Implementation Climate Research Articles

Utility of the Leadership and Organizational Change for Implementation-Systems Level (LOCI-SL) strategy for a statewide substance use treatment implementation effort

IntroductionMulti-level and cross-context implementation strategies are needed to support health systems, healthcare delivery organizations, and providers to adopt evidence-based practice (EBP) for substance use disorder (SUD) treatment. However, misalignment between state oversight agencies and healthcare organizations about which services to prioritize and which outcomes are reasonable to expect can hinder implementation success and widespread access to high-quality care. This study investigated the utility of the Leadership and Organizational Change for Implementation-System Level (LOCI-SL) strategy for supporting statewide EBP implementation for SUD treatment. MethodsNine community mental health centers (CMHCs) contracted by a state agency participated in a combined motivational-enhancement therapy and cognitive behavioral therapy (MET/CBT) implementation effort. Five of the CMHCs also received the LOCI-SL strategy to obtain ongoing implementation support. We conducted 21 individual interviews and three small group interviews with 30 participants across CMHCs and state health agencies to investigate the utility of LOCI-SL in supporting their EBP implementation efforts. Deductive thematic analysis was guided by the Exploration, Preparation, Implementation, Sustainment Framework. ResultsFive themes described CMHCs' LOCI-SL and broader contextual experiences implementing EBPs: (1) LOCI-SL supported executives in Preparation phase activities that holistically considered organizational needs and capacity to implement and sustain EBPs; (2) LOCI-SL facilitated trust and communication processes across Preparation, Implementation, and Sustainment phases to improve EBP uptake; (3) LOCI-SL increased CMHCs' use of implementation climate strengthening activities throughout the Implementation phase; (4) state contracts did not emphasize quality and thus were not sufficient bridging factors to enforce EBP fidelity during Implementation; and, (5) limited funding and low Medicaid reimbursement rates hindered EBP use throughout the Implementation and Sustainment phases. ConclusionsLOCI-SL was viewed as a favorable and useful implementation strategy for supporting statewide adoption of EBPs. However, outer context barriers, including limited financial investments in the treatment system, impeded implementation and sustainment efforts. While previous research suggests that contracts are viable alignment-promoting bridging factors, this study demonstrates the importance of articulating implementation outcome expectations to aid state-contracted organizations in achieving EBP implementation success. This study also highlights the need for multi-level implementation strategies to effectively align implementation expectations between outer- and inner-context entities.

Inter-organizational alignment and implementation outcomes in integrated mental healthcare for children and adolescents: a cross-sectional observational study.

Integrated care involves care provided by a team of professionals, often in non-traditional settings. A common example worldwide is integrated school-based mental health (SBMH), which involves externally employed clinicians providing care at schools. Integrated mental healthcare can improve the accessibility and efficiency of evidence-based practices (EBPs) for vulnerable populations suffering from fragmented traditional care. However, integration can complicate EBP implementation due to overlapping organizational contexts, diminishing the public health impact. Emerging literature suggests that EBP implementation may benefit from the similarities in the implementation context factors between the different organizations in integrated care, which we termed inter-organizational alignment (IOA). This study quantitatively explored whether and how IOA in general and implementation context factors are associated with implementation outcomes in integrated SBMH. SBMH clinicians from community-based organizations (CBOs; nclinician = 27) and their proximal student-support school staff (nschool = 99) rated their schools and CBOs (clinician only) regarding general (organizational culture and molar climate) and implementation context factors (Implementation Climate and Leadership), and nine common implementation outcomes (e.g., treatment integrity, service access, acceptability). The levels of IOA were estimated by intra-class correlations (ICCs). We fitted multilevel models to estimate the standalone effects of context factors from CBOs and schools on implementation outcomes. We also estimated the 2-way interaction effects between CBO and school context factors (i.e., between-setting interdependence) on implementation outcomes. The IOA in general context factors exceeded those of implementation context factors. The standalone effects of implementation context factors on most implementation outcomes were larger than those of general context factors. Similarly, implementation context factors between CBOs and schools showed larger 2-way interaction effects on implementation outcomes than general context factors. This study preliminarily supported the importance of IOA in context factors for integrated SBMH. The findings shed light on how IOA in implementation and general context factors may be differentially associated with implementation outcomes across a broad array of integrated mental healthcare settings.

