Patterns in bottlenecks for implementation of health promotion interventions: a cross-sectional observational study on intervention-context interactions in the Netherlands.

BACKGROUND: From a complex systems perspective, implementation should be understood as the introduction of an intervention in a context with which it needs to interact in order to achieve its function in terms of improved health. The presence of intervention-context interactions could mean that during implementation particular patterns of crucial interaction points might arise. We examined the presence of - and regularities in - such 'bottlenecks for implementation', as this could create opportunities to predict and intervene in potential implementation problems. METHODS: We conducted a cross-sectional observational study against the background of municipal intersectoral policymaking in the Netherlands. We asked implementers of health promotion interventions to identify bottlenecks by rating the presence and importance of conditions for implementation in a range of intervention systems. We used descriptive statistics to characterize these systems (by their behaviour change method, health theme and implementation setting) and the conditions that acted as bottlenecks. After stratifying bottlenecks by intervention system and the system's characteristics, we tested our hypotheses by comparing the number and nature of the bottlenecks that emerged. RESULTS: More than half of the possible conditions were identified as a bottleneck for implementation. Bottlenecks occurred in all categories of conditions, e.g., relating to the implementer, the intervention, and political and administrative support, and often connected with intersectoral policymaking, e.g., relating to the co-implementer and the co-implementer's organization. Both our hypotheses were supported: (1) Each intervention system came across a unique set of - a limited number of - conditions hampering implementation; (2) Most bottlenecks were associated with the characteristics of the system in which they occurred, but bottlenecks also appeared in the absence of such an association, or remained absent in the presence thereof. CONCLUSIONS: We conclude that intervention-context interactions in integrated health policymaking may lead to both regularities and variations in bottlenecks for implementation. Regularities may partly be predicted by the function of an intervention system, and may serve as the basis for building the capacity needed for the structural changes that can bring about long-lasting health improvements. Variations may point at the need for flexibility in further tailoring the implementation approach to the - mostly unpredictable - problems at individual sites.

Turning catalytically active pores into active pumps.

We develop a semi-analytical model of self-diffusioosmotic transport in active pores, which includes advective transport and the inverse chemical reaction that consumes solute. In previous work [Antunes et al., Phys. Rev. Lett. 129, 188003 (2022)], we have demonstrated the existence of a spontaneous symmetry breaking in fore-aft symmetric pores that enables them to function as a micropump. We now show that this pumping transition is controlled by three timescales. Two timescales characterize advective and diffusive transport. The third timescale corresponds to how long a solute molecule resides in the pore before being consumed. Introducing asymmetry to the pore (either via the shape or the catalytic coating) reveals a second type of advection-enabled transition. In asymmetric pores, the flow rate exhibits discontinuous jumps and hysteresis loops upon tuning the parameters that control the asymmetry. This work demonstrates the interconnected roles of shape and catalytic patterning in the dynamics of active pores and shows how to design a pump for optimum performance.

Longitudinal changes in quality of life and psychosocial problems of primary school children in a deprived urban neighborhood over the course of a school-based integrated approach.

The municipality of Amsterdam implemented a 2-year school-based integrated approach in schools in a deprived neighborhood. The integrated approach targeted the domains of education, health and poverty and the children's school, neighborhood and home environment by involving various agencies and actors. In this study, changes in children's quality of life and psychosocial problems over the course of the integrated approach were examined and evaluated. A dynamic cohort design was used. At five measurement occasions (T1-T5) during 2 years, children from four consecutive grades in five schools filled out a questionnaire (total n = 614). In children between 7 and 13 years, quality of life was measured with the KIDSCREEN-10. In children between 9 and 13 years, psychosocial problems were measured with the Strengths and Difficulties Questionnaire. Generalized estimating equations were applied. Time, sex, age, socio-economic status, ethnic background, grade, and school were included as independent variables. Quality of life was higher from the first follow-up during the approach (T2) until the end of the approach (T4) compared to at the start of the approach (T1). At T5, several months after the approach ended, scores returned back to baseline. Likewise, a reduction in children's psychosocial problems was detected at the end of the approach (T4) compared to at the start of the approach (T1). However, both before and after that time point, no improvements were detected. This study shows that integrated approaches can be beneficial for children's quality of life and psychosocial health, but continued investments may be needed to maintain established improvements.Trial registration NTR6571 (NL6395), August 4 2017 retrospectively registered.

