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Over the last 4 decades, physical activity researchers have invested heavily in determining "what works" to promote healthy behaviors in schools. Single and multicomponent school-based interventions that target physical education, active transportation, and/or classroom activity breaks effectively increased physical activity among children and youth. Yet, few of these interventions are ever scaled-up and implemented under real-world conditions and in diverse populations. To achieve population-level health benefits, there is a need to design school-based health-promoting interventions for scalability and to consider key aspects of the scale-up process. In this opinion piece, we aim to identify challenges and advance knowledge and action toward scaling-up school-based physical activity interventions. We highlight the key roles of planning for scale-up at the outset, scale-up pathways, trust among partners and program support, program adaptation, evaluation of scale-up, and barriers and facilitators to scaling-up. We draw upon our experience scaling-up effective school-based interventions and provide a solid foundation from which others can work toward bridging the implementation-to-scale-up gap. [ABSTRACT FROM AUTHOR]

BACKGROUND: Family-based treatment (FBT), the leading intervention for adolescents with anorexia nervosa (AN), is severely understudied in outpatient care settings that serve publicly-insured populations. Many individuals with public insurance are lower-income, racially and ethnically diverse, and experience barriers to accessing evidence-based interventions for eating disorders (EDs). METHODS: Semi-structured interviews were conducted with ten interdisciplinary providers who provide specialty care to youth with EDs in an inpatient and/or outpatient medical setting. Interview questions were focused on the interdisciplinary providers experiences of caring for individuals with EDs, with a focus on differences in care for those with private insurance compared to public insurance. The interviews took place two years after training in FBT was delivered to mental health providers in San Francisco County, which created opportunities to explore provider perspectives on collaborating with newly-trained mental health providers in the community implementing FBT with publicly-insured youth. RESULTS: Content analysis converged on three themes: the critical importance of supporting mental health treatment within the context of medical care, complex challenges when helping patients and their families navigate publicly-funded health care systems, and the overall positive impact of the FBT rollout in San Francisco County. Participants emphasized greater confidence in patient outcomes when collaborating with FBT providers and noted discord when working with providers not trained in EDs or FBT. Referral systems, weight-based stigma, and a lack of appropriate services were highlighted as significant barriers to care. To facilitate treatment engagement in publicly-insured populations, participants stressed the importance of clinicians providing psychoeducation and providing services with a high degree of cultural competence. Participants expressed that patients ability to access FBT and providers ability to collaborate on cases markedly improved following the county training, increasing their sense of efficacy in delivering adequate patient care. CONCLUSIONS: The discussed themes highlight the importance of access to FBT for individuals in underserved communities, which can significantly reduce both provider and patient burden. Despite various barriers to utilizing FBT in publicly-funded settings, clinicians stressed that cultural adaptations increase the implementation of and facilitate family engagement in FBT, which is consistent with previous literature examining evidence-based intervention implementation science.

Despite a significant accumulation of research, there has been little systemic implementation of evidence-based practices (EBP) in youth mental health care. The fragmentation of the evidence base complicates implementation efforts. In light of this challenge, we sought to pilot a system that consolidates and coordinates the entire evidence base in a single direct service model (i.e., Managing and Adapting Practice; MAP) in the context of a legal reform of psychotherapy training in Germany. This pilot study aimed to evaluate the feasibility of the implementation of MAP into the curriculum of the reformed German masters program. Eligible participants were students in the masters program at Philipps-University Marburg during the winter-term 2022/2023. Students first learned about MAP through introductions and role plays (seminar 1), followed by actively planning and conducting interventions using MAP resources for patients in a case seminar under supervision (seminar 2). A repeated-measures survey was conducted to investigate students knowledge gains, perception of MAP and changes in their self-rated confidence to use EBP. Results indicated that students perceive MAP to be manageable to learn. Positive progress was achieved with regard to their knowledge and self-reported confidence to use EBP, although interpretation and generalization of the results are limited by small and homogeneous samples, lack of statistical power and missing comparison groups. The feasibility of the implementation and suitability of measures are discussed. Important implications could be drawn with regard to future investigations.

ObjectiveBlockchain has emerged as a potential data-sharing structure in healthcare because of its decentralization, immutability, and traceability. However, its use in the biomedical domain is yet to be investigated comprehensively, especially from the aspects of implementation and evaluation, by existing blockchain literature reviews. To address this, our review assesses blockchain applications implemented in practice and evaluated with quantitative metrics.Materials and methodsThis systematic review adapts the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework to review biomedical blockchain papers published by August 2023 from 3 databases. Blockchain application, implementation, and evaluation metrics were collected and summarized.ResultsFollowing screening, 11 articles were included in this review. Articles spanned a range of biomedical applications including COVID-19 medical data sharing, decentralized internet of things (IoT) data storage, clinical trial management, biomedical certificate storage, electronic health record (EHR) data sharing, and distributed predictive model generation. Only one article demonstrated blockchain deployment at a medical facility.DiscussionEthereum was the most common blockchain platform. All but one implementation was developed with private network permissions. Also, 8 articles contained storage speed metrics and 6 contained query speed metrics. However, inconsistencies in presented metrics and the small number of articles included limit technological comparisons with each other.ConclusionWhile blockchain demonstrates feasibility for adoption in healthcare, it is not as popular as currently existing technologies for biomedical data management. Addressing implementation and evaluation factors will better showcase blockchain's practical benefits, enabling blockchain to have a significant impact on the health sector.

ObjectiveOur objective was to gauge adherence to nationally endorsed protocols in implementation of pulse oximetry (POx) screening for critical congenital heart disease (CCHD) in infants after mandate by all states and to assess associated characteristics.Study designBetween March and October 2019, an online questionnaire was administered to nurse supervisors who oversee personnel conducting POx screening. The questionnaire used eight questions regarding performance and interpretation of screening protocols to measure policy consistency, which is adherence to nationally endorsed protocols for POx screening developed by professional medical societies. Multilevel linear regression models evaluated associations between policy consistency and characteristics of hospitals and individuals, state of hospital location, early versus late mandate adopters, and state reporting requirements.ResultsResponses from 189 nurse supervisors spanning 38 states were analyzed. Only 17% received maximum points indicating full policy consistency, and 24% selected all four options for potential hypoxia that require a repeat screen. Notably, 33% did not recognize ≤90% SpO2 as an immediate failed screen and 31% responded that an infant with SpO2 of 89% in one extremity will be rescreened by nurses in an hour rather than receiving an immediate physician referral. Lower policy consistency was associated with lack of state reporting mandates (beta = -1.23 p = 0.01) and early adoption by states (beta = -1.01, p

