Developing ethical standards for dissemination and implementation research: a roadmap for consensus and guidance.

BACKGROUND: As a relatively new field, dissemination and implementation research has not been included as a separate study design category for ethical consideration compared with clinical and social/behavioral research, yet it should be based on unique study designs, targets of intervention, and corresponding risks. MAIN TEXT: Research teams conducting dissemination and implementation research have raised important questions related to the responsible conduct of research such as collecting informed consent, site monitoring, identifying and mitigating risks of unintended consequences, and adverse event ascertainment and reporting in dissemination and implementation research. In this commentary, we highlight the need for guidance and consensus standards on ethical issues in dissemination and implementation research and describe some ethical domains and relevant questions in dissemination and implementation research. Additionally, we propose a process for conceptual development and a research agenda to create consensus standards for the responsible conduct of research for dissemination and implementation research. CONCLUSION: Thorough research is needed to understand the depth of ethical issues in dissemination and implementation research. A consensus-seeking process will be needed to develop new bioethical standards that carefully identify, measure, and mitigate unintended consequences in dissemination and implementation research.

Versatile Silver-Nanoparticle-Impregnated Membranes for Water Treatment: A Review.

Increased affordability, smaller footprint, and high permeability quality that meets stringent water quality standards have accelerated the uptake of membranes in water treatment. Moreover, low pressure, gravity-based microfiltration (MF) and ultrafiltration (UF) membranes eliminate the use of electricity and pumps. However, MF and UF processes remove contaminants by size exclusion, based on membrane pore size. This limits their application in the removal of smaller matter or even harmful microorganisms. There is a need to enhance the membrane properties to meet needs such as adequate disinfection, flux amelioration, and reduced membrane fouling. To achieve these, the incorporation of nanoparticles with unique properties in membranes has potential. Herein, we review recent developments in the impregnation of polymeric and ceramic microfiltration and ultrafiltration membranes with silver nanoparticles that are applied in water treatment. We critically evaluated the potential of these membranes in enhanced antifouling, increased permeability quality and flux compared to uncoated membranes. Despite the intensive research in this area, most studies have been performed at laboratory scale for short periods of time. There is a need for studies that assess the long-term stability of the nanoparticles and the impact on disinfection and antifouling performance. These challenges are addressed in this study and future directions.

High Impact for Whom? A Qualitative Analysis of Organization Concerns About the Transition to High-Impact Prevention Policy.

HIV represents a significant health burden in the United States. In 2012, the Centers for Disease Control and Prevention (CDC) stopped recommending many once-promoted interventions as part of a shift from one HIV intervention policy, Diffusion of Effective Behavioral Interventions (DEBI), to another, High Impact Prevention (HIP). Twenty-nine staff members from 10 organizations were interviewed to explore how organizations reacted to this shift. Three major themes emerged: (1) Personal experience, community assessment, and epidemiological evidence influenced organizations' perceptions of efficacy and preference for earlier interventions. (2) Organizations were concerned that HIP interventions were not a good fit for their priority populations. (3) Organizations were frustrated with the top-down approach by the CDC prioritizing HIP interventions over earlier interventions. These results indicate that organizations continue to see value in and provide DEBI interventions. In addition, a more participatory process incorporating qualitative evidence and organizations' experiences may be necessary to achieve widespread de-implementation of DEBI interventions.

Recovery Strategies for Heavy Metal-Inhibited Biological Nitrogen Removal from Wastewater Treatment Plants: A Review.

Biological nutrient removal is an integral part of a wastewater treatment plant. However, the microorganism responsible for nutrient removal is susceptible to inhibition by external toxicants such as heavy metals which have the potential to completely inhibit biological nutrient removal. The inhibition is a result of the interaction between heavy metals with the cell membrane and the deoxyribonucleic acid (DNA) of the cell. Several attempts, such as the addition of pretreatment steps, have been made to prevent heavy metals from entering the biological wastewater systems. However, the unexpected introduction of heavy metals into wastewater treatment plants result in the inhibition of the biological wastewater treatment systems. This necessitates the recovery of the biological process. The biological processes may be recovered naturally. However, the natural recovery takes time; additionally, the biological process may not be fully recovered under natural conditions. Several methods have been explored to catalyze the recovery process of the biological wastewater treatment process. Four methods have been discussed in this paper. These include the application of physical methods, chelating agents, external field energy, and biological accelerants. These methods are compared for their ability to catalase the process, as well as their environmental friendliness. The application of bio-accelerant was shown to be superior to other recovery strategies that were also reviewed in this paper. Furthermore, the application of external field energy has also been shown to accelerate the recovery process. Although EDTA has been gaining popularity as an alternative recovery strategy, chelating agents have been shown to harm the metal acquisition of bacteria, thereby affecting other metabolic processes that require heavy metals in small amounts. It was then concluded that understanding the mechanism of inhibition by specific heavy metals, and understanding the key microorganism in the inhibited process, is key to developing an effective recovery strategy.