Pumping and Mixing in Active Pores.

We show both numerically and analytically that a chemically patterned active pore can act as a micro- or nanopump for fluids, even if it is fore-aft symmetric. This is possible due to a spontaneous symmetry breaking which occurs when advection rather than diffusion is the dominant mechanism of solute transport. We further demonstrate that, for pumping and tuning the flow rate, a combination of geometrical and chemical inhomogeneities is required. For certain parameter values, the flow is unsteady, and persistent oscillations with a tunable frequency appear. Finally, we find that the flow exhibits convection rolls and hence promotes mixing in the low Reynolds number regime.

Implementation of a Dutch school-based integrated approach targeting education, health and poverty-a process evaluation.

This study provides an evaluation of the implementation of a school-based integrated approach to improve academic outcomes by targeting children's education, health, and poverty. A two-year municipal subsidy program was provided to four primary schools in a deprived urban neighborhood in Amsterdam. Schools were put in charge of the implementation and coordination of the program. The municipality and district authorities provided assistance. This study evaluated whether the program functioned as integrated approach, i.e., whether it targeted multiple domains and environments by involving various agencies and actors, and what factors facilitated or hampered this. It also yielded an overview of the initiatives implemented and the facilitators and barriers of successful implementation of initiatives. Principals' perceptions served as the main input for this study. We thematically analyzed seven written customized plans for spending the subsidy (one to two per school), 15 transcripts of interviews with the principals (three to four per school) and the minutes of 16 meetings between principals, policy officers, and researchers. According to the principals, the schools had made great progress in the education domain and in improving the school's pedagogical climate, but in the health and poverty domains less progress had been made. Apart from the municipality, relatively few external agencies and actors had been actively involved in the program, and progress in other environments than the school was hardly achieved. This study shows that functioning of the program as integrated approach was facilitated by connections between initiatives, and that hired, well-trusted third parties may be crucial to establish these connections. Lay summary This study evaluated whether a two-year municipal program to improve academic outcomes by targeting children's education, health, and poverty, provided to primary schools in a deprived urban neighborhood, functioned as intended, and if so why, or if not, why not. The program was intended to function as integrated approach. This means that it was supposed to target the mentioned domains, the school, home, and neighborhood environment, and to involve various agencies and actors, such as school staff, policy officers, parents, children, and external organizations. The school principals could implement multiple, self-chosen, initiatives. According to the principals, on whose perceptions this evaluation study was primarily based, both teaching and the school climate improved during the program. However, improvements in children's health and poverty levels, and outside the school environment in general, were more difficult to achieve. In addition, the program involved mainly school staff and policy officers. The program thus functioned as an integrated approach, but only to a limited extent. The functioning of the program as integrated approach was facilitated by involving hired third parties to stimulate interconnection of initiatives, i.e., initiatives serving the same goals, involving multiple agencies and actors, and/or being implemented in the same location.

Lattice Boltzmann simulations of stochastic thin film dewetting.

We study numerically the effect of thermal fluctuations and of variable fluid-substrate interactions on the spontaneous dewetting of thin liquid films. To this aim, we use a recently developed lattice Boltzmann method for thin liquid film flows, equipped with a properly devised stochastic term. While it is known that thermal fluctuations yield shorter rupture times, we show that this is a general feature of hydrophilic substrates, irrespective of the contact angle θ. The ratio between deterministic and stochastic rupture times, though, decreases with θ. Finally, we discuss the case of fluctuating thin film dewetting on chemically patterned substrates and its dependence on the form of the wettability gradients.

Lattice Boltzmann simulations of drying suspensions of soft particles.