Exploring educator and school professional perspectives of restorative practices implementation climate

ABSTRACT Restorative practices (RP) implementation requires substantial adult buy-in, time, leadership support, and resources. Limited studies have examined the implementation of RP from the perspectives of different groups of school professionals (e.g. teachers, paraprofessionals, and non-classroom staff) and their perceptions of RP implementation climate (i.e. support, efficacy, use). Fewer studies have investigated such differences in perceptions of RP support, efficacy, and utilization among school professionals at varying school levels (e.g. elementary, middle, and high school). We applied an exploratory, descriptive study design to better understand RP implementation among varying school roles and levels using a district-wide RP survey among school adults (N = 392) in a midsize urban school district in the Northeast. Perceptions of RP implementation differed by professional role, where paraprofessionals have similar levels of RP use and support compared to classroom teachers but indicate the lowest level of RP efficacy. Additionally, non-classroom staff reported the highest levels of RP support compared to paraprofessionals and teachers. Across school levels and implementation domains (support, efficacy, and use), elementary school staff reported the highest or most positive perceptions of RP implementation compared to middle and high school staff. Implications for implementing RP amongst various school roles, contexts, and levels are discussed.

Barriers and facilitators of implementation of new antibacterial technologies in patient care: an interview study with orthopedic healthcare professionals at a university hospital

BackgroundAntimicrobial resistance is a major global health threat. Therefore, promising new antibacterial technologies that could minimize our dependence on antibiotics should be widely adopted. This study aims to identify the barriers and facilitators of the adoption of new antibacterial technologies in hospital patient care.MethodsSemi-structured interviews, based on the Consolidated Framework for Implementation Research, were conducted with healthcare professionals related to the orthopedics department of an academic hospital in The Netherlands.ResultsIn total, 11 healthcare professionals were interviewed. Scientific evidence for the effectiveness of the technology was the most explicitly mentioned facilitator of adoption, but other (often contextual) factors were also considered to be important. At the level of the inner and outer setting, high costs and lacking coverage, competition from other firms, and problems with ordering and availability were the most explicit perceived barriers to adoption. Participants did not collectively feel the need for new antibacterial technologies.ConclusionsBarriers and facilitators of the adoption of new antibacterial technologies were identified related to the technology, the hospital, and external factors. The implementation climate might have an indirect influence on adoption. New antibacterial technologies that are scientifically proven effective, affordable, and easily obtainable will most likely be adopted.

Socioeconomic Impacts of Climate Mitigation Actions in Greece: Quantitative Assessment and Public Perception

Appropriately designed and implemented climate mitigation actions have multiple co-benefits (yet some trade-offs cannot be excluded) that result in substantial social and economic value beyond their direct impact on reducing energy consumption and GHG emissions. Despite their wider acknowledgement by the research community, decision makers and the public have incomplete information on these multiple effects. This paper has a twofold objective: First, through analytical bottom-up approaches, it assesses, in quantitative terms, the macroeconomic effects and the public health benefits attributed to a variety of mitigation actions under consideration in the context of the Greek Energy and Climate Plan. Second, it investigates, through a social survey, how citizens perceive climate change and value these multiple impacts of mitigation actions, and to what extent they are willing to pay for them and support the adoption of policy measures aiming at the green transition of the Greek economy. We show that mitigation actions bring about significant health benefits, particularly in cities, and generate significant positive macroeconomic effects, particularly if mitigation actions focus on the decarbonization of the building sector and on the exploitation of local renewable sources. We also argue that most people do not realize that climate mitigation actions can have wider benefits for society, such as tackling energy poverty, improving public health, and creating new jobs. Unwillingness to pay tends to be the prominent attitude. People who are more reluctant to cover a part of the cost of environmental protection are less likely to perceive that climate change is one of the main challenges at global and national level and support the adoption of climate mitigation policies. In this context, the national strategy for climate change should focus on effectively informing and engaging the public in climate mitigation strategies, strengthening the public trust in government institutions, promoting mutually acceptable solutions with the local communities, and providing incentives for changing citizens’ behavior towards climate-related actions.

