Future Policy Decisions Research Articles

Seasonality, rather than estuarine gradient or particle suspension/sinking dynamics, determines estuarine carbon distributions

Estuaries are important components of the global carbon cycle; exchanging carbon between aquatic, atmospheric, and terrestrial environments, representing important loci for blue carbon storage and greenhouse gas emissions. However, how estuarine gradients affect sinking/suspended particles, and dissolved organic matter dynamic interactions remains unexplored. We fractionated suspended/sinking particles to assess and characterise carbon fate differences. We investigated bacterial colonisation (SYBR Green I) and exopolymer concentrations (TEP/CSP) with microscopy staining techniques. C/H/N and dry weight analysis identified particle composition differences. Meanwhile, nutrient and carbon analysis, and excitation and emission matrix evaluations with a subsequent parallel factor (PARAFAC) analysis characterised dissolved organic matter.The lack of clear salinity driven patterns in our study are presumably due to strong mixing forces and high particle heterogeneity along the estuary, with only density differences between suspended and sinking particles. Elbe estuary particles' organic portion is made up of marine-like (sinking) and terrestrial-like (suspended) signatures. Salinity did not have a significant role in microbial degradation and carbon composition, although brackish estuary portions were more biologically active. Indicative of increased degradation rates, leading to decreased greenhouse gas emissions, which are especially relevant for estuaries, with their disproportionate greenhouse gas emissions. Bacterial colonisation decreased seawards, indicative of decreased degradation, and shifts in microbial community composition and functions.Our findings span diverse strands of research, concerning steady carbon contributions from both marine and terrestrial sources, carbon aromaticity, humification index, and bioavailability. Their integration highlights the importance of the Elbe estuary as a model system, providing robust information for future policy decisions affecting dissolved and particulate matter dynamics within the Elbe Estuary.

Quantifying the Cost of Shigella Diarrhea in the Enterics for Global Health (EFGH) Shigella Surveillance Study.

Comparative costs of public health interventions provide valuable data for decision making. However, the availability of comprehensive and context-specific costs is often limited. The Enterics for Global Health (EFGH) Shigella surveillance study-a facility-based diarrhea surveillance study across 7 countries-aims to generate evidence on health system and household costs associated with medically attended Shigella diarrhea in children. EFGH working groups comprising representatives from each country (Bangladesh, Kenya, Malawi, Mali, Pakistan, Peru, and The Gambia) developed the study methods. Over a 24-month surveillance period, facility-based surveys will collect data on resource use for the medical treatment of an estimated 9800 children aged 6-35 months with diarrhea. Through these surveys, we will describe and quantify medical resources used in the treatment of diarrhea (eg, medication, supplies, and provider salaries), nonmedical resources (eg, travel costs to the facility), and the amount of caregiver time lost from work to care for their sick child. To assign costs to each identified resource, we will use a combination of caregiver interviews, national medical price lists, and databases from the World Health Organization and the International Labor Organization. Our primary outcome will be the estimated cost per inpatient and outpatient episode of medically attended Shigella diarrhea treatment across countries, levels of care, and illness severity. We will conduct sensitivity and scenario analysis to determine how unit costs vary across scenarios. Results from this study will contribute to the existing body of literature on diarrhea costing and inform future policy decisions related to investments in preventive strategies for Shigella.

Understanding aggression displayed by patients and families towards intensive care staff: A systematic review.

The objective of this systematic review was to synthesise literature pertaining to patient and family violence (PFV) directed at Intensive Care Unit (ICU) staff. Study design was a systematic review. The data was not amenable to meta-analysis. Electronic searches of databases were conducted to identify studies between 1 January 2000 and 6 March 2023, limited to literature in English only. Published empirical peer-reviewed literature of any design (qualitative or quantitative) were included. Studies which only described workplace violence outside of ICU, systematic reviews, commentaries, editorials, letters, non-English literature and grey literature were excluded. All studies were appraised for quality and risk of bias using validated tools. Eighteen studies were identified: 13 quantitative; 2 qualitative and 3 mixed methodology. Themes included: (i) what is abuse and what do I do about it? (ii) who is at risk? (iii) it is common, but how common? (iv) workplace factors; (v) impact on patient care; (vi) effect on staff; (vii)the importance of the institutional response; and (viii) current or suggested solutions. This systematic review demonstrated that PFV in the ICU is neither well-understood nor well-managed due to multiple factors including non-standardised definition of abuse, normalisation, inadequate organisational support and general lack of education of staff and public. This will guide in future research and policy decision making.

