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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]

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.

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]

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]

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]

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]

The article examines the issue of legal regulation of nuclear and radiation safety relations in Ukraine in peacetime and martial law conditions. The legal aspects of the formation of nuclear legislation during the period of large-scale armed aggression of the Russian Federation against Ukraine are studied. The purpose of the article is to highlight the problems of legal regulation of nuclear and radiation safety relations in Ukraine in peacetime and martial law conditions. The authors of the article conducted a retrospective review and the current state of development of the national legislation of Ukraine in the field of ensuring nuclear and radiation safety. As a result of such consideration, it was determined that over thirty years, an extensive system of nuclear legislation has developed, at the same time, today the system of the legal framework in the field of the use of nuclear energy, ensuring nuclear and radiation safety, radiation protection of citizens from the effects of ionizing radiation in Ukraine consists of documents of three levels. The authors of the article came to the following conclusions. Ukraine must fulfill its international legal obligations in full. Despite the rather extensive system of nuclear legislation under martial law, it is actively developing and improving. At the same time, there is a need to solve the issue of improving foreign and international legislation, in particular, at the same time as the national legislation. EU legislation. In the future, the norms of this legislation must be implemented in the national legislation of all EU member states and the IAEA. Despite the inability of the IAEA to solve the issue of ensuring nuclear and radiation safety under the conditions of martial law, as well as the problem of constant nuclear blackmail by the Russian Federation, in our opinion, at the moment, it is the only international organization that is capable, by sending its experts, in particular, on the Zaporizhia NPP, which has been captured by Russian troops since March 2022, to have at least a small impact on solving the above-mentioned tasks. However, in the future, i.e. after the end of military operations in Ukraine, the international community will have to resolve issues related to the reorganization of international humanitarian law, as well as the activities of such organizations as the UN and the IAEA. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusion Chest x‐ray (CXR) plays an important role in childhood tuberculosis (TB) diagnosis, but access to quality CXR remains a major challenge in resource‐limited settings. Digital CXR (d‐CXR) can solve some image quality issues and facilitate their transfer for quality control. We assess the implementation of introducing d‐CXR in 12 district hospitals (DHs) in 2021–2022 across Cambodia, Cameroon, Ivory Coast, Mozambique, Sierra Leone and Uganda as part of the TB‐speed decentralisation study on childhood TB diagnosis.For digitisation of CXR, digital radiography (DR) plates were setup on existing analogue radiography devices. d‐CXR were transferred to an international server at Bordeaux University and downloaded by sites' clinicians for interpretation. We assessed the uptake and performance of CXR services and health care workers' (HCW) perceptions of d‐CXR implementation. We used a convergent mixed method approach utilising process data, individual interviews with 113 HCWs involved in performing or interpreting d‐CXRs and site support supervision reports.Of 3104 children with presumptive TB, 1642 (52.9%) had at least one d‐CXR, including 1505, 136 and 1 children with one, two and three d‐CXRs, respectively, resulting in a total of 1780 d‐CXR. Of them, 1773 (99.6%) were of good quality and 1772/1773 (99.9%) were interpreted by sites' clinicians. One hundred and sixty‐four children had no d‐CXR performed despite attending the radiography department: 126, 37 and 1 with one, two and three attempts, respectively. d‐CXRs were not performed in 21.6% (44/203) due to connectivity problem between the DR plate captor and the computer. HCW reported good perceptions of d‐CXR and of the DR plates provided. The main challenge was the upload to and download from the server of d‐CXRs due to limited internet access.d‐CXR using DR plates was feasible at DH level and provided good quality images but required overcoming operational challenges. [ABSTRACT FROM AUTHOR]

Me and my family is a knowledge-based motivational program that includes eight weekly therapeutic sessions provided via the social services for families in which parent(s) have substance use problems (SUP). Purpose: The aim of this study was to report experiences gained while conducting the research project, in which social workers' active participation was a core feature. Materials and method: Guided by the implementation framework AIF (Active Implementation Framework) data were collected from multiple sources, such as minutes from guidance sessions, meetings with managers, booster days, and transcriptions of focus group interviews with social workers. Results: Findings indicate that social workers need to receive training in research activities before program start and to have time for pre- and post-therapeutic session reflections To deliver and maintain an intervention like Me & my Family require cross-sectional cooperation and staff having academic degrees to develop reflections on program delivery. Research design experiences indicate that RCT methods proved difficult to accomplish. An additional finding was organizational structures in silos as a barrier to recruiting families. Conclusion: Involving social workers in doing research on practices concern needs for managerial support regarding scheduling, routines and interest in evidence-based practice, well-educated social workers, and special attention to research design in relation to clients' needs. Conclusions drawn from using the AIF framework include the need for continuous coaching and consultations as well as feed-back on results. [ABSTRACT FROM AUTHOR]