Multilevel interventions (MLIs) are appropriate to reduce health disparities among Indigenous peoples because of their ability to address these communities' diverse histories, dynamics, cultures, politics, and environments. Intervention science has highlighted the importance of context-sensitive MLIs in Indigenous communities that can prioritize Indigenous and local knowledge systems and emphasize the collective versus the individual. This paradigm shift away from individual-level focus interventions to community-level focus interventions underscores the need for community engagement and diverse partnerships in MLI design, implementation, and evaluation. In this paper, we discuss three case studies addressing how Indigenous partners collaborated with researchers in each stage of the design, implementation, and evaluation of MLIs to reduce health disparities impacting their communities. We highlight the following: (1) collaborations with multiple, diverse tribal partners to carry out MLIs which require iterative, consistent conversations over time; (2) inclusion of qualitative and Indigenous research methods in MLIs as a way to honor Indigenous and local knowledge systems as well as a way to understand a health disparity phenomenon in a community; and (3) relationship building, maintenance, and mutual respect among MLI partners to reconcile past research abuses, prevent extractive research practices, decolonize research processes, and generate co-created knowledge between Indigenous and academic communities.

Senate Bill (SB) 743 (2013) and its related regulations eliminated automobile level of service (LOS) and replaced it with vehicle miles traveled (VMT) as the primary transportation impact metric for land development projects under the California Environmental Quality Act. Actual implementation of the LOS-to-VMT shift was left up to lead agencies, primarily local governments. The LOS-to-VMT shift was expected to create many challenges, given the often-limited resources of local governments, the entrenched use of LOS, and the perceived lack of established practice regarding VMT estimation, mitigation, and monitoring. With those concerns in mind, researchers at the University of California, Davis investigated how local governments have been implementing the LOS-to-VMT shift for land development projects.  This policy brief summarizes the findings from that investigation. View the NCST Project Webpage

BACKGROUND: Despite the increased risk of cervical cancer (CC) among women living with HIV (WLHIV), CC screening and treatment (CCST) rates remain low in Africa. The integration of CCST services into established HIV programs in Africa can improve CC prevention and control. However, the paucity of evidence on effective implementation strategies (IS) has limited the success of integration in many countries. In this study, we seek to identify effective IS to enhance the integration of CCST services into existing HIV programs in Nigeria. METHODS: Our proposed study has formative and experimental activities across the four phases of the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. Through an implementation mapping conducted with stakeholders in the exploration phase, we identified a core package of IS (Core) and an enhanced package of IS (Core+) mostly selected from the Expert Recommendations for Implementing Change. In the preparation phase, we refined and tailored the Core and Core+ IS with the implementation resource teams for local appropriateness. In the implementation phase, we will conduct a cluster-randomized hybrid type III trial to assess the comparative effectiveness of Core versus Core+. HIV comprehensive treatment sites (k = 12) will be matched by region and randomized to Core or Core+ in the ratio of 1:1 stratified by region. In the sustainment phase, we will assess the sustainment of CCST at each site. The study outcomes will be assessed using RE-AIM: reach (screening rate), adoption (uptake of IS by study sites), IS fidelity (degree to which the IS occurred according to protocol), clinical intervention fidelity (delivery of CC screening, onsite treatment, and referral according to protocol), clinical effectiveness (posttreatment screen negative), and sustainment (continued integrated CCST service delivery). Additionally, we will descriptively explore potential mechanisms, including organizational readiness, implementation climate, CCST self-efficacy, and implementation intentions. DISCUSSION: The assessment of IS to increase CCST rates is consistent with the global plan of eliminating CC as a public health threat by 2030. Our study will identify a set of evidence-based IS for low-income settings to integrate evidence-based CCST interventions into routine HIV care in order to improve the health and life expectancy of WLHIV. TRIAL REGISTRATION: Prospectively registered on November 7, 2023, at ClinicalTrials.gov no. NCT06128304. https://classic. CLINICALTRIALS: gov/ct2/show/study/NCT06128304.

Research on Blockchain implementation in the Pharmaceutical Supply Chains (PSC) is lacking despite its strong potential to overcome conventional supply chain challenges. Thus, this study aims to provide critical insight into the nexus between Blockchain and PSC and further build a conceptual framework for implementation within the pharmaceutical industry. Following a systematic literature review and text mining approach, 65 interdisciplinary articles published between 2010 and 2021 were studied to capture the decade long developments. Descriptive and thematic analysis showcases nascent developments of Blockchain in PSC. The drivers and barriers to adoption, implementation stages, and applications identified through the thematic analysis guide in setting the agenda for future research, primarily focussing on the use of Blockchain for drug counterfeiting, recall issues, along with other sector-specific challenges such as patient privacy, regulations and clinical trials. Research on Blockchain for PSC has been slow compared to other sectors, but has accelerated since the Covid-19 pandemic. Identified influential factors, implementation process and apparent applications are expected to influence researchers and practitioners in developing a roadmap for adopting Blockchain in the pharmaceutical industry. The proposed conceptual framework is novel and provides valuable directions to producers, regulators and governments to implement Blockchain in the pharmaceutical industry. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although research on the implementation of evidence-based psychological treatments (EBPTs) has advanced rapidly, research on the sustainment of implemented EBPTs remains limited. This is concerning, given that EBPT activities and benefits regularly decline post-implementation. To advance research on sustainment, the present protocol focuses on the third and final phase-the Sustainment Phase-of a hybrid type 2 cluster-randomized controlled trial investigating the implementation and sustainment of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) for patients with serious mental illness and sleep and circadian problems in community mental health centers (CMHCs). Prior to the first two phases of the trial-the Implementation Phase and Train-the-Trainer Phase-TranS-C was adapted to fit the CMHC context. Then, 10 CMHCs were cluster-randomized to implement Standard or Adapted TranS-C via facilitation and train-the-trainer. The primary goal of the Sustainment Phase is to investigate whether adapting TranS-C to fit the CMHC context predicts improved sustainment outcomes. METHODS: Data collection for the Sustainment Phase will commence at least three months after implementation efforts in partnering CMHCs have ended and may continue for up to one year. CMHC providers will be recruited to complete surveys (N = 154) and a semi-structured interview (N = 40) on sustainment outcomes and mechanisms. Aim 1 is to report the sustainment outcomes of TranS-C. Aim 2 is to evaluate whether manipulating EBPT fit to context (i.e., Standard versus Adapted TranS-C) predicts sustainment outcomes. Aim 3 is to test whether provider perceptions of fit mediate the relation between treatment condition (i.e., Standard versus Adapted TranS-C) and sustainment outcomes. Mixed methods will be used to analyze the data. DISCUSSION: The present study seeks to advance our understanding of sustainment predictors, mechanisms, and outcomes by investigating (a) whether the implementation strategy of adapting an EBPT (i.e., TranS-C) to the CMHC context predicts improved sustainment outcomes and (b) whether this relation is mediated by improved provider perceptions of treatment fit. Together, the findings may help inform more precise implementation efforts that contribute to lasting change. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05956678 . Registered on July 21, 2023.