Nursing Leaders’ Influence on Clinical Nurses’ Evidence-Based Practice Implementation: Impact of an Evidence-Based Practice Leadership Behavior Program

Unit-level nursing leaders’ behaviors may foster the organization’s implementation climate for evidence-based practice. This study used a quantitative, pre-test, post-test comparative design to determine whether acute and critical care nursing leaders’ participation in an EBP Leadership Behavior Program made a difference in nursing leaders’ self-reported and clinical nurses’ perceptions of nursing leaders’ EBP leadership behaviors and competencies. The program was designed for nursing leaders that included synchronous and asynchronous activities. Findings indicated that nursing leaders’ EBP competencies and EBP leadership behaviors significantly improved following participation in the program. However, clinical nurses’ perceptions did not statistically significant change.

Improving measurement-based care implementation in youth mental health through organizational leadership and climate: a mechanistic analysis within a randomized trial

BackgroundTheory and correlational research indicate organizational leadership and climate are important for successful implementation of evidence-based practices (EBPs) in healthcare settings; however, experimental evidence is lacking. We addressed this gap using data from the WISDOM (Working to Implement and Sustain Digital Outcome Measures) hybrid type III effectiveness-implementation trial. Primary outcomes from WISDOM indicated the Leadership and Organizational Change for Implementation (LOCI) strategy improved fidelity to measurement-based care (MBC) in youth mental health services. In this study, we tested LOCI’s hypothesized mechanisms of change, namely: (1) LOCI will improve implementation and transformational leadership, which in turn will (2) mediate LOCI’s effect on implementation climate, which in turn will (3) mediate LOCI’s effect on MBC fidelity.MethodsTwenty-one outpatient mental health clinics serving youth were randomly assigned to LOCI plus MBC training and technical assistance or MBC training and technical assistance only. Clinicians rated their leaders’ implementation leadership, transformational leadership, and clinic implementation climate for MBC at five time points (baseline, 4-, 8-, 12-, and 18-months post-baseline). MBC fidelity was assessed using electronic metadata for youth outpatients who initiated treatment in the 12 months following MBC training. Hypotheses were tested using longitudinal mixed-effects models and multilevel mediation analyses.ResultsLOCI significantly improved implementation leadership and implementation climate from baseline to follow-up at 4-, 8-, 12-, and 18-month post-baseline (all ps < .01), producing large effects (range of ds = 0.76 to 1.34). LOCI’s effects on transformational leadership were small at 4 months (d = 0.31, p = .019) and nonsignificant thereafter (ps > .05). LOCI’s improvement of clinic implementation climate from baseline to 12 months was mediated by improvement in implementation leadership from baseline to 4 months (proportion mediated [pm] = 0.82, p = .004). Transformational leadership did not mediate LOCI’s effect on implementation climate (p = 0.136). Improvement in clinic implementation climate from baseline to 12 months mediated LOCI’s effect on MBC fidelity during the same period (pm = 0.71, p = .045).ConclusionsLOCI improved MBC fidelity in youth mental health services by improving clinic implementation climate, which was itself improved by increased implementation leadership. Fidelity to EBPs in healthcare settings can be improved by developing organizational leaders and strong implementation climates.Trial registrationClinicalTrials.gov identifier: NCT04096274. Registered September 18, 2019.

