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Throughout the western world, goal oriented care (GOC) is increasingly promoted as a strategy towards more person-centered, integrated care. The implementation of goal-oriented care not only takes place at the micro-level with individual primary care providers (PCPs) changing their approach, but also requires meso- and macro-level investment. In this study, we zoom in on experiences and actions of various meso- and macro-level actors that are actively engaged with implementing GOC, both within their organization or at the policy level. In-depth interviews were conducted with n = 23 actors from a variety of different organizations (governmental institutions, provider organizations, patient organizations, health/social care organizations, primary care zones/care councils, etc.), using a semi- interview guide inspired by realist interviewing. Three main drivers for implementation were identified: recognition, commitment and coordination. On top of that, results were interpreted through Rogers' Diffusion of Innovations (Dol) theory in which five attributes are discussed that contribute to or hinder implementation success. Our findings can help define actions to support and facilitate the implementation process of an innovation such as GOC. • Implementing goal-oriented primary care is complex and multi-faceted. • Recognition, commitment and coordination are key ingredients for implementation. •Five attributes of goal-oriented care can help define implementation strategies. [ABSTRACT FROM AUTHOR]

In this study, ultrasound (US) disintegration was evaluated as a digestate treatment strategy. Digestate treatment is the physical, chemical or biological treatment and recirculation AD of the effluents of the anaerobic digesters (i.e., digestate) to the digester as supplementary feed to increase their utilization potential for energy conversion or green chemical production in post-valorization pathways. In this scope, semi-continuous small pilot scale manure digesters were operated in parallel with various operational settings. One of the digesters was fed by adding disintegrated digestate to an equal volume of fresh manure feed (recycle ratio of 1). The obtained results showed that US-assisted digestate treatment at 1500 kJ/kg TS specific energy input with 30 days of hydraulic retention time increased the methane production rate by 18%. The increased methane production rate was found to be related to the applied specific energy and organic loading rate. A basic cost-benefit analysis showed that the energy demand of the US disintegration at lab scale was higher than the energy that can be recovered from the additional biogas produced. • Ultrasound-assisted digestate treatment increases soluble COD of the digestate. • Higher methane production is correlated with the specific energy input of treatment. • Digestate treatment with lower intensity is favored for increased methane production. • Energy consumption of the US reactor exceeds energy gain from extra produced biogas. [ABSTRACT FROM AUTHOR]