• DMHIs can expand the scale, efficiency, and effectiveness of psychological services. • Issues of reach, adoption, implementation, and maintenance limit DMHI impact. • Gaps in DMHI research and practice are examined and potential solutions presented. • It is discussed how new technologies and advances in the profession will shape DMHIs' future. • Suggestions to advance DMHI equity in research and practice are provided. In recent years, digital mental health interventions (DMHIs) have emerged as a paradigm shift in care delivery that could expand the scale, efficiency, and effectiveness of psychological services. However, DMHI impact is constrained by issues related to limited reach, poor adoption, implementation barriers, and insufficient long-term maintenance. Organized by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, this paper surveys the current state of DMHIs, highlighting research and practice gaps as well as potential strategies to move the field forward. Similarly, we discuss the role that emerging technologies and changes in the profession will play in shaping DMHIs in years to come. Finally, concrete and actionable steps to advance equity in the DMHI field are provided, with an emphasis on strategies to increase the representativeness of marginalized populations in DMHI research, the inclusion of these groups in the design and testing of DMHIs, and how to improve the contextual and cultural fit of DMHIs. [ABSTRACT FROM AUTHOR]

• This review summarizes the history and science of LGBTQ-affirmative psychotherapy. • This review outlines a future research agenda for LGBTQ-affirmative psychotherapy. • Research is needed on LGBTQ-affirmative psychotherapy mechanisms and moderators. • Research is needed on therapy orientations beyond CBT and with diverse populations. • Future implementation efforts should embed therapy within structural interventions. Sexual and gender minority (SGM) individuals experience significantly higher levels of depression, anxiety, and behavioral comorbidities (i.e., substance use, suicide) compared to heterosexual and cisgender individuals. LGBTQ-affirmative psychotherapy aims to ameliorate the adverse psychosocial processes, ultimately caused by stigma, that underlie this disparity. Over the past two decades, the mental health field has introduced professional guidelines and treatment protocols for LGBTQ-affirmative psychotherapy, and established their efficacy across distinct SGM populations, delivery modalities, and settings. This state of the science review outlines the history, current evidence, and future directions of LGBTQ-affirmative psychotherapy. It provides an historical account of clinically relevant research for SGM populations and outlines the factors that moved the field from pathologizing perspectives to affirmative approaches. It then discusses the current evidence for LGBTQ-affirmative psychotherapy, as well as studies identifying treatment moderators, including race/ethnicity and stigma exposure, as well as potential treatment mechanisms, including hypervigilance, shame, negative self-schemas, unassertiveness, and emotion dysregulation. SGM individuals can only benefit from LGBTQ-affirmative psychotherapy if protocols are widely available and used by therapists. To this end, the article presents current findings on implementation and dissemination, such as therapist training, and different treatment delivery modalities. Finally, the article outlines an agenda for future research to advance the field of LGBTQ-affirmative psychotherapy, including identifying treatment mechanisms, successfully implementing and disseminating treatment protocols, determining which contexts and client characteristics warrant adaptations to current protocols, and understanding how LGBTQ-affirmative psychotherapy can interact with structural and systemic conditions to exert the strongest possible impact on SGM mental health. [ABSTRACT FROM AUTHOR]

Numerous influential policy and scientific bodies are calling for more rapid advances in the scale-up of child and youth mental health services (CYMHS). A number of CYMHS innovations hold promise for advancing scale-up but little is known about how real-world efforts are progressing. We conducted a scoping review to identify promising approaches to CYMHS scale-up across the globe. Searches were completed in six databases (Academic Search Complete, CINAHL, MEDLINE, PsychInfo, PubMed, and Web of Science). Article selection and synthesis were conducted in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist. A second search focused on low-and-middle-income countries (LMIC) was conducted based on the Cochrane Library recommended search filters of the World Bank listed LMIC countries. Authors used a double coding strategy during the title/abstract and full-text review. Twenty-eight articles meeting the eligibility criteria were identified that described 22 initiatives (in 11 different countries). Our review found the majority of published scale-up studies in CYMHS were not informed by scale-up frameworks in design or reporting. The methods and outcomes used in the identified articles were highly variable and limited our ability to draw conclusions about comparative effectiveness although promising approaches emerged. Successes and failures identified in our review largely reflect consensus in the broader literature regarding the need for strategies to better navigate the complexities of system and policy implementation while ensuring CYMHS interventions fit local contexts. [ABSTRACT FROM AUTHOR]