Developing and testing a produce prescription implementation blueprint to improve food security in a clinical setting: a pilot study protocol

BackgroundFood insecurity is common in the United States, especially in Rhode Island, where it affects up to 33% of residents. Food insecurity is associated with adverse health outcomes and disproportionally affects people from minoritized backgrounds. Produce prescription programs, in which healthcare providers write “prescriptions” for free or reduced cost vegetables, have been used to address food insecurity and diet-related chronic disease. Although there is growing evidence for the effectiveness of produce prescription programs in improving food security and diet quality, there have been few efforts to use implementation science methods to improve the adoption of these programs.MethodsThis two-phase pilot study will examine determinants and preliminary implementation and effectiveness outcomes for an existing produce prescription program. The existing program is funded by an Accountable Care Organization in Rhode Island and delivered in primary care practices. For the first phase, we conducted a formative evaluation, guided by the Consolidated Framework for Implementation Research 2.0, to assess barriers, facilitators, and existing implementation strategies for the produce prescription program. Responses from the formative evaluation were analyzed using a rapid qualitative analytic approach to yield a summary of existing barriers and facilitators. In the second phase, we presented our formative evaluation findings to a community advisory board consisting of primary care staff, Accountable Care Organization staff, and staff who source and deliver the vegetables. The community advisory board used this information to identify and refine a set of implementation strategies to support the adoption of the program via an implementation blueprint. Guided by the implementation blueprint, we will conduct a single-arm pilot study to assess implementation antecedents (i.e., feasibility, acceptability, appropriateness, implementation climate, implementation readiness), implementation outcomes (i.e., adoption), and preliminary program effectiveness (i.e., food and nutrition security). The first phase is complete, and the second phase is ongoing.DiscussionThis study will advance the existing literature on produce prescription programs by formally assessing implementation determinants and developing a tailored set of implementation strategies to address identified barriers. Results from this study will inform a future fully powered hybrid type 3 study that will use the tailored implementation strategies and assess implementation and effectiveness outcomes for a produce prescription program.Trial registrationClinical trials: NCT05941403, Registered June 9, 2023.

The sociotechnical dynamics of blue carbon management: Testing typologies of ideographs, innovation, and co-impacts for marine carbon removal

Efforts to halt the precipitous decline of marine ecosystems are taking on additional importance in relation to discussions of climate change and carbon removal. Out of all biological carbon captured in the world, more than half is stored by marine living organisms, and the oceans represent the largest long-term sink for carbon. Blue carbon, the preservation and enhancement of marine and coastal ecosystems for carbon removal, is treated as a potentially cost-effective way to capture and store carbon, generate community co-benefits, and implement conservation and climate agendas. However, blue carbon ecosystems are among the most unproven climate intervention options, in part given their status as highly threatened systems which moreover have critical connections to planetary health and food security. Based on extensive place-based field research and document analysis, this study examines three blue carbon innovations: coral reef preservation in Australia, seagrass restoration in the United Kingdom, and macroalgae (seaweed) cultivation and deep ocean storage in the United States. Empirically, it utilizes an extensive, original dataset of expert interviews (N=46), site visits (N=38) and document analysis undertaken over late 2022 and 2023. Conceptually, it advances our understanding of typologies related to narratives and ideographs, innovation and technological styles, and community co-impacts. It thus offers comparative case study work across three locations and blue carbon approaches with original mixed-methods data aimed at novel theoretical triangulation across three typological frameworks.

Sediment particle tracking data for the Carpathian reservoir under climate and land use change scenarios

AbstractAlthough the Carpathian Mts. area is considered as extremely prone to surface erosion which results in capacity loss of the dammed reservoirs, a lack of data to follow details of this process is perceivable. The research of the selected sediment fractions transport tracking was conducted using the capabilities of the digital platform—Macromodel DNS (Discharge‐Nutrient‐Sea) for the catchment with drinking water reservoir in the Polish part of Western Carpathian. The continuity of sediment transport simulation in two hydrologically different elements of the catchment—the river and the reservoir—was possible due to consolidation of two models in the platform—SWAT (Soil &amp; Water Assessment Tool) and AdH/PTM (Adaptive Hydraulics Model/Particle Tracking Model). The result of those modules' integration was a database for tracking the individual sediment fractions delivered to the reservoir and deposited in specific reservoir zones. The implementation of climate and land use change scenarios allowed additionally to analyse the estimation of those processes in the future. The simulation outcomes consist of daily flows and monthly sediment loads at the reservoir inflow and the individual sediment particle fractions deposition location inside of the reservoir.