The ordering of particles in the drying process of a colloidal suspension is crucial in determining the properties of the resulting film. For example, microscopic inhomogeneities can lead to the formation of cracks and defects that can deteriorate the quality of the film considerably. This type of problem is inherently multiscale and here we study it numerically, using our recently developed method for the simulation of soft polymeric capsules in multicomponent fluids. We focus on the effect of the particle softness on the film microstructure during the drying phase and how it relates to the formation of defects. We quantify the order of the particles by measuring both the Voronoi entropy and the isotropic order parameter. Surprisingly, both observables exhibit a non-monotonic behaviour when the softness of the particles is increased. We further investigate the correlation between the interparticle interaction and the change in the microstructure during the evaporation phase. We observe that the rigid particles form chain-like structures that tend to scatter into small clusters when the particle softness is increased. This article is part of the theme issue 'Progress in mesoscale methods for fluid dynamics simulation'.

Scallop Theorem and Swimming at the Mesoscale.

By comparing theoretical modeling, simulations, and experiments, we show that there exists a swimming regime at low Reynolds numbers solely driven by the inertia of the swimmer itself. This is demonstrated by considering a dumbbell with an asymmetry in coasting time in its two spheres. Despite deforming in a reciprocal fashion, the dumbbell swims by generating a nonreciprocal Stokesian flow, which arises from the asymmetry in coasting times. This asymmetry acts as a second degree of freedom, which allows the scallop theorem to be fulfilled at the mesoscopic scale.

Smoking Cessation in Lower Socioeconomic Groups: Adaptation and Pilot Test of a Rolling Group Intervention.

BACKGROUND: Socioeconomic inequalities in smoking rates persist and tend to increase, as evidence-based smoking cessation programs are insufficiently accessible and appropriate for lower socioeconomic status (SES) smokers to achieve long-term abstinence. Our study is aimed at systematically adapting and pilot testing a smoking cessation intervention for this specific target group. METHODS: First, we conducted a needs assessment, including a literature review and interviews with lower SES smokers and professional stakeholders. Next, we selected candidate interventions for adaptation and decided which components needed to be adopted, adapted, or newly developed. We used Intervention Mapping to select effective methods and practical strategies and to build a coherent smoking cessation program. Finally, we pilot tested the adapted intervention to assess its potential effectiveness and its acceptability for lower SES smokers. RESULTS: The core of the adapted rolling group intervention was the evidence-based combination of behavioral support and pharmacotherapy. The intervention offered both group and individual support. It was open to smokers, smokers who had quit, and quitters who had relapsed. The professional-led group meetings had a fixed structure. Themes addressed included quitting-related coping skills and health-related and poverty-related issues. Methods applied were role modeling, practical learning, reinforcement, and positive feedback. In the pilot test, half of the 22 lower SES smokers successfully quit smoking. The intervention allowed them to "quit at their own pace" and to continue despite a possible relapse. Participants appraised the opportunities for social comparison and role modeling and the encouraging atmosphere. The trainers were appreciated for their competencies and personal feedback. CONCLUSIONS: Our adapted rolling group intervention for lower SES smokers was potentially effective as well as feasible, suitable, and acceptable for the target group. Further research should determine the intervention's effectiveness. Our detailed report about the adaptation process and resulting intervention may help reveal the mechanisms through which such interventions might operate effectively.

Probing sedimentation non-ideality of particulate systems using analytical centrifugation.

Analytical centrifugation is a versatile technique for the quantitative characterization of colloidal systems including colloidal stability. The recent developments in data acquisition and evaluation allow the accurate determination of particle size, shape anisotropy and particle density. High precision analytical centrifugation is in particular suited for the study of particle interactions and concentration-dependent sedimentation coefficients. We present a holistic approach for the quantitative determination of sedimentation non-ideality via analytical centrifugation for polydisperse, plain and amino-functionalized silica particles spanning over one order of magnitude in particle size between 100 nm and 1200 nm. These systems typically behave as neutral hard spheres as predicted by auxiliary lattice Boltzmann simulations. The extent of electrostatic interactions and their impact on sedimentation non-ideality can be quantified by the repulsion range, which is the ratio of the Debye length and the average interparticle distance. Experimental access to the repulsion range is provided through conductivity measurements. With the experimental repulsion range at hand, we estimate the effect of polydispersity on concentration-dependent sedimentation properties through a combination of lattice Boltzmann and Brownian dynamics simulations. Finally, we determine the concentration-dependent sedimentation properties of charge-stabilized, fluorescently-labeled silica particles with a nominal particle size of 30 nm and reduced interparticle distance, hence an elevated repulsion range. Overall, our results demonstrate how the influence of hard-sphere type and electrostatic interactions can be quantified when probing sedimentation non-ideality of particulate systems using analytical centrifugation even for systems exhibiting moderate sample heterogeneity and complex interactions.