In the autism field, there is increasing interest in translating evidence-based interventions (EBIs) into systems that serve young autistic children and their families. Public Early Intervention systems have been a focal point of research-based implementation efforts given that these systems are federally mandated to provide services to children birth to three years of age with developmental delays under Part C of the Individuals with Disabilities Education Act. Although a growing number of research studies are now training Early Intervention providers to deliver autism EBIs, this work has been conducted on a relatively small scale and has only just begun to consider the alignment of these models with Early Intervention systems and whether sufficient infrastructure exists to scale up these training efforts and to sustain their public health impact. This commentary aims to address this gap by reviewing factors that have been found to uniformly impact the scale-up of EBIs across diverse public systems (Fagan 20, 1147–1168, 2019), and to extend this framework to the implementation of EBIs within public Early Intervention systems. These factors include developer and funder capacity, the public's awareness of and support for EBIs, the system's leadership support for EBI use, the capacity for community engagement in implementation efforts, the availability of a skilled workforce capable of delivering EBIs, and the capacity for data monitoring and quality improvement. This commentary discusses how these factors may specifically impact the scale-up of autism EBIs within EI systems to support toddlers and young, autistic children, and implications for autism researchers. [ABSTRACT FROM AUTHOR]

Background: Implementation issues often impede the realisation of the potential benefits of technology in disability care organisations for people with disabilities. Therefore, we conducted a longitudinal study to gain insights into the barriers and facilitators to implementation. Methods: From 2019 to 2022, data were collected using questionnaires and interviews during 28 implementation projects in 26 disability care organisations. Results: Barriers and facilitators were identified using 9 themes and 26 subthemes. The main themes identified were finances, disability care organisations, internal collaborations, external collaborations, technology, care staff, project teams, people with disabilities, and context. Most factors mentioned as barriers in one organisation were mentioned as facilitators in others. This suggests that barriers can be resolved to improve implementation. Conclusion: A large number of barriers and facilitators spanning the organisation suggests that the implementation of technology should be considered an organisational reform. Acting upon them is crucial for the successful implementation of technology. [ABSTRACT FROM AUTHOR]

To account for the explanatory role representations play in cognitive science, Egan's deflationary account introduces a distinction between cognitive and mathematical contents. According to that account, only the latter are genuine explanatory posits of cognitive-scientific theories, as they represent the arguments and values cognitive devices need to represent to compute. Here, I argue that the deflationary account suffers from two important problems, whose roots trace back to the introduction of mathematical contents. First, I will argue that mathematical contents do not satisfy important and widely accepted desiderata all theories of content are called to satisfy, such as content determinacy and naturalism. Secondly, I will claim that there are cases in which mathematical contents cannot play the explanatory role the deflationary account claims they play, proposing an empirical counterexample. Lastly, I will conclude the paper highlighting two important implications of my arguments, concerning recent theoretical proposals to naturalize representations via physical computation, and the popular predictive processing theory of cognition. [ABSTRACT FROM AUTHOR]

Multicultural peer-consultation teams represent one promising approach to supporting mental health providers by providing consultation that is multiculturally conscious and integrates front-and-center concepts related to diversity in identities and lived experiences (i.e., multiculturalism), intersectionality, inclusivity, health equity, antiracism, and anti-oppression. Herein, we take an implementation science-informed approach to describing the development, implementation, and sustainment of multicultural peer-consultation teams in two professional settings—a Veterans Affairs hospital and a psychology department training clinic. We operationalize the core and adaptable components of this model. Last, we reflect on our collective lessons learned and offer recommendations based on our efforts to create teams across mental health care settings. Thus, the present article may function as an implementation blueprint of sorts that others can follow as they consider ways that they can create similar teams at their institutions. Public Significance Statement: With increased recognition of widening health inequities disproportionately impacting communities that have been systematically excluded and/or harmed by the mental health field, there is a crucial need for educational approaches that empower and equip clinicians with the knowledge and skills to provide care that is multiculturally conscious, inclusive, equitable, antiracist, and anti-oppressive. Multicultural peer-consultation teams represent one approach aligned with these goals. This article describes the multicultural peer-consultation model and reports on its implementation across distinct mental health care settings, with the aim of continued wide-scale dissemination to ultimately make a sustained public health impact. [ABSTRACT FROM AUTHOR]