Factors influencing teachers' sustained implementation of a kindergarten curriculum within the United States: A qualitative analysis

AbstractTeachers play a critical role in deciding what curricula are used in their classrooms. We examine the factors that teachers describe as influencing their sustainment or discontinuation of a literacy curriculum, Zoology One, following their participation in a randomised controlled trial (RCT) examining the curriculum's efficacy. This study was conducted in a large urban district in the United States and the curriculum was implemented in kindergarten classrooms with children who are typically 5 and 6 years old. One year after their participation in the RCT, teachers who had been randomised to implement Zoology One during the efficacy study (N = 19) participated in interviews about their ongoing use of the curriculum. We analysed the interview data using a staged coding approach to understand the factors that teachers described influencing their sustainment or discontinuation of the curriculum. We used a multilevel framework to organise results across three levels: individual‐level, school‐level and macro‐level. Results indicate that teacher perceptions of the curriculum, including those related to its effectiveness and age‐appropriateness, contributed to sustained use. At the same time, some teachers' perceptions that the curriculum approaches were not sufficient for their students led them to discontinue some curriculum components. The implementation climate at their school, as well as the widespread adoption of a particular phonics programme within the school district, also influenced teachers' sustainment or discontinuation. Taken together, these results highlight the importance of teachers' perceptions of a curriculum as well as the critical role that the school and district context play in curricular sustainment.

Perspectives of Patients and Professionals on Implementing a Computer Adaptive Vision-Related Quality of Life Outcome (CAT-EyeQ) in Clinical Practice.

The CAT-EyeQ is a computer adaptive test (CAT) which measures vision-related quality of life in patients having exudative retinal diseases. The aim of this study is to investigate the usability of the CAT-EyeQ in clinical practice and identify potential barriers and facilitators for implementation (problem analysis). Patients and health care professionals participated in the study regarding the usability of the CAT-EyeQ, and clinic managers and health care professionals were included in the problem analysis for implementation. In total, we conducted 18 semi-structured interviews. The Consolidated Framework for Implementation Research (CFIR) was used to develop the interview guides and to structure results. Six themes were derived from the usability study and problem analysis: (1) quality of the CAT-EyeQ and the applicability to patients' needs and preferences, (2) embedding the CAT-EyeQ in current practice, (3) implementation climate of the eye hospitals, (4) attitude of professionals, (5) engaging and encouraging professionals, and (6) integration of the CAT-EyeQ in health care - needs after piloting. Patients and professionals mentioned that the CAT-EyeQ improved insight into the impact of eye diseases on a patient's daily life, it allowed for more attention on the patient perspective and the structured measurement of vision-related quality of life. The main perceived barriers mentioned by professionals for using the CAT-EyeQ were lack of time and the integration of the patient-reported outcome measure (PROM) results within the electronic patient record (EPR). The CAT-EyeQ, accompanied by an overview of stakeholder perspectives resulting from this implementation study, can now be used in clinical practice.

Comparative effectiveness of implementation strategies for Accelerating Cervical Cancer Elimination through the integration of Screen-and-treat Services (ACCESS study): protocol for a cluster randomized hybrid type III trial in Nigeria

BackgroundDespite 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.MethodsOur 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.DiscussionThe 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 registrationProspectively registered on November 7, 2023, at ClinicalTrials.gov no. NCT06128304. https://classic.clinicaltrials.gov/ct2/show/study/NCT06128304

Building Climate Change into Medical Education: A Society of General Internal Medicine Position Statement.

