This paper reviews what is known about the challenges of implementing quality improvement programs and draws on data from a systematic continuous quality improvement (CQI) project in remote communities in Australia and Fiji, known as Audit and Best practice for Chronic Disease, to synthesise lessons and discuss the potential for broader application in low and middle income countries, including Pacific Island countries and territories. Although a number of systematic reviews have indicated that quality improvement programs can be effective in changing professional practice and improving the quality of care and patient outcomes, little is known about the key ingredients for change or how services use and implement different strategies to achieve improvements. We identify key features of an innovative CQI model and factors related to implementation that support improvement in diabetes service delivery and intermediate outcomes. Requirements for supporting CQI are identified and the potential for wider application discussed. It is argued that the participatory action research approach supports innovation and broad-based change and the evidence it has produced extends the current knowledge base and facilitates the translation of knowledge into action, for both policy and practice.

Geophysical investigations documenting enhanced magnetic susceptibility (MS) within the water table fluctuation zone at hydrocarbon contaminated sites suggest that MS can be used as a proxy for investigating microbial mediated iron reduction during intrinsic bioremediation. Here, we investigated the microbial community composition over a 5-year period at a hydrocarbon-contaminated site that exhibited transient elevated MS responses. Our objective was to determine the key microbial populations in zones of elevated MS. We retrieved sediment cores from the petroleum-contaminated site near Bemidji, MN, United States, and performed MS measurements on these cores. We also characterized the microbial community composition by high-throughput 16S rRNA gene amplicon sequencing from samples collected along the complete core length. Our spatial and temporal analysis revealed that the microbial community composition was generally stable throughout the period of investigation. In addition, we observed distinct vertical redox zonations extending from the upper vadose zone into the saturated zone. These distinct redox zonations were concomitant with the dominant microbial metabolic processes as follows: (1) the upper vadose zone was dominated by aerobic microbial populations; (2) the lower vadose zone was dominated by methanotrophic populations, iron reducers and iron oxidizers; (3) the smear zone was dominated by iron reducers; and (4) the free product zone was dominated by syntrophic and methanogenic populations. Although the common notion is that high MS values are caused by high magnetite concentrations that can be biotically formed through the activities of iron-reducing bacteria, here we show that the highest magnetic susceptibilities were measured in the free-phase petroleum zone, where a methanogenic community was predominant. This field study may contribute to the emerging knowledge that methanogens can switch their metabolism from methanogenesis to iron reduction with associated magnetite precipitation in hydrocarbon contaminated sediments. Thus, geophysical methods such as MS may help to identify zones where iron cycling/reduction by methanogens is occurring.

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Natural attenuation is very often the remediation method of necessity, rather than choice, for beach environments impacted by offshore exploration/drilling accidents. Robust methods that can be efficiently utilized in difficult to access and ecologically sensitive areas are needed for the long-term monitoring of such degradation processes. A prime candidate for such a monitoring tool is the spectral induced polarization (SIP) method, a geophysical technique successfully used for characterization and monitoring of hydrocarbon degradation in freshwater environments. In this laboratory experiment the SIP method successfully monitored the natural degradation of beach sediments impacted by the Deepwater Horizon oil spill. Using the SIP, we were able to differentiate between biotic (e.g., microbial driven) and abiotic (e.g., dilution) degradation processes and infer degradation rates. To our knowledge this is the first effort to use the SIP method as a monitoring aid in high salinity environments.Plain Language Summary Offshore drilling/exploration accidents can result in the contamination of remote and ecologically sensitive areas. In most cases the only realistic remediation choice is natural degradation. In this paper we discuss the use of a noninvasive geophysical method, termed spectral induced polarization, as a monitoring tool of oil contamination degradation in brackish environments. The presented laboratory works supports the suitability of the method for monitoring not only the progress of degradation but also any microbial related degradation processes.

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