This European Society of Clinical Microbiology and Infectious Diseases guideline provides evidence-based recommendations to support a selection of appropriate antibiotic use practices for patients seen in the emergency department (ED) and guidance for their implementation. The topics addressed in this guideline are (a) Do biomarkers or rapid pathogen tests improve antibiotic prescribing and/or clinical outcomes? (b) Does taking blood cultures in common infectious syndromes improve antibiotic prescribing and/or clinical outcomes? (c) Does watchful waiting without antibacterial therapy or with delayed antibiotic prescribing reduce antibiotic prescribing without worsening clinical outcomes in patients with specific infectious syndromes? (d) Do structured culture follow-up programs in patients discharged from the ED with cultures pending improve antibiotic prescribing? An expert panel was convened by European Society of Clinical Microbiology and Infectious Diseases and the guideline chair. The panel selected in consensus the four most relevant antimicrobial stewardship topics according to pre-defined relevance criteria. For each main question for the four topics, a systematic review was performed, including randomized controlled trials and observational studies. Both clinical outcomes and stewardship process outcomes related to antibiotic use were deemed relevant. The literature searches were conducted between May 2021 and March 2022. In April 2022, the panel members were formally asked to suggest additional studies that were not identified in the initial searches. Data were summarized in a meta-analysis if possible or otherwise summarized narratively. The certainty of the evidence was classified according to the Grading of Recommendations Assessment, Development and Evaluation criteria. The guideline panel reviewed the evidence per topic critically appraising the evidence and formulated recommendations through a consensus-based process. The strength of the recommendations was classified as strong or weak. To substantiate the implementation process, implementation trials or observational studies describing facilitators/barriers for implementation were identified from the same searches and were summarized narratively. The recommendations on the use of biomarkers and rapid pathogen diagnostic tests focus on the initiation of antibiotics in patients admitted through the ED. Their effect on the discontinuation or de-escalation of antibiotics during hospital stay was not reported, neither was their effect on hospital infection prevention and control practices. The recommendations on watchful waiting (i.e. withholding antibiotics with some form of follow-up) focus on specific infectious syndromes for which the primary care literature was also included. The recommendations on blood cultures focus on the indication in three common infectious syndromes in the ED explicitly excluding patients with sepsis or septic shock. Most recommendations are based on very low and low certainty of evidence, leading to weak recommendations or, when no evidence was available, to best practice statements. Implementation of these recommendations needs to be adapted to the specific settings and circumstances of the ED. The scarcity of high-quality studies in the area of antimicrobial stewardship in the ED highlights the need for future research in this field. [ABSTRACT FROM AUTHOR]

Peptides carry important functions in normal physiological and pathophysiological processes and can serve as clinically useful biomarkers. Given the ability to diffuse passively across endothelial barriers, endogenous peptides can be examined in several body fluids, including among others urine, blood, and cerebrospinal fluid. This review article provides an update on the recently published literature that reports on investigating native peptides in body fluids using mass spectrometry‐based platforms, specifically those studies that focus on the application of peptides as biomarkers to improve clinical management. We emphasize on the critical evaluation of their clinical value, how close they are to implementation, and the associated challenges and potential solutions to facilitate clinical implementation. During the last 5 years, numerous studies have been published, demonstrating the increased interest in mass spectrometry for the assessment of endogenous peptides as potential biomarkers. Importantly, the presence of few successful examples of implementation in patients' management and/or in the context of clinical trials indicates that the peptide biomarker field is evolving. Nevertheless, most studies still report evidence based on small sample size, while validation phases are frequently missing. Therefore, a gap between discovery and implementation still exists. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) has garnered significant public attention over the last few years and has become part of our everyday lives. This is no different in histopathology, with vast amounts of private and public sector investment into digital reporting and AI development. There are now several companies with commercially available AI decision support tools ready for adoption by pathologists in digitally mature laboratories. Many more pathology-oriented AI tools, with a variety of uses across the patient pathway, are on the horizon and include the possibility of multimodal integration. However, for AI in pathology to be used effectively and its benefits realized, there needs to be widespread 'business as usual' use of digital laboratory workflows and digital reporting. The NHS is currently undergoing a national pathology transformation programme that includes targets for digital reporting and AI ready capabilities for all laboratories in England. In this article, we provide an update on the current progress of AI development in histopathology including the AI tools currently available and potential future applications. We also discuss the ongoing implementation of digital pathology services in the NHS and highlight the barriers to building a strong foundation for AI tool deployment. This builds upon, and complements, our previous article on these issues. [ABSTRACT FROM AUTHOR]