Building expertise in climate and planetary health among healthcare professionals cannot come with greater urgency as the threats from climate change become increasingly apparent. Current and future healthcare professionals-particularly internists-will increasingly need to understand the interconnectedness of natural systems and human health to better serve their patients longitudinally. Despite this, few national medical societies and accreditation bodies espouse frameworks for climate change and planetary health-related education at the undergraduate (UME), graduate (GME), and continuing (CME) medical education level. As a community of medical educators with an enduring interest in climate change and planetary health, the Society of General Internal Medicine (SGIM) recognizes the need to explicitly define structured educational opportunities and core competencies in both UME and GME as well as pathways for faculty development. In this position statement, we build from the related SGIM Climate and Health position statement, and review and synthesize existing position statements made by US-based medical societies and accreditation bodies that focus on climate change and planetary health-related medical education, identify gaps using Bloom's Hierarchy, and provide recommendations on behalf of SGIM regarding the development of climate and planetary health curricula development. Identified gaps include (1) limited systematic approach to climate and planetary health medical education at all levels; (2) minimal emphasis on learner-driven approaches; (3) limited focus on physician and learner well-being; and (4) limited role for health equity and climate justice. Recommendations include a call to relevant accreditation bodies to explicitly include climate change and planetary health as a competency, extend the structural competency framework to climate change and planetary health to build climate justice, proactively include learners in curricular development and teaching, and ensure resources and support to design and implement climate and planetary health-focused education that includes well-being and resiliency.

A mixed-methods evaluation of organization and individual factors influencing provider intentions to use caregiver coaching in community-based early intervention.

Most psycho-social interventions contain multiple components. Practitioners often vary in their implementation of different intervention components. Caregiver coaching is a multicomponent intervention for young autistic children that is highly effective but poorly implemented in community-based early intervention (EI). Previous research has shown that EI providers' intentions, and the determinants of their intentions, to implement caregiver coaching vary across components. Organizational culture and climate likely influence these psychological determinants of intention by affecting beliefs that underlie attitudes, norms, and self-efficacy to implement an intervention. Research in this area is limited, which limits the development of theoretically driven, multilevel implementation strategies to support multi-component interventions. This mixed methods study evaluated the relationships among organizational leadership, culture and climate, attitudes, norms, self-efficacy, and EI providers' intentions to implement the components of caregiver coaching. We surveyed 264 EI providers from 37 agencies regarding their intentions and determinants of intentions to use caregiver coaching. We also asked questions about the organizational culture, climate, and leadership in their agencies related to caregiver coaching. We used multilevel structural equation models to estimate associations among intentions, psychological determinants of intentions (attitudes, descriptive norms, injunctive norms, and self-efficacy), and organizational factors (implementation climate and leadership). We conducted qualitative interviews with 36 providers, stratified by strength of intentions to use coaching. We used mixed-methods analysis to gain an in-depth understanding of the organization and individual-level factors. The associations among intentions, psychological determinants of intentions, and organizational factors varied across core components of caregiver coaching. Qualitative interviews elucidated how providers describe the importance of each component. For example, providers' attitudes toward coaching caregivers and their perceptions of caregivers' expectations for service were particularly salient themes related to their use of caregiver coaching. Results highlight the importance of multi-level strategies that strategically target individual intervention components as well as organization-level and individual-level constructs. This approach holds promise for improving the implementation of complex, multicomponent, psychosocial interventions in community-based service systems.

A method for estimating localized CO2 emissions from co-located satellite XCO2 and NO2 images