The Use of the Consolidated Framework for Implementation Research to Understand Facilitators and Barriers to Sexually Transmitted Infection Screening in Primary Care.

BACKGROUND: Adolescents bear a disproportionate burden of sexually transmitted infections (STIs) and the sequelae of delayed treatment, yet STI screening is infrequently performed in pediatric primary care clinics with many of those at-risk not administered testing. This study aims to understand contextual factors influencing STI screening and testing among adolescents in pediatric primary care. METHODS: We used the Consolidated Framework for Implementation Research (CFIR) as part of a stepwise approach to facilitate a deep understanding the pediatric primary care environment. We conducted semistructured interviews of physicians, nurses, and patient-parent dyads from 4 pediatric primary care practices in the St. Louis metropolitan area about STI screening practices and common concerns regarding STI screening. Qualitative analysis was conducted using a categorical coding technique informed by the CFIR followed by a thematic coding technique. RESULTS: We interviewed 23 physicians/nurses and 12 patient-parent dyads. Individual-level barriers to STI screening and testing included wide variability in clinicians' practice patterns and their perception of STI risk in the patient population. Structural barriers included a lack of capacity to perform testing in clinic and time constraints during patient visits. Confidentiality issues also created significant barriers to screening and testing on both individual and structural levels. Adopting confidential methods for testing and educating providers on patients' recommendations for STI testing were discussed as ways to potentially improve STI care in pediatric patients. CONCLUSIONS: Our use of the CFIR facilitated a systematic approach to identify gaps in STI care for adolescents and identified opportunities to close those gaps. An integrated, systematic approach that enhances patient confidentiality and improves clinicians' knowledge could address gaps in STI care in pediatric primary care settings.

Persistence of inefficient HIV prevention interventions: a mixed-method analysis of the reasons why.

Growing evidence suggests that public health organizations continue to provide inefficient interventions even when better intervention options may be available. Factors informing an organization's decision to continue providing inefficient interventions are unclear. We present an analysis of HIV service organizations to understand factors influencing organizations to continue or end interventions. Between 2017 and 2019, HIV service organizations were recruited from the Center for Disease Control and Prevention's (CDC) website gettested.org, in the 20 metropolitan areas with the highest HIV incidence. Organizations were eligible to participate if they had provided at least one of 37 HIV prevention interventions identified as inefficient by the CDC. 877 organizations were recruited, with a response rate of 66%, (n = 578). Thirty-eight percent (n = 213) of organizations met the eligibility criteria, and 188 organizations completed the survey asking about reasons for continuing or ending interventions. Funding status (41%, n = 79) and client demand for interventions (60%, n = 116) were reported as the primary driving factors why organizations continued ineffective interventions. Scientific evidence was a rarely reported reason for ending an inefficient intervention (12%, n = 23). Qualitative responses indicated interventions were continued if clients demanded interventions they found useful or if staff perceived interventions as improving client behavior and health outcomes. Conversely, interventions were ended if client demand or retention was low, not relevant to the target population or funding ended. The decision to continue or end inefficient interventions is influenced by a number of factors-most often by funding and client interest but not scientific evidence.

Better Service by Doing Less: Introducing De-implementation Research in HIV.

The course of HIV research has led to a multitude of interventions to prevent and treat HIV. With the arrival of more effective interventions comes the need to end, or de-implement, less effective interventions. PURPOSE OF REVIEW: To describe the state of de-implementation research in HIV and provide a rationale for expanded research in this area. RECENT FINDINGS: Existing studies have identified a set of HIV-specific interventions appropriate for de-implementing and described the persistence of interventions that should be ended. However, to our knowledge, strategies to successfully promote appropriate de-implementation of HIV-specific interventions have not been examined. De-implementing interventions that are no longer needed is an opportunity to improve the quality and effectiveness of HIV services. Opportunities to expand this field of research abound.