• Acknowledging complexity through advanced knowledge synthesis, competence of the context, and broad and strong stakeholder involvement is crucial is crucial to manage task complexity. • Clear consensus-based criteria for selecting low-value imaging procedures are key. • Having a clear target group is important. • Stakeholder engagement is crucial to ascertain intervention relevance and compliance. • Active and well-motivated intervention collaborators is a necessary but not sufficient condition. • It is crucial to pay close attention to the mechanisms of low-value imaging and the barriers to reduce it. Substantial overuse of health care services is identified and intensified efforts are incited to reduce low-value services in general and in imaging in particular. To report crucial success factors for developing and implementing interventions to reduce specific low-value imaging examinations based on a case study in Norway. Mixed methods design including one systematic review, one scoping review, implementation science, qualitative interviews, content analysis of stakeholders' input, and stakeholder deliberations. The description and analysis of an intervention to reduce low-value imaging in Norway identifies six general success factors: 1) Acknowledging complexity: advanced knowledge synthesis, competence of the context, and broad and strong stakeholder involvement is crucial to manage de-implementation complexity. 2) Clear consensus-based criteria for selecting low-value imaging procedures are key. 3) Having a clear target group is critical. 4) Stakeholder engagement is essential to ascertain intervention relevance and compliance. 5) Active and well-motivated intervention collaborators is imperative. 6) Paying close attention to the mechanisms of low-value imaging and the barriers to reduce it is decisive. Reducing low-value imaging is crucial to increase the quality, safety, efficiency, and sustainability of the health services. Reducing low-value imaging is a complex task and paying attention to specific practical success factors is key. [Display omitted] [ABSTRACT FROM AUTHOR]

Less than one third of research evidence is translated into policy or practice. Knowledge translation requires effective dissemination, adoption and finally implementation. These three stages are equally important, however, existing knowledge translation models and frameworks provide little and disparate information about the steps and activities required for effective dissemination. This study aimed to empirically develop a consolidated framework of evidence-based steps and activities for disseminating research evidence. We identified models and frameworks from a scoping review and dissemination and implementation webtool. We synthesised them into a prototype dissemination framework. Models and frameworks were eligible to inform steps in our framework if they fulfilled at least one of three elements of dissemination: intending to generate awareness of a message, incorporates targeting an audience: tailoring communication. An initial coding framework was created to organise data into dissemination steps. Drawing on 'co-approach' principles, authors of the included models and frameworks (dissemination experts) and health service researchers (end users) were invited to test and refine the prototype framework at a workshop. From 48 models and frameworks reviewed, only 32 fulfilled one or more of the three dissemination elements. The initial coding framework, upon refinement, yielded the Guide to Disseminating Research (GuiDiR) comprising five steps. 1) Identify target audiences and dissemination partners. 2) Engage with dissemination partners. 3) Identify barriers and enablers to dissemination. 4) Create dissemination messages. 5) Disseminate and evaluate. Multiple activities were identified for each step and no single model or framework represents all steps and activities in GuiDiR. GuiDiR unifies dissemination components from knowledge translation models and frameworks and harmonises language into a format accessible to non-experts. It outlines for researchers, funders and practitioners the expected structure of dissemination and details the activities for executing an evidence-based dissemination strategy. • The Guide to Disseminating Research (GuiDiR) is a unified framework of dissemination steps and activities. • GuiDiR aims to support researchers, funders and practitioners to facilitate planning and executing a dissemination strategy. • GuiDiR is novel in its explicit and comprehensive focus on the process of dissemination. • GuiDiR should be used in combination with knowledge translation frameworks that focus on adoption and/or implementation. • The value of combining dissemination experts and end user opinion in GuiDiR's development is a key strength. [ABSTRACT FROM AUTHOR]

