Implementation outcome instruments for use in physical healthcare settings: a systematic review

BACKGROUND: Implementation research aims to facilitate the timely and routine implementation and sustainment of evidence-based interventions and services. A glaring gap in this endeavour is the capability of researchers, healthcare practitioners and managers to quantitatively evaluate implementation efforts using psychometrically sound instruments. To encourage and support the use of precise and accurate implementation outcome measures, this systematic review aimed to identify and appraise studies that assess the measurement properties of quantitative implementation outcome instruments used in physical healthcare settings. METHOD: The following data sources were searched from inception to March 2019, with no language restrictions: MEDLINE, EMBASE, PsycINFO, HMIC, CINAHL and the Cochrane library. Studies that evaluated the measurement properties of implementation outcome instruments in physical healthcare settings were eligible for inclusion. Proctor et al.'s taxonomy of implementation outcomes was used to guide the inclusion of implementation outcomes: acceptability, appropriateness, feasibility, adoption, penetration, implementation cost and sustainability. Methodological quality of the included studies was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Psychometric quality of the included instruments was assessed using the Contemporary Psychometrics checklist (ConPsy). Usability was determined by number of items per instrument. RESULTS: Fifty-eight publications reporting on the measurement properties of 55 implementation outcome instruments (65 scales) were identified. The majority of instruments assessed acceptability (n = 33), followed by appropriateness (n = 7), adoption (n = 4), feasibility (n = 4), penetration (n = 4) and sustainability (n = 3) of evidence-based practice. The methodological quality of individual scales was low, with few studies rated as 'excellent' for reliability (6/62) and validity (7/63), and both studies that assessed responsiveness rated as 'poor' (2/2). The psychometric quality of the scales was also low, with 12/65 scales scoring 7 or more out of 22, indicating greater psychometric strength. Six scales (6/65) rated as 'excellent' for usability. CONCLUSION: Investigators assessing implementation outcomes quantitatively should select instruments based on their methodological and psychometric quality to promote consistent and comparable implementation evaluations. Rather than developing ad hoc instruments, we encourage further psychometric testing of instruments with promising methodological and psychometric evidence. SYSTEMATIC REVIEW REGISTRATION: PROSPERO 2017 CRD42017065348

Probing the biogenesis pathway and dynamics of thylakoid membranes.

How thylakoid membranes are generated to form a metabolically active membrane network and how thylakoid membranes orchestrate the insertion and localization of protein complexes for efficient electron flux remain elusive. Here, we develop a method to modulate thylakoid biogenesis in the rod-shaped cyanobacterium Synechococcus elongatus PCC 7942 by modulating light intensity during cell growth, and probe the spatial-temporal stepwise biogenesis process of thylakoid membranes in cells. Our results reveal that the plasma membrane and regularly arranged concentric thylakoid layers have no physical connections. The newly synthesized thylakoid membrane fragments emerge between the plasma membrane and pre-existing thylakoids. Photosystem I monomers appear in the thylakoid membranes earlier than other mature photosystem assemblies, followed by generation of Photosystem I trimers and Photosystem II complexes. Redistribution of photosynthetic complexes during thylakoid biogenesis ensures establishment of the spatial organization of the functional thylakoid network. This study provides insights into the dynamic biogenesis process and maturation of the functional photosynthetic machinery

The liquid limit of peat and its application to the understanding of Irish blanket bog failures

Catastrophic failures of blanket bogs, involving the escape and outflow of large volumes of semi-liquid basal peat, are well-known phenomena in Ireland but have only very rarely been reported from elsewhere in the world. Their precise causes and mechanisms are as yet unclear. The liquid limit (wL) was identified as a potentially useful indicator of the susceptibility of peat to such failure because peat has extremely high natural water contents and, as an index property, wL takes no account of the properties or structures of highly heterogeneous intact peat. However, the usual procedure for determining the wL of peat is not fully standardised. Prepared samples will normally include potentially highly reactive particles of disrupted fibres and wood fragments that would not be present in such freshly disintegrated form in the field. This paper presents results from wL determinations of peat obtained from the scar margins of three bog failures in northwest Ireland, using four different test procedures including a method involving wet-sieving of the peat to separate the humified <425-μm fraction for testing without incorporating artificially fragmented particles of fibres. The sampled peat was classified as H8–H10 according to the von Post humification scale. The fibre contents varied between the sites, but the ash contents were <3% in all but one test sample, and bulk densities (dry and field-wet) of the peat from all three sites were almost identical. wL results from the wet-sieving method were 708–785%, compared with 633–980% from the standard method. The highest measured field water contents exceeded the wet-sieved wL for all three of the field sites. Tests of cone penetration into intact peat cores demonstrated the influence of the reinforcing effect of in situ fibres. The results strongly suggest the need to adopt a fully standardised procedure for determining the wL of peat. Additional shear vane measurements of intact and remoulded peat from a bog failure in Northern Ireland indicated a very high ‘strength sensitivity’. This leads to the suggestion that a slight disturbance of basal peat can lead to a loss of strength that rapidly propagates as local stresses change and cause further remoulding as water contents exceed wL