Does partnership diversity in intersectoral policymaking matter for health promoting intervention packages' composition? A multiple-case study in the Netherlands.

Intersectoral policymaking to improve public health includes integrated health promotion (HP) intervention packages that address a variety of health behavior determinants. The involvement of different partners is assumed to be necessary to implement such integrated packages. We examined how partnership diversity was associated with the composition of intervention packages implemented in Dutch municipalities. In a longitudinal multiple-case study (2012-14), we collected questionnaire data among 31 project leaders and 152 intervention implementers in 31 (alliances of) municipalities. Package composition was assessed in terms of intervention strategies, implementation settings and targeted behavioral determinants. Partnership diversity during the adoption and implementation phases was assessed in terms of the actors and sectors, as well as private partners and citizens involved. The association between partnership diversity and package composition was examined using crosstabs. Almost all packages integrated multiple strategies, but mostly education, facilitation and case finding, in multiple, but mostly health and public settings, such as schools. The packages targeted diverse behavioral determinants, although mainly personal and social environmental factors. A variety of partners from multiple sectors was involved, during both adoption and implementation of the packages. However, partners from the health, welfare and education sectors were mostly involved. More partnership diversity, especially during implementation, was associated with more integrated intervention packages. In intersectoral policymaking, investment in diversely composed partnerships seems worthwhile for implementing integrated intervention packages. However, investments in other conditions, like framing health issues and network management, are also needed to make environmental determinants of health behavior the object of HP.

Sensitivity of C-Reactive Protein and Procalcitonin Measured by Point-of-Care Tests to Diagnose Urinary Tract Infections in Nursing Home Residents: A Cross-Sectional Study.

BACKGROUND: Diagnosing urinary tract infections (UTIs) in nursing home residents is complex, as specific urinary symptoms are often absent and asymptomatic bacteriuria (ASB) is prevalent. The aim of this study was to assess the sensitivity of blood C-reactive protein (CRP) and procalcitonin (PCT), measured by point-of-care tests (PoCTs), to diagnose UTIs in this setting. METHODS: Elderly residents (≥65 years old) with a suspected UTI were recruited from psychogeriatric, somatic, or rehabilitation wards across 13 participating nursing homes. CRP and PCT were tested simultaneously in the same study participants. To assess the tests' sensitivities, a stringent definition of "true" UTI was used that included the presence of symptoms, urinary leucocytes, a positive urine culture, and symptom resolution during antibiotic treatment covering isolated uropathogen(s). The original sample size was 440 suspected UTI episodes, in order to detect a clinically relevant sensitivity of at least 65% when calculated using the matched analysis approach to compare both PoCTs. RESULTS: After enrollment of 302 episodes (68.6% of the planned sample size), an unplanned and funder-mandated interim analysis was done, resulting in premature discontinuation of the study for futility. For 247 of 266 eligible episodes, all mandatory items required for the true UTI definition (92.9%) were available. In total, 49 episodes fulfilled our stringent UTI definition (19.8%). The sensitivities of CRP (cut-off, 6.5 mg/L) and PCT (cut-off, 0.025 ng/mL) were 52.3% (95% confidence interval [CI], 36.7-67.5%) and 37.0% (95% CI, 23.2-52.5%), respectively. CONCLUSIONS: Our results indicate that CRP and PCT are not suitable tests for distinguishing UTI and ASB in nursing home residents. CLINICAL TRIALS REGISTRATION: Netherlands Trial Registry NL6293.

"A false sense of confidence" The perceived role of inflammatory point-of-care testing in managing urinary tract infections in Dutch nursing homes: a qualitative study.

