed, which may be caused by Gd3+ ions or more oxygen defects in deposits. In addition, the catalytic activity of porous Gd-doped CeO2 toward CO oxidation was studied

Fano resonances in plasmonic core-shell particles and the Purcell effect

Despite a long history, light scattering by particles with size comparable with the light wavelength still unveils surprising optical phenomena, and many of them are related to the Fano effect. Originally described in the context of atomic physics, the Fano resonance in light scattering arises from the interference between a narrow subradiant mode and a spectrally broad radiation line. Here, we present an overview of Fano resonances in coated spherical scatterers within the framework of the Lorenz-Mie theory. We briefly introduce the concept of conventional and unconventional Fano resonances in light scattering. These resonances are associated with the interference between electromagnetic modes excited in the particle with different or the same multipole moment, respectively. In addition, we investigate the modification of the spontaneous-emission rate of an optical emitter at the presence of a plasmonic nanoshell. This modification of decay rate due to electromagnetic environment is referred to as the Purcell effect. We analytically show that the Purcell factor related to a dipole emitter oriented orthogonal or tangential to the spherical surface can exhibit Fano or Lorentzian line shapes in the near field, respectively.Comment: 28 pages, 10 figures; invited book chapter to appear in "Fano Resonances in Optics and Microwaves: Physics and Application", Springer Series in Optical Sciences (2018), edited by E. O. Kamenetskii, A. Sadreev, and A. Miroshnichenk