In contrast to traditional randomized controlled trials, embedded pragmatic clinical trials (ePCTs) are conducted within healthcare settings with real-world patient populations. ePCTs are intentionally designed to align with health system priorities leveraging existing healthcare system infrastructure and resources to ease intervention implementation and increase the likelihood that effective interventions translate into routine practice following the trial. The NIH Pragmatic Trials Collaboratory, funded by the National Institutes of Health (NIH), supports the conduct of large-scale ePCT Demonstration Projects that address major public health issues within healthcare systems. The Collaboratory has a unique opportunity to draw on the Demonstration Project experiences to generate lessons learned related to ePCTs and the dissemination and implementation of interventions tested in ePCTs. In this article, we use case studies from six completed Demonstration Projects to summarize the Collaboratory's experience with post-trial interpretation of results, and implications for sustainment (or de-implementation) of tested interventions. We highlight three key lessons learned. First, ineffective interventions (i.e., ePCT is null for the primary outcome) may be sustained if they have other measured benefits (e.g., secondary outcome or subgroup) or even perceived benefits (e.g., staff like the intervention). Second, effective interventions-even those solicited by the health system and/or designed with significant health system partner buy-in-may not be sustained if they require significant resources. Third, alignment with policy incentives is essential for achieving sustainment and scale-up of effective interventions. Our experiences point to several recommendations to aid in considering post-trial sustainment or de-implementation of interventions tested in ePCTs: (1) include secondary outcome measures that are salient to health system partners; (2) collect all appropriate data to allow for post hoc analysis of subgroups; (3) collect experience data from clinicians and staff; (4) engage policy-makers before starting the trial.

IntroductionOpioid overdose deaths are increasing rapidly in the United States. Medications for opioid use disorder (MOUD) are effective and can be delivered in primary care, but uptake has been limited in rural communities. Referral to and coordination with an external telemedicine (TM) vendor by rural primary care clinics for MOUD (TM-MOUD) may increase MOUD access for rural patients, but we know little about perspectives on this model among key stakeholders. As part of a TM-MOUD feasibility study, we explored TM-MOUD acceptability and feasibility among personnel and patients from seven rural primary care clinics and a TM-MOUD vendor.MethodsWe conducted virtual interviews or focus groups with clinic administrators (n = 7 interviews), clinic primary care and behavioral health providers (8 groups, n = 30), other clinic staff (9 groups, n = 37), patients receiving MOUD (n = 16 interviews), TM-MOUD vendor staff (n = 4 interviews), and vendor-affiliated behavioral health and prescribing providers (n = 17 interviews). We asked about experiences with and acceptability of MOUD (primarily buprenorphine) and telemedicine (TM) and a TM-MOUD referral and coordination model. We conducted content analysis to identify themes and participants quantitatively rated acceptability of TM-MOUD elements on a 4-item scale.ResultsPerceived benefits of vendor-based TM-MOUD included reduced logistical barriers, more privacy and less stigma, and access to services not available locally (e.g., counseling, pain management). Barriers included lack of internet or poor connectivity in patients' homes, limited communication and trust between TM-MOUD and clinic providers, and questions about the value to the clinic of TM-MOUD referral to external vendor. Acceptability ratings for TM-MOUD were generally high; they were lowest among frontline staff.ConclusionsRural primary care clinic personnel, TM-MOUD vendor personnel, and patients generally perceived referral from primary care to a TM-MOUD vendor to hold potential for increasing access to MOUD in rural communities. Increasing TM-MOUD uptake requires buy-in and understanding among staff of the TM-MOUD workflow, TM services offered, requirements for patients, advantages over clinic-based or TM services from clinic providers, and identification of appropriate patients. Poverty, along with patient hesitation to initiate treatment, creates substantial barriers to MOUD treatment generally; insufficient internet availability creates a substantial barrier to TM-MOUD.

BACKGROUND: Family-based treatment (FBT) is the leading intervention for adolescents with anorexia nervosa (AN); however, it is under researched in socioeconomically disadvantaged and racially diverse youth. METHODS: Semi-structured interviews were completed with ten FBT clinicians who practice in publicly-funded settings. Interview questions were focused on implementation challenges, overall acceptability and appropriateness of FBT, and naturally-occurring treatment adaptations. RESULTS: Content analysis revealed common themes relating to the implementation of FBT in publicly-funded, community-based settings: acceptability and appropriateness, complexity and learnability, perceived core components of FBT, cultural adaptations, socioeconomic factors, logistical considerations, organizational and systemic barriers, training acceptability, participants self-efficacy, and telehealth accommodations. CONCLUSION: The discussed themes offer insights into the implementation of FBT for settings with limited resources, aligning with prior research on clinical adaptations for multicultural patients. Recognizing these themes can guide clinical adjustments and refine the adapted treatment model in real-world settings for patients facing systemic barriers.

BackgroundElectronic health records (EHRs) are a cost-effective approach to provide the necessary foundations for clinical trial research. The ability to use EHRs in real-world clinical settings allows for pragmatic approaches to intervention studies with the emerging adult HIV population within these settings; however, the regulatory components related to the use of EHR data in multisite clinical trials poses unique challenges that researchers may find themselves unprepared to address, which may result in delays in study implementation and adversely impact study timelines, and risk noncompliance with established guidance.ObjectiveAs part of the larger Adolescent Trials Network (ATN) for HIV/AIDS Interventions Protocol 162b (ATN 162b) study that evaluated clinical-level outcomes of an intervention including HIV treatment and pre-exposure prophylaxis services to improve retention within the emerging adult HIV population, the objective of this study is to highlight the regulatory process and challenges in the implementation of a multisite pragmatic trial using EHRs to assist future researchers conducting similar studies in navigating the often time-consuming regulatory process and ensure compliance with adherence to study timelines and compliance with institutional and sponsor guidelines.MethodsEight sites were engaged in research activities, with 4 sites selected from participant recruitment venues as part of the ATN, who participated in the intervention and data extraction activities, and an additional 4 sites were engaged in data management and analysis. The ATN 162b protocol team worked with site personnel to establish the necessary regulatory infrastructure to collect EHR data to evaluate retention in care and viral suppression, as well as para-data on the intervention component to assess the feasibility and acceptability of the mobile health intervention. Methods to develop this infrastructure included site-specific training activities and the development of both institutional reliance and data use agreements.ResultsDue to variations in site-specific activities, and the associated regulatory implications, the study team used a phased approach with the data extraction sites as phase 1 and intervention sites as phase 2. This phased approach was intended to address the unique regulatory needs of all participating sites to ensure that all sites were properly onboarded and all regulatory components were in place. Across all sites, the regulatory process spanned 6 months for the 4 data extraction and intervention sites, and up to 10 months for the data management and analysis sites.ConclusionsThe process for engaging in multisite clinical trial studies using EHR data is a multistep, collaborative effort that requires proper advanced planning from the proposal stage to adequately implement the necessary training and infrastructure. Planning, training, and understanding the various regulatory aspects, including the necessity of data use agreements, reliance agreements, external institutional review board review, and engagement with clinical sites, are foremost considerations to ensure successful implementation and adherence to pragmatic trial timelines and outcomes.