Recent updates on treatment patterns in patients with treated attention-deficit/hyperactivity disorders from a nationwide real-world database in South Korea.

The prevalence of attention-deficit/hyperactivity disorder (ADHD) is steadily increasing across Korea. We analyzed ADHD patients with ADHD medications (Rx) characteristics and treatment patterns compared to patients without Rx and identified the differences between pediatric-/adult- and active-/transient-patients with Rx. Using a nationwide claims dataset from 2020 to 2021, we conducted a prevalence-based cross-sectional study and analyzed the recent patients' characteristics and patterns among ADHD patients. Among 132 017 ADHD patients with Rx, differences from 20 312 without Rx across all characteristics except sex. We found significant differences in characteristics and treatment patterns between pediatric-/adult- and active-/transient-patients with Rx. Age-specific sex ratios notably diverged in pediatric patients (61.2%), but remained similar in adults, revealing significant psychiatric comorbidities differences. Active-patients peaked at 6-11 years (41.4%), while transient-patients at 18-30 years (36.1%). Predominantly, methylphenidate (89.7%), atomoxetine (27.8%), and clonidine (2.8%) were prescribed, with 85% experiencing treatment changes within methylphenidate formulations. In pediatric patients, extended-release methylphenidate was preferred (56.1%), adults favored oral delivery system methylphenidate (71.5%), and active-patients had higher treatment rates than transient-patients across all patterns, with low monotherapy rates. This study provides epidemiologic insights into recent characteristics and treatment patterns of ADHD patients with Rx in Korea, providing valuable evidence for identifying those actively receiving ADHD treatment in future healthcare policy decisions.

Investigating the impact of the future carbon market on the profitability of carbon capture, utilization, and storage (CCUS) projects; the case of oil fields in southern Iraq

Carbon capture utilization and storage for enhanced oil recovery (CCUS-EOR) is considered a promising solution to meet future global energy needs while significantly reducing carbon dioxide emissions. However, the future growth of CCUS-EOR is uncertain due to the global economic recession and low oil prices. This research analyzes the impact of uncertain oil and carbon market prices on the economic value of a CCUS-EOR project which contributes to appropriate investment and future policy decisions. To explore the potential trade-offs between available carbon dioxide (CO2) quantities for trading or injection for enhanced oil recovery, the market's trading mechanism is analyzed by predicting future oil and carbon prices. The forecasted market prices are then used in an optimization model to estimate the optimal cumulative cash flow from implementing a proposed CCUS-EOR project to capture CO2 from the Hartha power plant located in the southern Basra Province of Iraq, considering three different oil fields of Rumaila, Nassriya, and Noor. The results revealed that the profitability of the proposed CCUS-EOR project is affected by both oil and carbon market prices, and a higher carbon price is needed to compensate for the financial setbacks, resulting from reduced oil prices. The research also features the strategic decision-making of oil fields across different sizes in response to various price scenarios. The medium-sized fields consistently prioritize carbon injection for enhanced oil recovery (EOR) over market trading. In contrast, small and giant fields adapt their approach based on the prevailing market price dynamics.

Assessing the Risk of Uncontrolled Space Debris Re-entry: A Case for Airspace Management and Flight Safety

We explore the risks associated with uncontrolled space debris re-entry and the implications for airspace management and flight safety. With the increasing number of satellites and other objects being launched into space the potential for uncontrolled re-entry events poses a unique challenge for airspace management and public safety. While there have been no recorded instances of aircraft damage or human injury due to re-entering space debris, the increasing frequency of such events necessitates a comprehensive understanding of the associated risks and appropriate mitigation strategies. We briefly examine the current methods for tracking and predicting space debris re-entry, concentrating on the decision-making process for airspace closures, and the risk assessment for ground airborne safety. Our analysis aims to contribute to the ongoing dialogue on space debris management and to inform future policy and operational decisions in the context of civil aviation and public safety.