BACKGROUND: Diagnosing urinary tract infections (UTI) in nursing home residents is complex, due to frequent non-specific symptomatology and asymptomatic bacteriuria. The objective of this study was to explore health care professionals' perceptions of the proposed use of inflammatory marker Point-Of-Care Testing (POCT) in this respect. METHODS: We conducted a qualitative inquiry (2018-2019) alongside the multicenter PROGRESS study (NL6293), which assessed the sensitivity of C-reactive protein and procalcitonin POCT in UTI. We used semi-structured face-to-face interviews. The participants were physicians (n = 12) and nurses (n = 6) from 13 nursing homes in the Netherlands. Most respondents were not familiar with inflammatory marker POCT, while some used POCT for respiratory tract infections. Both the interview guide and the analysis of the interview transcripts were based on the Consolidated Framework for Implementation Research. RESULTS: All respondents acknowledged that sufficiently sensitive POCT could decrease diagnostic uncertainty to some extent in residents presenting with non-specific symptoms. They primarily thought that negative test results would rule out UTI and justify withholding antibiotic treatment. Secondly, they described how positive test results could rule in UTI and justify antimicrobial treatment. However, most respondents also expected new diagnostic uncertainties to arise. Firstly, in case of negative test results, they were not sure how to deal with residents' persisting non-specific symptoms. Secondly, in case of positive test results, they feared overlooking infections other than UTI. These new uncertainties could lead to inappropriate antibiotics use. Therefore, POCT was thought to create a false sense of confidence. CONCLUSIONS: Our study suggests that inflammatory marker POCT will only improve UTI management in nursing homes to some extent. To realize the expected added value, any implementation of POCT requires thorough guidance to ensure appropriate use. Developing UTI markers with high negative and positive predictive values may offer greater potential to improve UTI management in nursing homes.

Numerical simulations of self-diffusiophoretic colloids at fluid interfaces.

The dynamics of active colloids is very sensitive to the presence of boundaries and interfaces which therefore can be used to control their motion. Here we analyze the dynamics of active colloids adsorbed at a fluid-fluid interface. By using a mesoscopic numerical approach which relies on an approximated numerical solution of the Navier-Stokes equation, we show that when adsorbed at a fluid interface, an active colloid experiences a net torque even in the absence of a viscosity contrast between the two adjacent fluids. In particular, we study the dependence of this torque on the contact angle of the colloid with the fluid-fluid interface and on its surface properties. We rationalize our results via an approximate approach which accounts for the appearance of a local friction coefficient. By providing insight into the dynamics of active colloids adsorbed at fluid interfaces, our results are relevant for two-dimensional self assembly and emulsion stabilization by means of active colloids.

Lattice Boltzmann method for thin-liquid-film hydrodynamics.

We propose an approach to the numerical simulation of thin-film flows based on the lattice Boltzmann method. We outline the basic features of the method, show in which limits the expected thin-film equations are recovered, and perform validation tests. The numerical scheme is applied to the viscous Rayleigh-Taylor instability of a thin film and to the spreading of a sessile drop toward its equilibrium contact angle configuration. We show that the Cox-Voinov law is satisfied and that the effect of a tunable slip length on the substrate is correctly captured. We address, then, the problem of a droplet sliding on an inclined plane, finding that the Capillary number scales linearly with the Bond number, in agreement with experimental results. At last, we demonstrate the ability of the method to handle heterogenous and complex systems by showcasing the controlled dewetting of a thin film on a chemically structured substrate.

Conditions for addressing environmental determinants of health behavior in intersectoral policy networks: A fuzzy set Qualitative Comparative Analysis.

Improving health requires changes in the social, physical, economic and political determinants of health behavior. For the realization of policies that address these environmental determinants, intersectoral policy networks are considered necessary for the pooling of resources to implement different policy instruments. However, such network diversity may increase network complexity and therefore hamper network performance. Network complexity may be reduced by network management and the provision of financial resources. This study examined whether network diversity - amidst the other conditions - is indeed needed to address environmental determinants of health behavior. We included 25 intersectoral policy networks in Dutch municipalities aimed at reducing overweight, smoking, and alcohol/drugs abuse. For our fuzzy set Qualitative Comparative Analysis we used data from three web-based surveys among (a) project leaders regarding network diversity and size (n = 38); (b) project leaders and project partners regarding management (n = 278); and (c) implementation professionals regarding types of environmental determinants addressed (n = 137). Data on budgets were retrieved from project application forms. Contrary to their intentions, most policy networks typically addressed personal determinants. If the environment was addressed too, it was mostly the social environment. To address environmental determinants of health behavior, network diversity (>50% of the actors are non-public health) was necessary in networks that were either small (<16 actors) or had small budgets (<€183,172), when both were intensively managed. Irrespective of network diversity, environmental determinants also were addressed by small networks with large budgets, and by large networks with small budgets, when both provided network management. We conclude that network diversity is important - although not necessary - for resource pooling to address environmental determinants of health behavior, but only effective in the presence of network management. Our findings may support intersectoral policy networks in improving health behaviors by addressing a variety of environmental determinants.