Abstract. Carbon dioxide (CO2) is the most important anthropogenic greenhouse gas. Its atmospheric concentration has increased by almost 50 % since the beginning of the industrial era, causing climate change. Fossil fuel combustion is responsible for most of the atmospheric CO2 increase, which originates to a large extent from localized sources such as power stations. Independent estimates of the emissions from these sources are key to tracking the effectiveness of implemented climate policies to mitigate climate change. We developed an automatic procedure to quantify CO2 emissions from localized sources based on a cross-sectional mass-balance approach and applied it to infer CO2 emissions from the Bełchatów Power Station (Poland) using atmospheric observations from the Orbiting Carbon Observatory 3 (OCO-3) in its snapshot area map (SAM) mode. As a result of the challenge of identifying CO2 emission plumes from satellite data with adequate accuracy, we located and constrained the shape of emission plumes using TROPOspheric Monitoring Instrument (TROPOMI) NO2 column densities. We automatically analysed all available OCO-3 overpasses over the Bełchatów Power Station from July 2019 to November 2022 and found a total of nine that were suitable for the estimation of CO2 emissions using our method. The mean uncertainty in the obtained estimates was 5.8 Mt CO2 yr−1 (22.0 %), mainly driven by the dispersion of the cross-sectional fluxes downwind of the source, e.g. due to turbulence. This dispersion uncertainty was characterized using a semivariogram, made possible by the OCO-3 imaging capability over a target region in SAM mode, which provides observations containing plume information up to several tens of kilometres downwind of the source. A bottom-up emission estimate was computed based on the hourly power-plant-generated power and emission factors to validate the satellite-based estimates. We found that the two independent estimates agree within their 1σ uncertainty in eight out of nine analysed overpasses and have a high Pearson's correlation coefficient of 0.92. Our results confirm the potential to monitor large localized CO2 emission sources from space-based observations and the usefulness of NO2 estimates for plume detection. They also illustrate the potential to improve CO2 monitoring capabilities with the planned Copernicus Anthropogenic CO2 Monitoring (CO2M) satellite constellation, which will provide simultaneously retrieved XCO2 and NO2 maps.

Mental Health Provider Reach and Engagement in a Countywide Training Initiative.

Many training initiatives are underway to increase implementation of evidence-based practice (EBPs) in mental healthcare. However, little is known about what types of trainings and supports yield the highest reach and engagement. Supported by a tax-funded, countywide initiative to improve access to quality care for youths, the current mixed methods study evaluates mental health (MH) provider reach, or registering for the training initiative, and engagement, or participation in training activities, for several EBP training and implementation supports. MH providers were offered free 1) formal EBP workshops, 2) a biweekly learning community, 3) individual case consultation, and 4) confidential online clinical feedback system. To register, interested providers (N = 698) completed a web-based assessment measuring clinical practice information, organizational implementation climate, and EBP knowledge, attitudes, and practices. Thirteen providers, selected via purposeful sampling stratified by level of participation, completed semi-structured qualitative interviews. While the training initiative achieved high reach (66% of county agencies had a provider register), far fewer providers engaged substantially in training. Quantitative results indicated that providers whose professional discipline was not psychology, had higher baseline EBP knowledge, more extensive use of common evidence-based strategies, and less extensive use of other therapy strategies, engaged in more training. Rapid qualitative analysis of interviews expanded upon these findings and illuminated provider, organizational, system, practical, and training activity-specific barriers and facilitators to engagement. Findings suggest the importance of identifying strategies for improving provider engagement in training activities beyond workshops. Implications for future research and training initiatives are discussed.

Diffusion of medications for opioid use disorder treatment in jail settings: a convergent mixed methods study of jail staff perspectives

BackgroundImplementation of medications for opioid use disorder (MOUD) in jails varies by facility and across states. Organizational climate, including staff attitudes toward change and exposure to education, can influence perceptions of innovations like MOUD in jails. Using a mixed methods design, we aimed to understand the association between organizational climate and jail staff perceptions of MOUD.MethodsJail staff (n = 111) who operate MOUD programs in 6 Massachusetts jails completed surveys that included the Organizational Readiness for Implementing Change (ORIC) survey. Random effects logistic regression models assessed associations between organizational climate and several outcomes of perceived MOUD efficacy, acceptability, and knowledge, while controlling for covariates. Jail staff (N = 61) participated in qualitative interviews and focus groups focused on organizational climate and knowledge diffusion, which we analyzed using inductive and deductive methods.ResultsThe results indicate that organizational change readiness on the ORIC was associated with positive perceptions of MOUD, and educational resources facilitated MOUD implementation. Greater ORIC was associated with higher perception of methadone as highly acceptable for jail populations (Odds ratio [OR] 2.3, 95% Confidence Interval [CI] 1.2 to 4.4), and high knowledge of methadone (OR 2.3, 95% CI 1.1 to 4.9), with similar magnitude of effects for buprenorphine. High levels of training for jail staff on methadone and buprenorphine were also associated with higher knowledge of these medications (Methadone: OR 7.2, 95% CI 2.2 to 23.2; Buprenorphine: OR 3.4, 95% CI 1.2 to 9.5). Qualitative results point towards the importance of organizational climate and elucidate educational strategies to improve staff perceptions of MOUD.ConclusionResults underscore the importance of organizational climate for successful implementation of jail MOUD programs and provide support for medication-specific educational resources as a facilitator of successful MOUD implementation in jail settings. Findings highlight implementation strategies that may improve jail staff perceptions of MOUD.