Modernization of Railway Wagons for Customer Satisfaction and Safety

This article focuses on the assessment of the efficiency of the modernization of railway wagons intended for passenger transport. The modernization of railway wagons is an important step towards ensuring the safer and more efficient operation of railways. However, this modernization is not without risks and, in addition to its many positive effects, it can also bring new challenges in the form of breakdowns and technical problems. Failures in passenger rail vehicles are a challenge facing manufacturers and transport operators, and identifying the relationships between these failures can help to improve the design, manufacture, and maintenance of these vehicles. Passenger rail vehicle failures can vary in nature, whether mechanical, electrical, or inside the vehicle. This paper attempts to provide a comprehensive view of the effectiveness of passenger rail car retrofitting based on the data collected and statistical analyses. The article further focuses on the description of selected rail passenger wagons, describes the analyses of the statistical data using the correlation between the selected rail wagon failures and their significance, in addition to whether the impact of modernization reduces the number of rail wagon failures. The results of this statistical analysis can be used to better understand the impact of modernization on different aspects of passenger transport and will help in making future investment and policy decisions in this area. © 2017 Elsevier Inc. All rights reserved.

The Devil in the details: The factors determining the selection of intrazonal congestion management methods across Europe

The European electricity market is becoming increasingly interconnected, raising questions about how intrazonal congestion management, typically governed by national regulations, interacts with the coupled cross-zonal markets. A major concern is the lack of information regarding intrazonal congestion management methods. This paper addresses this issue by examining different ways in which European transmission system operators (TSOs) use third-party resources to manage congestion in short-term electricity markets. We create a decision-tree-based classification to represent all identified congestion management methods and select three cases for comprehensive evaluation using predefined assessment criteria. While doing so, we identify a trade-off between efficiency and ease of implementation. The balance between these two factors is determined by the severity of the congestion. In a severely congested grid, locational signals are critical, requiring a better alignment between the network representation in the market clearing and the physical network constraints. When the congestion is less severe, TSOs can choose other congestion management methods based on factors such as the predictability of congestion and resource availability. These findings shed light on the complexities of congestion management in an integrated European market and can inform future policy decisions.

Analisis Dampak Kebijakan Fiskal: Evaluasi Perubahan Peraturan Pajak Tahun 2021 terhadap Pertumbuhan Ekonomi di Kalteng

This study aims to evaluate how these changes in taxation policy affect the economic dynamics of the region. Through a quantitative approach and using secondary data from Statistics Indonesia, this research includes a Difference in Difference analysis to compare the changes in economic growth before and after the changes in tax regulations in Central Kalimantan. This evaluation is important because fiscal policy, especially in terms of taxation, has great potential to affect people's welfare, the region's competitiveness in attracting investment, as well as the growth of key sectors. The results will provide a deeper understanding of the implications of fiscal policy on the regional economy, provide valuable input for future policy decision makers, and serve as a guideline for other regions that may face similar policy changes.

Race, sex, and age disparities in death penalty sentencing: a systematic review

Demographic factors can influence death penalty outcomes. This systematic review examines literature regarding intersectionality of race, sex, and age disparities in capital punishment sentencing. Three databases were searched with similar terms, yielding 1,258 articles for review. After evaluating the remaining articles based on inclusion and exclusion criteria, 12 articles were included for the final review. Differences in outcomes were reported when evaluating the race, sex, and/or age of both the defendant and the victim. Most studies found disadvantaged death penalty sentencing outcomes for both minority defendants and minority victims. Implications for future research and policy decisions are discussed.

Twenty-two-year incidence trend of urological cancers in the Republic of Korea: 1999-2020.

Cancer is a disease with high social costs, and policymaking through accurate statistics is very important. This study presents the national cancer statistics on the incidence of urological cancers in the Republic of Korea over 22 years, from 1999 to 2020. Through the Korean Statistical Information Service, data on the incidence of urological cancers by sex and age in each year was obtained. For each urological cancer, the number of cases, crude incidence rate (CIR), and age-standardized incidence rate (ASR) were calculated, and the statistical trends were confirmed by joinpoint regression analysis. Urological cancers, which have increased ASR over 22 years, are as follows: prostate cancer (average annual percent change [AAPC]=6.72%, p-trend<0.05), testicular cancer (AAPC=5.26%, p-trend<0.05), ureter cancer (AAPC=4.16%, p-trend<0.05), kidney cancer (AAPC=4.14%, p-trend<0.05), renal pelvis cancer (AAPC=3.86%, p-trend<0.05), and total urological cancer (AAPC=4.37%, p-trend<0.05). Urological cancers, which has decreased ASR over 22 years, are as follows: penile cancer (AAPC=-2.93%, p-trend<0.05) and bladder cancer (AAPC=-0.31%, p-trend<0.05). It was confirmed that the ASR of all urological cancers increased for 22 years, except for bladder and penile cancer. With the aging of the population, the CIR increased for all urological cancers. This study will serve as basic data for future research and policy decisions.