Heart failure (HF) is a common disease with increasing prevalence around the world. There is high morbidity and mortality associated with poorly controlled HF along with increasing costs and strain on healthcare systems due to a high rate of rehospitalization and resource utilization. Despite the establishment of clear evidence-based guideline directed medical therapies (GDMT) proven to improve HF morbidity and mortality, there remains significant clinical inertia to optimizing HF patients on GDMT. Only a minority of HF patients are prescribed on all four classes of GDMT. To bridge the gap between the vulnerable population of HF patients and lifesaving GDMT, HF implementation is of increasing importance. HF implementation involves strategies and techniques to improve GDMT optimization along with other modalities to improve HF management. HF implementation meets patients where they are, including at the time of acute decompensation in the inpatient setting, at the vulnerable discharge stage, and at the chronic management stage in the outpatient setting. Inpatient HF implementation strategies include protocolized rapid titration of GDMT, site-level audit-and-feedback, virtual GDMT optimization teams, and electronic health record notifications and alerts. Discharge HF implementation strategies include education at patient and provider levels, discharge summaries, and HF transitional programs. Outpatient HF implementation strategies include digital innovations such as electronic health record utilization and mobile applications, population level strategies such as registries and clinical dashboards), changes in HF team structure and member roles, remote monitoring with implanted devices and telemonitoring, and hospital at home care model. With a growing population of HF patients, there is an increasing need for novel and creative HF implementation and monitoring methods.

OBJECTIVE: Characterize key factors and training needs of U.S. cancer centers in implementing family caregiver support services. METHODS: Sequential explanatory mixed methods design consisting of: (1) a national survey of clinicians and administrators from Commission-on-Cancer-accredited cancer centers (N = 238) on factors and training needed for establishing new caregiver programs and (2) qualitative interviews with a subsample of survey respondents (N = 30) to elicit feedback on survey findings and the outline of an implementation strategy to facilitate implementation of evidence-based family caregiver support (the Caregiver Support Accelerator). Survey data was tabulated using descriptive statistics and transcribed interviews were analyzed using thematic analysis. RESULTS: Top factors for developing new caregiver programs were that the program be: consistent with the cancer centers mission and strategic plan (87%), supported by clinic leadership (86.5%) and providers and staff (85.7%), and low cost or cost effective (84.9%). Top training needs were how to: train staff to implement programs (72.3%), obtain program materials (63.0%), and evaluate program outcomes (62.6%). Only 3.8% reported that no training was needed. Qualitative interviews yielded four main themes: (1) gaining leadership, clinician, and staff buy-in and support is essential; (2) cost and clinician burden are major factors to program implementation; (3) training should help with adapting and marketing programs to local context and culture; and (4) the Accelerator strategy is comprehensive and would benefit from key organizational partnerships and policy standards. CONCLUSION: Findings will be used to inform and refine the Accelerator implementation strategy to facilitate the adoption and growth of evidence-based cancer caregiver support in U.S. cancer centers.

IssueWhen frontline employees' voice is not heard and their ideas are not implemented, patient care is negatively impacted, and frontline employees are more likely to experience burnout and less likely to engage in subsequent change efforts.Critical theoretical analysisTheory about what happens to voiced ideas during the critical stage after employees voice and before performance outcomes are measured is nascent. We draw on research from organizational behavior, human resource management, and health care management to develop a multilevel model encompassing practices and processes at the individual, team, managerial, and organizational levels that, together, provide a nuanced picture of how voiced ideas reach implementation.Insight/advanceWe offer a multilevel understanding of the practices and processes through which voice leads to implementation; illuminate the importance of thinking temporally about voice to better understand the complex dynamics required for voiced ideas to reach implementation; and highlight factors that help ideas reach implementation, including voicers' personal and interpersonal tactics with colleagues and managers, as well as senior leaders modeling and explaining norms and making voice-related processes and practices transparent.Practice implicationsOur model provides evidence-based strategies for bolstering rejected or ignored ideas, including how voicers (re)articulate ideas, whom they enlist to advance ideas, how they engage peers and managers to improve conditions for intentional experimentation, and how they take advantage of listening structures and other formal mechanisms for voice. Our model also highlights how senior leaders can make change processes and priorities explicit and transparent.

This study assessed the various stakeholders' support for the National Learning Camp (NLC) implementation at Liloan Elementary School in Liloan, Cebu. A qualitative method engaging in a key informant interview using a semistructured interview guide, purposive sampling in determining the 20 respondents and thematic analysis was utilized in this paper to determine the stakeholder support initiatives in the implementation of the National Learning Camp (NLC) 2024. The findings revealed how the school head, acting as a stakeholder, facilitated positive interactions and connections between parents, students, and teachers while emphasizing their role in the program's implementation. The school head also looked for alternatives for the limited educational resources used during the National Learning Camp's implementation. The teachers were wholly committed to using NLC in lesson planning, mentoring, performance evaluation, and parent communication to guarantee that pupils had mastered literacy and numeracy. As an essential stakeholder, the parents have shown their utmost support by attending several parent-teacher conferences, watching their kid's development, contributing financially, and offering their volunteer time when needed. Despite financial limitations, budgetary restrictions, and instructional time constraints, the National Learning Camp significantly improved the pupils' academic excellence and performance, instilling a sense of optimism in all stakeholders, including the audience, about the potential of the NLC. [ABSTRACT FROM AUTHOR]