Purpose: Interventions focused on women – and mothers, in particular – who have experienced violence in relationships are critical to supporting both mothers and their children. Existing evaluation research on such interventions focuses almost exclusively on outcome evaluation. Yet, these interventions are often multifaceted, requiring strong theoretical foundations, systemic changes, and capacity building for stakeholders at multiple levels. The goal of the current study was to describe critical intervention and implementation factors associated with an interpersonal violence intervention for mothers in communities across Canada, by understanding mothers' experiences in the intervention. Method: Participants (N = 43, M = 30.14 years) were mothers in 11 different community-based projects. Participants completed interviews or focus groups following participation in a 6–8 week intervention, wherein they were asked open-ended questions about their experiences in the intervention. Results: Using a phenomenological approach, five key themes emerged as being particularly impactful to mothers' experiences in the intervention: readiness, group content, group structure, group characteristics, and the broader structure of the community-based projects. Conclusion: Themes mapped onto the overarching theoretical frameworks from which the intervention is based: supporting relationships, building safety, and leveraging the existing capacities of community-based organizations that serve vulnerable families. Results highlight aspects of the intervention and experience that emerged as important to those experiencing violence in relationships. [ABSTRACT FROM AUTHOR]

Genetic testing in patients with ovarian carcinoma (OC) is crucial, as around 10–15% of these women have a genetic predisposition to OC. Although guidelines have recommended universal germline testing for all patients with OC for a decade, implementation has proved challenging, thus resulting in low germline-testing rates (around 30–50%). Many new initiatives to improve genetic-testing rates have emerged, but most have been carried out at the local level, leading to differences in workflows within and between countries. We present an example of a nationwide implementation project that has successfully led to a uniform, high-quality genetic-testing workflow for women with OC. Nationwide multidisciplinary meetings generated consensus on the preferred workflow for OC genetic testing: the "Tumor-First" workflow. This workflow means starting by testing the tumor DNA for the presence of pathogenic variants in OC-risk genes, thus providing a prescreen to germline testing while yielding information on the effectiveness of treatment with PARP inhibitors. This new workflow efficiently stratifies genetic counseling and germline testing and reduces healthcare costs. Although challenging, the nationwide implementation of this workflow was successful, resulting in tumor-DNA testing rates exceeding 80%. In this article, we present our structured implementation approach, illustrate our implementation strategies—which were tailored to identified factors important to implementation—and share the lessons learned from the Tumor-First implementation project. This knowledge could facilitate the future implementation of workflows aimed at optimizing the recognition of hereditary cancers. [ABSTRACT FROM AUTHOR]

Objectives Well-designed electronic health records (EHRs) training programs for clinical practice are known to be valuable. Training programs should be role-specific and there is a need to identify key implementation factors of EHR training programs for nurses. This scoping review (1) characterizes the EHR training programs used and (2) identifies their implementation facilitators and barriers. Materials and Methods We searched MEDLINE, CINAHL, PsycINFO, and Web of Science on September 3, 2023, for peer-reviewed articles that described EHR training program implementation or delivery to nurses in inpatient settings without any date restrictions. We mapped implementation factors to the Consolidated Framework for Implementation Research. Additional themes were inductively identified by reviewing these findings. Results This review included 30 articles. Healthcare systems' approaches to implementing and delivering EHR training programs were highly varied. For implementation factors, we observed themes in innovation (eg, ability to practice EHR skills after training is over, personalizing training, training pace), inner setting (eg, availability of computers, clear documentation requirements and expectations), individual (eg, computer literacy, learning preferences), and implementation process (eg, trainers and support staff hold nursing backgrounds, establishing process for dissemination of EHR updates). No themes in the outer setting were observed. Discussion We found that multilevel factors can influence the implementation and delivery of EHR training programs for inpatient nurses. Several areas for future research were identified, such as evaluating nurse preceptorship models and developing training programs for ongoing EHR training (eg, in response to new EHR workflows or features). Conclusions This scoping review highlighted numerous factors pertaining to training interventions, healthcare systems, and implementation approaches. Meanwhile, it is unclear how external factors outside of a healthcare system influence EHR training programs. Additional studies are needed that focus on EHR retraining programs, comparing outcomes of different training models, and how to effectively disseminate updates with the EHR to nurses. [ABSTRACT FROM AUTHOR]

This case study discusses the concept of big data analytics, which involves managing and analyzing large, complex data to discover patterns and insights. Implementing big data analytics has many benefits, such as improving decision-making processes, enhancing accounting processes and compliance, boosting marketing campaigns, and providing better credit risk assessment procedures. This case study aims for the student to understand the challenges of big data analytics implementation in a Malaysian commercial bank. Students take on the role of a Senior IT Manager who needs to consider solutions to the implementation problems. Although the team proposed using cloud-based services as a solution to these issues, the CEO expressed concerns about security risks and requested other alternative solutions. The team has also been requested to come up with solutions to the data quality issues experienced by the case study bank. [ABSTRACT FROM AUTHOR]