Application of various machine learning algorithms in view of predicting the CO2 emissions in the transportation sector

This study applies three different artificial intelligence algorithms (Multi-layer Perceptron (MLP), Extreme Gradient Boosting (XGBoost), and Support Vector Machine (SVM)) to estimate CO2 emissions in Türkiye’s transportation sector. The input parameters considered are Energy consumption (ENERGY), Vehicle Kilometers (VK), POPulation (POP), Year (Y), and Gross Domestic Product Per Capita (GDP). Strong correlations are observed, with ENERGY having the highest correlation followed by VK, POP, Y, and GDP. Four scenarios are designed based on the correlation effect: scenario 1 (ENERGY/VK/POP/Y/GDP), scenario 2 (ENERGY/VK/POP/Y), scenario 3 (ENERGY/VK/POP), and scenario 4 (ENERGY/VK). Experiments compare their effects on CO2 emissions using statistical indicators (R2, RMSE, MSE, and MAE). Across all scenarios and algorithms, R2 values range from 0.8969 to 0.9886, and RMSE values range from 0.0333 to 0.1007. The XGBoost algorithm performs best in scenario 4. Artificial intelligence algorithms prove successful in estimating CO2 emissions. This study has significant implications for policymakers and stakeholders. It highlights the need to review energy investments in transportation and implement regulations, restrictions, legislation, and obligations to reduce emissions. Artificial intelligence algorithms offer the potential for developing effective strategies. Policymakers can use these insights to prioritize sustainable energy investments. In conclusion, this study provides insights into the relationship between input parameters and CO2 emissions in the transportation sector. It emphasizes the importance of proactive measures and policies to address the sector’s environmental impact. It also contributes to the understanding of AI-assisted CO2 emissions forecasting in the transport sector, potentially informing future policy decisions aimed at emission reduction and sustainable transport development.

Assessing the effectiveness of agricultural policies on development: A systematic literature review from diverse countries

This research strives to evaluate the efficacy of farm-related policies in promoting development by conducting a global analysis across diverse nations. The assessment seeks to distill invaluable insights through a comparative examination of agricultural policies implemented in various countries. The research employs a systematic literature review as its methodology. This comprehensive review systematically scrutinizes the impact of agricultural policies on development, with a specific focus on a carefully chosen set of countries: Mali, Cameroon, South Africa, Indonesia, Vietnam, the United States, European nations, and Brazil. The study encapsulates the lessons gleaned from these nations' experiences in bolstering their agricultural sectors to achieve objectives such as economic advancement, food security, environmental responsibility, poverty reduction, and rural community development. By synthesizing and contrasting findings from a multitude of studies, this research strives to furnish a holistic comprehension of the outcome of agricultural policies on development outcomes. Through a nuanced analysis pertaining to the strengths and weaknesses of these countries' agricultural policies in the context of development, this research seeks to offer useful understandings to shape future policy decisions and further the cause of agricultural development on a global scale.

A refined measurement method of highway truck carbon emissions in the context of carbon peaking and carbon neutrality --Take G30 Yandun Toll Station as an Example

This study uses two different carbon emission factor methods to analyze the differences in carbon emissions from trucks under different types and times. The analysis is based on the Xinjiang Expressway Database and other data, with the G30 Yandun Toll Station as an example. The study aims to provide insight into the environmental impact of trucking and inform future policy decisions. The study indicates that heavy-duty trucks are responsible for 90% and 97% of the total carbon emissions from all trucks, respectively. The number of vehicles and the type of trucks are the main factors contributing to these emissions. Additionally, the second quarter shows the highest carbon emissions, while the first quarter exhibits the most considerable difference between the results of the two methods. In March, carbon emissions were at their highest. Additionally, the fuel consumption of trucks with GVW ⩾ 31000kg was the highest, with a significant difference between the results of the two methods. It is worth noting that the fuel consumption of trucks with GVW ⩾ 31000kg was also measured. This study provides data to support the implementation of policies related to transportation carbon emissions in Xinjiang. The paper is significant for promoting green travel.