This research aimed to determine the level of implementation, and challenges of K-12 program in public secondary schools of District VI, Quezon City, to serve as a basis for an action plan. The study used the descriptive survey method of research. It used a survey questionnaire in a checklist form to gather the data from two groups of respondents: the teachers, and the school leaders/ coordinators. Based on the findings, it was found out that the level of implementation of the K-12 program was high in terms of instructional materials, school facilities and equipment, and teachers' preparedness as assessed by the two groups of respondents. In addition, there was a significant difference between the assessment of the two groups of respondents on the level of K-12 implementation in terms of instructional materials, but no significant difference in terms of school facilities and equipment, and teachers' preparedness. Moreso, the challenges encountered by the teachers with regard to the K-12 program implementation were a) congested most essential learning competencies, b) time allotment is not enough, c) lack of additional training, d) the student-teacher ratio is not proportional and, e) facilities are lacking like advanced laboratories for experiments. On the other hand, the group of school leaders/ coordinators encountered challenges as follows; a) lack of technology-based equipment for advanced subjects, b) insufficient number of training days, and c) time allotment is not enough to cover all the lessons. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Design Methods Results Conclusion Implications for Nursing and Patient Care Impact Reporting Method Patient or Public Contribution Trial Registration To evaluate the implementation of the Transitional Care Model (TCM), an evidence‐based, advanced practice registered nurse‐led multi‐component intervention, as part of a randomised controlled trial during the first year of the COVID‐19 pandemic.Parallel convergent mixed‐methods approach.Data for this study were collected between June 2020 and February 2021. Data from 78 patients who received the intervention and 68 recorded meetings with system leaders and clinical teams were analysed using descriptive statistics, directed content analysis, and joint display.Fidelity to delivery of elements of the TCM components was variable, with the Hospital‐to‐Home visit elements having the widest range (14.3%–100%) and Maintaining Relationships elements having the highest range (97.3%–98.6%). There were 27 identified challenges and 15 strategies for implementing the TCM with fidelity during the pandemic.The COVID‐19 pandemic impacted all aspects of the delivery of the TCM across all sites. This historical event highlighted the need for services and support for patients and caregivers transitioning from the hospital to home.Evidence‐based solutions are needed to enhance healthcare delivery and patient outcomes. Findings will guide nurses in implementing proven transitional care interventions.Findings will inform the implementation and scaling of transitional care and other evidence‐based interventions across diverse healthcare settings.GRAMMS reporting guidelines.No patient or public contribution.ClinicalTrials.gov identifier: NCT04212962. https://www.clinicaltrials.gov/study/NCT04212962?titles=NCT04212962&rank=1 [ABSTRACT FROM AUTHOR]

This study aimed to unveil the teachers' challenges in the implementation of Homeroom Guidance Program. It also looked into the similarities and differences among the participants in terms of challenges, copings and insights. This qualitative multiple case study explored the challenges, coping strategies and insights of six class advisers randomly selected for the study. Results revealed that based on the experiences of the participants, language barrier, limited parental involvement and lack of support and motivation from the administration were the challenges encountered in the implementation. But despite these challenges, some teachers managed to cope by becoming resourceful to reach out for support and collaboration with stakeholders and to persevere for the program. As for the insights gained by the participants, most of them emphasized the acceptance for positive change and for continuous improvement and embracing the holistic impact of the homeroom guidance program. This study may serve as a guide to researchers and educational leaders to have a deeper understanding about the challenging journey of teachers in shaping the course of future studies, fostering a continuous and informed discourse and proper monitoring on the evolving landscape of homeroom guidance in education for its effective implementation. [ABSTRACT FROM AUTHOR]

The purpose of this qualitative study was to explore the experiences of teachers on the implementation of positive discipline. Thus, this study utilized phenomenological approach. Additionally, purposive sampling was used to select the participants. Moreover, an in-depth study was explored delving into the problems encountered specially by five (5) teachers at Datu Dumagkal Danial Elementary School. The study explored the challenges, coping mechanisms, and insights by teachers on the implementation of positive discipline. The challenges of participants as teachers formulated the following emergent themes: rigorous, impact of positive discipline, different perspective, and misbehaving. The coping mechanism of the teachers formulated the themes: teacher mentoring, balancing kindness and firmness, positive reinforcement, and proactive behavior support. The insights of the teachers formulated the following themes: teaching by heart, patience and understanding, individualized approach, and gains. Overall, this study provided valuable insights into the real-world experiences of teachers implementing positive discipline, highlighting the challenges they faced, the strategies they employed to cope, and the insights they gained from their practice. [ABSTRACT FROM AUTHOR]