Structural integration and performance of inter-sectoral public health-related policy networks: An analysis across policy phases.

BACKGROUND: Inter-sectoral policy networks may be effective in addressing environmental determinants of health with interventions. However, contradictory results are reported on relations between structural network characteristics (i.e., composition and integration) and network performance, such as addressing environmental determinants of health. This study examines these relations in different phases of the policy process. METHODS: A multiple-case study was performed on four public health-related policy networks. Using a snowball method among network actors, overall and sub-networks per policy phase were identified and the policy sector of each actor was assigned. To operationalise the outcome variable, interventions were classified by the proportion of environmental determinants they addressed. RESULTS: In the overall networks, no relation was found between structural network characteristics and network performance. In most effective cases, the policy development sub-networks were characterised by integration with less interrelations between actors (low cohesion), more equally distributed distances between the actors (low closeness centralisation), and horizontal integration in inter-sectoral cliques. The most effective case had non-public health central actors with less connections in all sub-networks. CONCLUSION: The results suggest that, to address environmental determinants of health, sub-networks should be inter-sectorally composed in the policy development rather than in the intervention development and implementation phases, and that policy development actors should have the opportunity to connect with other actors, without strong direction from a central actor.

Dynamic wetting: status and prospective of single particle based experiments and simulations.

The fundamental molecular and microscopic properties of materials leading to dynamic wetting and relaxation effects have been subject to numerous studies in the past decades, but a thorough understanding is still missing. While most previous experiments utilize fluids deposited on planar substrates, this article focuses on an attractive alternative based on single colloidal particles: colloidal particles have the ability to strongly interact with fluid-fluid interfaces and the behavior strongly depends on the surface properties of the particles and the fluids used. Recent progress in the manipulation and synthesis of colloidal particles with well-defined surface properties and shapes makes them ideal candidates to probe the fundamental surface properties leading to dynamic wetting effects. In this paper we review and discuss the status of experimental and numerical techniques to characterize the dynamic wetting of single particles at fluid-fluid interfaces, with the aim to assist scientists and engineers in the design of new experimental techniques and particle-based (bio)analytical tools.

Factors influencing perceived sustainability of Dutch community health programs.

We assessed the perceived sustainability of community health programs organized by local intersectoral coalitions, as well as the factors that collaborating partners think might influence sustainability. Semi-structured interviews were conducted among 31 collaborating partners of 5 community health programs in deprived neighborhoods in the southern part of the Netherlands. The interview guide was based on a conceptual framework that includes factors related to the context, the leading organization, leadership, the coalition, collaborating partners, interventions and outcomes. Interviews were recorded, transcribed and content analyzed using NVivo 8.0. Participants in each of the programs varied in their perceptions of the sustainability of the program, but those people collaborating in pre-existing neighborhood structures expressed relatively high faith in their continuation. The participating citizens in particular believed that these structures would continue to address the health of the community in the future. We found factors from all categories of the conceptual framework that were perceived to influence sustainability. The program leaders appeared to be crucial to the programs, as they were frequently mentioned in close interaction with other factors. Program leaders should use a motivating and supportive leadership style and should act as 'program champions'.

Hydrodynamic interactions induce anomalous diffusion under partial confinement.

Under partial confinement, the motion of colloidal particles is restricted to a plane or a line but their dynamics is influenced by hydrodynamic interactions mediated by the unconfined, three-dimensional flow of the embedding fluid. We demonstrate that this dimensionality mismatch induces a characteristic divergence in the collective diffusion coefficient of the colloidal subsystem. This result, independent of the specific interparticle forces in the colloid, is solely due to the kinematical constraint on the colloidal particles, and it is different from the known divergence of transport coefficients in purely one or two-dimensional fluids.