Health Literacy of Polish University Students and Its Relation to Sources of Health Education and Socialization

This study aimed to evaluate Polish university students’ health literacy (HL) in the context of school and out-of-school health education and socialisation. The survey was conducted in two Polish universities between March 2023 and April 2024 using an online questionnaire. The research revealed the correlation between the HL of Polish university students and both school and non-school health education and socialisation, with a higher positive association with non-school health socialisation. Furthermore, the study revealed statistically significant differences between the general HL of Polish university students and the sources of health education. The lack of health education at school seemed to be the most significant differentiating factor. Health-literate students mean health-literate citizens. Achieving this goal should be at the forefront of future policy decisions. Therefore, implementing health education and health promotion throughout the school system (including higher education) should be a priority today.

Toxicity of glyphosate and its degradation products in aquatic ecosystems: a review

Context: The intensifying utilization of glyphosate has provoked global scientific concern due to the potential large-scale impact on ecosystems. In 2015, the International Agency for Research on Cancer (IARC) reclassified glyphosate and its degradation byproduct, aminomethylphosphonic acid (AMPA), as Category 2A, indicating probable human carcinogenicity. Knowledge Gap: A review of the existing literature reveals a relative scarcity of information on the aquatic impact of glyphosate and its degradation products. Purpose: To determine the scope and implications of the impact of glyphosate and its degradation products on aquatic ecosystems, in order to better understand their ecotoxicological effects and provide a foundation for future research and policy decisions in this area. Methodology: A systematic review of ecotoxicological studies published in Spanish and English over the last 12 years was conducted to assess the effects of glyphosate and its degradation products on aquatic ecosystems and the risks to various species. Approximately 95 documents were reviewed, including data from 69, addressing toxicity, biodegradation, contamination, and international regulations. Results: Studies have shown that chronic exposure to glyphosate can alter the metabolism in fish and affect the life cycle of organisms such as Daphnia Magna. The composition of glyphosate, along with its adjuvants, can increase its toxicity and pose risks to the aquatic ecosystem, making it crucial to understand the specific formulations and their concentrations. Conclusions: The increased use of glyphosate raised global scientific concerns due to its potential impact on ecosystems, with the IARC classifying it as possibly carcinogenic to humans. Studies showed acute toxicity to aquatic organisms and highlighted the need for risk assessment methodologies for long-term impacts on ecosystems and human.

Financial innovation, environmental degradation, and environmental Kuznets curve trends in China.

This study examines the environmental Kuznets curve (EKC) theory and its possible relevance in the context of China and the complex and one-of-a-kind interaction between financial innovation, environmental deterioration, and China. China's fast industrialization and consequent economic expansion have been accompanied by significant environmental difficulties, despite the country's status as the world's second largest economy. The research takes a secondary data approach to its investigation of this topic, drawing on a large dataset that spans many decades to ensure a thorough examination of the dynamic interaction between financial innovation and numerous environmental variables. The primary objective of this research is to determine whether or not recent developments in financial technology have contributed to the current trends of environmental degradation in China. In keeping with the central tenet of the EKC hypothesis, this study uses cutting-edge econometric techniques to investigate the existence of nonlinear correlations and inflection points. In addition, the research analyzes how policy interventions and regulatory measures have shaped the tendencies spotted. In elucidating the usefulness of financial innovation as a tool for promoting environmental betterment, this study's findings substantially contribute to the current discussion around sustainable development and economic policy. This research also carefully assesses the applicability of the EKC theory in China, providing insights that may be used to inform future environmental policy decisions. Ultimately, the success of measures to promote sustained economic growth and the preservation of the environment in China depends on an in-depth understanding of these delicate relationships. In addition, the lessons learned from this study have the potential to serve as a guide for economies facing similar difficulties.

Real-world effectiveness of full and booster mRNA vaccination for coronavirus disease 2019 against disease severity during the delta- and omicron-dominant phases: A propensity score-matched cohort study using the nationwide registry data in Japan