The study determined the implementation of Ministry of Basic Higher and Technical Education (MBHTE) School Programs as basis for enhancement program for school year 2023-2024 using descriptive-evaluative research design that combined survey and interview in data gathering to 378 respondents. The mean and thematic analysis was used in interpretation of data. Results revealed that the extent of integration of the key principles in the implementation of MBHTE school programs in terms of inclusivity, equity, right based, rooted in context, integrated and balanced are all highly integrated. The common themes that emerged during interview shows there are minimal problems encountered by the teachers. These included challenges inadequate resources specially technology equipment and competency in using them and integration of lifelong learning as balanced to academic aspects of learning. The study concludes that the MBHTE are effective in the implementation of the key principles of the ministry. The inclusive and equitable school services helped students to feel safe and motivated to go to school. The strict compliance to rights-based education services further ensured children are safe in the school. The rooted concept of implementing the curriculum as mandated by law and the balanced integration of services made the teaching learning promotive of the welfare of the students. However, challenges such as lack of sufficient materials and equipment for technology integration in instruction as well as need for development of teacher competency can hamper the attainment of the goals of school programs. The needs to s strengthen the lifelong learning integration in the instruction of teachers can prepare the students to be competitive in the future. The study recommended that the MBHTE must provide allocation to upgrade technological equipment of the schools as part of the urgent programs since this is vital in improving the quality of instruction to the students. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusion\nIMPLICATIONS FOR REHABILITATIONIn 2023, the World Health Assembly endorsed a Resolution on Strengthening Rehabilitation in Health Systems. This study aims to explore the perspectives of Swiss rehabilitation stakeholders regarding the relevance, challenges, and opportunities of the Resolution for Switzerland.A cross-sectional online survey was conducted among Swiss rehabilitation stakeholders. Purposive snowball sampling with a quota system ensured a representative sample. Survey development and reporting adhered to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Descriptive analysis was applied to quantitative data, while thematic analysis was used for free-text responses.A representative sample of 282 Swiss rehabilitation stakeholders completed the survey. Developing multidisciplinary rehabilitation skills emerged as the most relevant action in the Resolution. Primary challenges centred on financing and workforce issues and integrated care, while main opportunities included policy development and advocacy efforts.This study enhances the understanding of current challenges and opportunities for rehabilitation in Switzerland. Leveraging this approach and related findings into national and international policy considerations can support policymakers responding in a contextualised manner to the urges of the Resolution.Financing, workforce and integrated care issues pose significant challenges to the implementation of the World Health Assembly (WHA) Resolution on Strengthening Rehabilitation in Switzerland.Policy development, advocacy chances, workforce development and existing expertise present opportunities for improving rehabilitation services.The results of this survey will be synthesised, together with available evidence, in the format of a policy brief, facilitating informed decision-making and policy development in regards to the WHA Resolution on Strengthening Rehabilitation.This study serves as a model case for other countries’ implementation efforts for the WHA Resolution for Rehabilitation, providing insights and guidance for enhancing rehabilitation services globally.Financing, workforce and integrated care issues pose significant challenges to the implementation of the World Health Assembly (WHA) Resolution on Strengthening Rehabilitation in Switzerland.Policy development, advocacy chances, workforce development and existing expertise present opportunities for improving rehabilitation services.The results of this survey will be synthesised, together with available evidence, in the format of a policy brief, facilitating informed decision-making and policy development in regards to the WHA Resolution on Strengthening Rehabilitation.This study serves as a model case for other countries’ implementation efforts for the WHA Resolution for Rehabilitation, providing insights and guidance for enhancing rehabilitation services globally. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusions Psychiatric measurement‐based care (MBC) can be more effective than usual care, but health systems face implementation challenges. Achieving attitudinal alignment before implementing MBC is critical, yet few studies incorporate perspectives from multiple stakeholders this early in planning. This analysis identifies alignment and themes in pre‐implementation feedback from patients, providers, and administrators regarding a planned MBC implementation in a safety net psychiatry clinic.We used interview guides informed by Conceptual Model of Implementation Research to gather qualitative pre‐implementation attitudes about perceived Appropriateness, Acceptability, and Feasibility of an MBC measure (Computerized Adaptive Test—Mental Health; CAT‐MH) from five patients, two providers, and six administrators. We applied rapid qualitative analysis methods to general actionable feedback for department leadership still planning implementation. We used a multistep process to generate thematic findings with potential relevance for other similar mental health settings.There was more attitudinal alignment across stakeholder groups regarding MBC's Acceptability and Feasibility than its Appropriateness. All three groups agreed that it was important to contextualize MBC for patients and providers, anticipate MBC's impact on patient–provider relationships, and consider the system's capacity to respond to patient needs unearthed by CAT‐MH before implementation began. Our thematic analysis suggests: (1) Introducing MBC may complicated patient–provider relationships by adding a new and potentially conflicting input for decision making, that is, MBC data, to the more typical inputs of patient report and provider expertise; (2) MBC poses theoretical risks to health equity for safety net patients because of limitations in access to MBC tools themselves and the resources needed to respond to MBC data; and (3) Tension exists between individual‐ and system‐level applications of MBC.Our analysis highlights shifting treatment dynamics, equity considerations, and tension between individual‐ and population‐level needs that our participants anticipated when planning for MBC implementation in a safety net psychiatry clinic. [ABSTRACT FROM AUTHOR]

Clinical prediction models have been widely acknowledged as informative tools providing evidence‐based support for clinical decision making. However, prediction models are often underused in clinical practice due to many reasons including missing information upon real‐time risk calculation in electronic health records (EHR) system. Existing literature to address this challenge focuses on statistical comparison of various approaches while overlooking the feasibility of their implementation in EHR. In this article, we propose a novel and feasible submodel approach to address this challenge for prediction models developed using the model approximation (also termed "preconditioning") method. The proposed submodel coefficients are equivalent to the corresponding original prediction model coefficients plus a correction factor. Comprehensive simulations were conducted to assess the performance of the proposed method and compared with the existing "one‐step‐sweep" approach as well as the imputation approach. In general, the simulation results show the preconditioning‐based submodel approach is robust to various heterogeneity scenarios and is comparable to the imputation‐based approach, while the "one‐step‐sweep" approach is less robust under certain heterogeneity scenarios. The proposed method was applied to facilitate real‐time implementation of a prediction model to identify emergency department patients with acute heart failure who can be safely discharged home. [ABSTRACT FROM AUTHOR]

Introduction: Prenatal exome sequencing (pES) can enhance genetic diagnosis of fetuses with structural anomalies and has recently been introduced as a national service in England. We aimed to examine service outcomes such as diagnostic yield (definite final diagnosis), referral rate, and sources of referral, and explore variation in outcomes of pES by individual or service level factors between 01 October 2021 and 30 June 2022. Methods: pES testing results from the National Health Service laboratories performing testing were linked to National Congenital Anomaly and Rare Disease Registration Service data and the Maternity Services Data Set and descriptive statistics computed. Results: There were 475,089 women who gave birth in England during the study period. The referral rate for pES was 8.6 (95% CI 7.8, 9.4) per 10,000 maternities. About 59% of those referred proceeded with pES testing and 35% of women who proceeded received a definite final diagnosis with a median turnaround time of 15 days. Of those who had pES testing, 64.6% had a live birth, 25.3% underwent termination of pregnancy (median gestational age at termination: 26 weeks), and 9.3% had a stillbirth. Among the 85 women who had a definite final diagnosis, 40% had a termination of pregnancy, 18% had a stillbirth, and 42% had a live birth. The corresponding figures among women without a definite final diagnosis were 18%, 5%, and 78%, respectively. Among women who had a termination of pregnancy, the median gestational age at final report was 24.9 weeks and 26.2 weeks at termination. Variation observed in some of the characteristics and outcomes between regional services were limited by small sample size. Conclusion: This study showed that of those referred, pES testing provided a diagnosis for one in three pregnancies with a fetal anomaly across England during the study period when other tests had been non-informative. Women who opted for a termination of pregnancy underwent the procedure at relatively late gestations. Earlier referral for pES, streamlining pathways, and faster turnaround times may help results to be available at an earlier gestation to allow families more time to make decisions around continuing or terminating their pregnancy. The variation in service outcomes between regional services needs to be investigated further to understand the reasons for these differences. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization (WHO) encourages all member states to adopt and implement a package of essential evidence-based interventions called the Best Buys to reduce the burden of non-communicable diseases (NCDs). To date, little is known about the implementation of national policies and interventions for NCD control in the WHO member states in sub-Saharan Africa. Our study aimed to evaluate the implementation of national policies and interventions (WHO Best Buys) for non-communicable disease prevention and control in Ghana. Methods: This was explanatory mixed methods research which started with a document review of Ghana's WHO Best Buys scores from the 2015, 2017, 2018, 2020 and 2022 WHO NCD Progress Monitor Reports. Thereafter, we conducted 25 key informant interviews and one focus group discussion (11 participants) with key policymakers and stakeholders in the NCD landscape in Ghana to understand the implementation of the NCD policies and interventions, and the policy implementation gaps and challenges faced. Data from the NCD Progress reports were presented using mean scores whilst the qualitative data was analysed thematically. Results: Ghana has shown some advancements in the implementation of the WHO Best Buys measures. Ghana's implementation scores for 2015, 2017, 2020 and 2022 were 5.0, 9.0, 5.0 and 5.5 respectively, against the mean implementation scores of 7.6/19 for lower-middle-income countries and 9.5/19 for upper-middle-income countries. Efforts to decrease major risk factors such as excessive alcohol consumption and unhealthy diet have been progressing slowly. The most common challenges were related to a) the role of socio-cultural factors, b) stakeholder engagement, c) enforcement and implementation of public health policies, d) implementation guidelines, e) public awareness and education on NCDs, f) financing of NCD prevention and control, g) curative-centered health systems, and h) over-centralization of NCD care. Conclusion: Ghana has made progress in adopting the WHO Best Buys targeting risk factors of NCDs. However, the country faces contextual barriers to effective implementation. With the retrogression of some measures over time despite making progress in some earlier years, further investigation is needed to identify facilitators for sustained implementation of the WHO Best Buys interventions. [ABSTRACT FROM AUTHOR]

Background: The lack of training for professionals on how to manage suicide risk is an important barrier to effective intervention. Dialectical Behavior Therapy Intensive Training™ (DBT-IT) includes specific training for suicide and has shown promising results to enhance implementation of DBT. To our knowledge, no published studies have evaluated the effect of DBT-IT on therapists' attitudes towards treating suicide risk and among Spanish-speaking mental health professionals. The main aim of this study was to evaluate the effect of DBT-IT on therapists' attitudes regarding treating suicide risk and its relationship with the implementation of DBT before and after receiving DBT-IT. Methods: A total of 242 mental health workers (76.4% women, mean age 35.38, SD = 9.17; 77.7% from Latin America; 22.3% from Spain) who had received a DBT-IT participated in the study. Self-efficacy (Efficacy in Assessing and Managing Suicide Risk Scale) and concerns (Concerns about Treating Suicidal Clients Scale) in treating suicide, perceived burnout (Copenhagen Burnout Inventory), confidence in applying DBT (Behavioral Anticipation and Confidence Questionnaire), barriers to implementation (Barriers to Implementation Inventory), implementation of DBT and reach were measured via online survey at parts 1 (pre-training) and 2 (post-training, after 9 months of implementation) of the DBT-IT. Results: Differences between pre-training and post-training (n = 61) indicated statistically significant improvements in self-efficacy, concerns about the lack of training and competence in treating suicide, and confidence in applying DBT. Statistically significant increases in the rates of DBT treatment modes implementation (except for individual therapy) and mindfulness practice, as well as the number of team members and consultation team hours, were also found. Findings also indicated statistically significant positive correlations between burnout and concerns about treating suicidal clients, as well as with structural and administrative implementation barriers, and between self-efficacy in managing suicide, confidence in applying DBT and implementation of DBT treatment modes. Participants with more implementation barriers reported lower rates of consultation team meetings and phone coaching implementation. Conclusions: DBT-IT could be an adequate training model to increase self-efficacy and confidence in treating suicide risk as well as to facilitate implementation of DBT treatment modes by Spanish-speaking mental health professionals. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]

Background: Shared decision making in healthcare is a fundamental right for patients. Healthcare professionals' perception of their own abilities to enable shared decision making is crucial for implementing shared decision making within service. IcanSDM (I can shared decision making) is a brief measure to investigate healthcare professionals' perception of shared decision making approaches to their practices. It was developed in Canada with French and English versions, and recently translated into German. This study aims to adapt the IcanSDM measure for Danish-speaking healthcare professionals, and evaluate its psychometric properties. Methods: Cultural adaptation and translation based on Beaton et al.'s approach was applied. A forward translation by ten people and a backward translation by two people were performed. To assess comprehensibility, cognitive interviews were conducted with 24 healthcare professionals. Eighty healthcare professionals who were trained in shared decision making for either one hour (n = 65) or one day (n = 15) participated in the psychometric evaluation. The evaluation concerned acceptance, item characteristics, skewness, item difficulties, corrected item-total correlations, inter-item correlations, factorial structure, internal consistency, and responsiveness. Results: The forward and backward translation revealed few discrepancies, and participants understood the items well. The psychometric evaluation showed a high completion rate and acceptable item difficulties and discrimination values. Both the factor analysis and the internal consistency showed a 2-factor structure: 1) healthcare professionals' capacity to implement shared decision making; and 2) healthcare professionals' capacity to practise shared decision making. The IcanSDM_Danish obtained a Cronbach's alpha coefficient of 0.74. The evaluation of responsiveness showed improvement, but was not statistically significant. Conclusion: The IcanSDM_Danish has good cross-cultural validity and internal consistency, and a 2-factor structure. The IcanSDM_Danish is capable of providing reliable and valid measurement when evaluating constructed knowledge about shared decision making, and may be able to support the implementation of shared decision making training and evaluation of its impact. [ABSTRACT FROM AUTHOR]

The article presents information on a pilot program which aims to assess the feasibility of employing and expanding remote physiologic monitoring (RPM) services at an academic medical center. Topics discussed include the overall flow of the project, patients eligible for enrollment in the program, and pharmacist intervention.

AbstractDebates over the role of trade policy in addressing climate change have gained steam in recent years. One proposed mechanism that might lead to improved climate outcomes runs through preferential trade agreements (PTAs) and their committees, which may provide a forum for ambitious actors to promote higher standards. So far, we know little about whether and when such promotion occurs at PTA committees. The paper argues that at the PTA implementation stage, where public scrutiny has largely subsided and climate-minded actors are in a weakened position, conventional trade interests, rather than genuine climate concerns, shape discussions of climate issues between the parties. An analysis of minutes from committee meetings under 19 European Union PTAs, supported by interview evidence, shows that the parties discuss climate issues routinely and extensively, but that especially with its major trade partners, the EU discusses climate issues primarily in connection to, and prioritizes, trade interests, notably the advancement and safeguarding of market access for EU companies. Only with smaller trade partners is climate more often discussed ‘in its own right’. Opening the black box of PTA committees, the paper speaks to debates about issue linkages and tensions between conventional trade and other interests in trade agreements. [ABSTRACT FROM AUTHOR]