BackgroundTo date, few studies from the Asian region have reported the effectiveness of messenger ribonucleic acid coronavirus disease 2019 (COVID-19) vaccines against disease progression and death after hospitalization. MethodsWe evaluated the data from the COVID-19 registry in Japan during the delta- and omicron-dominant phases. A propensity score-matched cohort study was conducted between the incompletely (0–1 dose) and fully (2 doses) vaccinated groups during the delta-dominant phase and among the incompletely, fully, and booster (3 doses) vaccinated groups during the omicron-dominant phase. ResultsIn the delta-dominant phase, 411 pairs were matched. The fully vaccinated group showed a significantly lower oxygen supplementation rate (24.1 % vs. 41.1 %, p < 0.001) but little difference in the mortality rate (2.2 % vs. 2.9 %, p = 0.66). In the omicron-dominant phase, 1494 pairs from the incompletely and fully vaccinated groups, and 425 pairs from the fully and booster vaccinated groups were matched. Full vaccination reduced both the oxygen supplementation rate (18.6 % vs 25.7 %, p < 0.001) and mortality rate (0.7 % vs 2.3 %, p < 0.001). Booster vaccination showed little difference in either the rate of oxygen supplementation (21.2 % vs. 24.7 %, p = 0.25) or mortality (1.2 % vs. 2.6 %, p = 0.21) compared with full vaccination. ConclusionsFull vaccination reduced disease severity during the delta- and omicron-dominant phases; booster vaccination did not further enhance the protective effects against disease progression during the omicron-dominant phase compared to full vaccination. Future vaccine strategies and policy decisions should consider preventing infection or disease progression in the target population, as well as the characteristics of the dominant variant in that phase.

MMS hotspots: a cross-sectional comparison of U.S. counties with and without Mohs micrographic surgery

Healthcare access greatly impacts skin cancer diagnosis and mortality rates. Recognition of current disparities in Mohs micrographic surgery (MMS) access can assist future policy and clinical decisions to correct them. For the years 2014–2018, the CPT codes for MMS (17,311 and 17,313) were counted on a per county level across the United States per the Medicare Centers for Medicare & Medicaid Services (CMS) Medicare Prescriber Database. Any county with 0 MMS CPT codes recorded were classified as “without MMS cases.” MMS “hotspots” were identified as counties that possessed a high average number of MMS cases compared to the national average, while also being surrounded by counties that possessed a low average number of MMS cases compared to the national average. Three thousand eighty-four counties in the United States were analyzed; 785 (25%) counties were designated as “with MMS cases” and 2301 (75%) “without MMS cases.” There were no significant differences in age, ethnicity distribution, or cost per enrollee between the two designations. 74% of counties with MMS cases were considered urban, while only 25% of those without cases were urban (p < 0.01). The median household income was markedly higher in counties with MMS cases ($71,428 vs. $58,913, p < 0.01). With respect to education, more individuals in counties with MMS cases possessed their General Education Development (GED) (89% vs. 86%, p < 0.01) or a college degree (30% vs. 19%, p < 0.01). Forty-nine counties were considered MMS “hotspots.” The density of MMS procedures varies greatly based on geography, maintaining the urban–rural disparity matched by the distribution of MMS surgeons. Additionally, there remains a wide income and educational gap between counties with and without MMS. Identifying MMS hotspots may facilitate further investigation into potential surgical access disparities.

Perspectives on implementing Individual Placement and Support (IPS) within primary health care settings for adults living in British Columbia, Canada

BackgroundIndividual placement and support (IPS) is an evidence-based practice (EBP) designed to help people with severe mental illness re-enter the labour market. Implementing an IPS program within a new context (e.g., primary health care setting) to support populations that are complex and multi-barriered presents a set of unique challenges and considerations. This paper provides community-based perspectives that identify implementation strengths and challenges and highlights potential strategies aimed at addressing emergent barriers.MethodsA case study was conducted across three community health centres in British Columbia (BC), Canada, where a novel IPS program was embedded within primary care services. Data collection consisted of open-ended surveys and focus groups with service providers directly involved in program implementation and their associated clinical and managerial support teams (n = 15). Using the updated Consolidated Framework for Implementation Research (CFIR) as a guide, we performed deductive thematic analysis to identify key areas impacting IPS implementation.ResultsIntegration with existing health care systems and primary health care teams and support from leadership across all levels were identified as both key facilitators and barriers to implementation. Facilitators and barriers were identified across all domains, with those within innovation and process most easily addressed. Four cross-cutting themes emerged for promoting more integrated and sustainable program implementation: investing in pre-implementation activities, supporting a dynamic and flexible program, building from community experiences, and developing a system for shared knowledge.ConclusionsImplementing an IPS program embedded within primary health care settings is complex and requires extensive planning and consultation with community-based service providers and decision-makers to achieve full integration. Future practice and policy decisions aimed at supporting employment and well-being should be made in collaboration with communities.