Background: Suicide is the fourth leading cause of death among young people aged 15–29 worldwide. Young people often present to emergency departments (EDs) with self-harm and suicide-related behaviors. The period following discharge from the ED is recognized as one of elevated risk for both repeated self-harm and suicide. During this critical time, suicide prevention aftercare services are recommended. Despite their increased popularity, evidence demonstrating the effectiveness of these models is very limited. Methods: Using a hybrid effectiveness-implementation type I design, this evaluation will assess the effectiveness and implementation of a suicide prevention aftercare (Hospital Outreach Post-suicidal Engagement; HOPE) service designed to reduce risk of self-harm and suicide in young people aged 12–25 who are referred to the service following an ED presentation for self-harm or suicide attempt. Two complementing theoretical frameworks will guide this evaluation, specifically the design, data collection, analysis, and interpretation of results. The RE-AIM evaluation framework will be used to assess Reach, Effectiveness (including cost-effectiveness), Adoption, Implementation and Maintenance of the HOPE aftercare service. The PRISM implementation framework will be used to assess multi-level contextual factors hypothesized to affect the RE-AIM outcomes. Several data sources will be used to assess the changes in primary and secondary outcomes from baseline to post–intervention, and at follow-up, including user and provider self-report surveys, semi-structured interviews, and routinely collected hospital data. An historical control study will also be conducted using data from the Self-Harm Monitoring System for Victoria to examine the impact of the service on rates of self-harm and suicide-related presentations to ED, and compare trends prior to and following commencement of the HOPE aftercare service. In addition, dynamic systems modelling will be used to assess the future scalability of the service. Discussion: Findings from this evaluation will determine the effectiveness, including cost-effectiveness, of the HOPE aftercare service and describe the implementation context. They will inform the future development and sustainability of this and other similar services across Australia and internationally. Trial registration: This trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) on the 19th December 2023 (Registration number ACTRN12623001332617). We do not foresee any amendments to this protocol however, if any unforeseen modifications are required, they will be submitted to ANZCTR. Trial sponsor: Orygen, 35 Poplar Road, Parkville, VIC, 3052, Australia. [ABSTRACT FROM AUTHOR]

Introduction: Anticipating and addressing implementation challenges is critical to ensuring success of mobile healthcare programs. Mobile Prosthetic and Orthotic (O&P) Care (MoPOC) is a new U.S. Department of Veterans Affairs (VA) program that aims to improve access to VA-based O&P services through a national network of traveling O&P clinicians who deliver care in rural communities. We conducted an iterative evaluation guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to identify challenges and associated strategies for successful implementation of this mobile O&P program. Methods: MoPOC is delivered by an O&P clinician anchored at a VA medical center (VAMC). Clinicians travel to remote VA clinics and Veteran's homes with a custom vehicle which provides storage and a workshop to modify O&P devices. Each clinician is supported by a program support assistant. MoPOC was implemented in three phases. The qualitative evaluation of MoPOC implementation was conducted as part of a larger evaluation of MoPOC program outcomes. We conducted semi-structured interviews and regular check-ins with MoPOC clinicians, site managers, and stakeholders both prior to implementation and throughout the implementation process. Interviews were recorded and transcribed verbatim. Data was analyzed across sites and comparatively by phase using a rapid matrix analysis to identify themes related to adoption and implementation challenges and key strategies developed to address those challenges. Results: We identified four key themes related to successful program implementation, each with associated challenges and improvement strategies: (1) "Finding the right sites for MoPOC" through intentional recruitment and site selection; (2) Identifying the "sweet spot": Balancing program capacity, sustainability, and MoPOC clinician satisfaction; (3) Shifting from testing to standardizing; and (4) "Being strategic with hiring" to improve program adoption. Discussion: Implementation challenges were related to recruiting and selecting successful sites, ensuring timely program adoption, balancing site level adaptation and program standardization, and scaling programs to enhance efficiency, reach, and satisfaction. An iterative approach guided by the RE-AIM framework resulted in program improvement and more rapid implementation in each successive phase. The challenges described in MoPOC implementation may be common issues in implementing new mobile programs in rural areas. [ABSTRACT FROM AUTHOR]

The article analyzes the impact of EU law on national legal systems and the world order. With the collapse of the Soviet Union, the EU began active work on strengthening its authority and influence. In the 1990s, the EU (whose members also belonged to the Council of Europe) made the ratification of the Convention for the Protection of Human Rights and Fundamental Freedoms (with Protocols) (European Convention on Human Rights) a necessary condition for EU membership, which involved a lot of preparatory work in the field of human rights for candidate countries. The founding treaties of the EU, in contrast to ordinary international treaties, established a new legal order with its own institutions, in favor of which states limited their sovereign rights in increasingly wide areas, the subjects of which are not only member states, but also their citizens. The active development of integration processes taking place within the framework of the EU leads to further convergence and closer interaction of the national legal systems of the member states with the EU, as a result of which the circle of legal relations, which are legally regulated by the norms of EU law, is expanding. A key role in the proper functioning and implementation of these norms (EU law) is played by the specific procedure of their implementation into the national law of the member states, which is understood as the process of transposition of the norms of EU law, including the creation of the order and procedures for their introduction into the national legal systems of the member states. With the deepening of European integration, the constitutionalization of EU law began: the founding treaties evolved from a set of agreements binding only on member states to founding treaties that provide the basis of a single legal regime. This regime grants rights and imposes obligations on all public and natural persons on the territory of the EU, since the norms of the founding treaties have direct effect and absolute supremacy, forming a kind of integration legal system. Currently, there is a close connection between EU law and the national legislation of the EU member states. The impact of EU law on the national legal systems of candidate countries for EU membership is indisputable. These trends suggest that while the emergence of Community (now Union) law has given rise to a new legal order, distinct from national law, these historically distinct legal orders now form a common legal system. [ABSTRACT FROM AUTHOR]

Universal approaches to implementing environmental management accounting (EMA) have resulted in a paradigm shift in managing the physical and monetary aspects of the environment globally. While in developing countries, large enterprises continue to lead in implementing EMA, small and medium enterprises (SMEs) are finding it difficult to optimally benefit from embracing EMA. Hence, various players such as policymakers, academics, and environmental experts promote the establishment of new approaches that SMEs can apply to overcome a wide range of barriers inhibiting the successful implementation of EMA. Theories of small business growth, such as stakeholder and institutional, resource-based, and knowledge-based theories, advocate that an enterprise's success depends on the influence of stakeholders' expectations and institutional requirements and the management of the available resources and relevant expertise. A customised framework for applying these four (4) theories to understand the position of SMEs regarding EMA implementation barriers and the approach to address them is lacking. Therefore, in this article, we used a systematic literature review (SLR) using Preferred Reporting Items for Systematic Literature Review (PRISMA) to define the main aspects of these four (4) theories in the context of EMA implementation and identify EMA implementation barriers confronting SMEs. We recommend that SMEs consider applying the proposed framework to address EMA implementation barriers. The outcomes presented have implications for SME owners, government, environmental regulators, and large enterprises in establishing strong networks to encourage the implementation of EMA across the business spectrum. [ABSTRACT FROM AUTHOR]