The status of implemented climate smart agriculture practices preferred by farmers of haor area as a climate resilient approach

Bangladesh's Haor regions are famous for their natural resources and are unable to escape climate vulnerability. Triggered by climate vulnerabilities farmers are heading towards climate-resilient approaches. Hence, research was done in the haor area of Sunamganj district to analyze the status of adopted Climate-Smart Agriculture (CSA) techniques in Chhatak, Sunamganj, and Jagannathpur which are prone to severe flooding and climate conditions. Around 450 farmers were randomly selected and CSA adopters were contacted. A structured questionnaire was prepared with open-ended and closed-ended questions. The final questionnaire contained demographic questions and a list of adopted cropland and homestead CSA practices, and the survey proceeded with 115 finalized CSA adopters. MS Excel and SPSS were used to analyze the data. The data were expressed using frequency, percent, mean, and standard deviation. A t-test, analysis of variance, multiple linear regression, Pearson correlation, boxplot, and normal P–P plots were employed to test data normality. The analysis revealed that 30 CSA practices were identified to be practiced in cropland where major preferences were found for appropriate seed storage (100%), USG application (100%), IPM (98%), and good quality seed (95%) in cropland, whereas agroforestry (71%), organic fertilizer application (63%), perching (63%) and IPM (59%) were major CSA practices among the 18 identified practices in homesteads. The adoption level of CSA practices was found in the score category of 11–23 for cropland (90%) and up to 10 for homestead (68%). The results showed that the adoption status of CSA practices was inefficient for quick flood occurrence. CSA practices are not applied enough in haor areas' homesteads due to lack of knowledge, information access, and technical and financial resources. Thus, CSA should be implemented which necessitates working on barriers restricting CSA adoption through strengthening the infrastructure of technologies, supportive policies, and institutional framework.

Advancing the implementation of take-home naloxone by community pharmacists: Testing the role of COM-B.

Opioid-related overdose fatalities are rising despite the increased accessibility of take-home naloxone (THN). Targeted implementation strategies are needed to improve the distribution of naloxone. This study investigates the effectiveness of a short video targeting pharmacists that addresses implementation barriers. A pre-post, mixed methods design was adopted to examine the effect of a brief behaviour change intervention (an educational video informed by the capability, opportunity, motivation affecting behaviour (COM-B) model), on factors affecting pharmacists' implementation of THN in Western Australia. Paired samples t-tests for were used to investigate intentions, knowledge, skill, confidence, feasibility, appropriateness, acceptability, attitudes, anticipated patient reactions, social support and implementation climate. Structural equation modelling examined the associations between constructs and to test the proposed mediation of motivation on capability and opportunity affecting intentions to discuss and provide THN. We analysed data from 102 participants. At follow-up and after all participants had viewed the video, participants had significantly improved intentions, skill, confidence, anticipated reactions, social support and perceptions that THN implementation was feasible, appropriate and acceptable. No significant differences were seen for attitudes, knowledge or implementation climate. The proposed mediation effect of motivation on the associations between opportunity and intentions and capability and intentions was not supported. A short video directly targeting identified implementation barriers has the ability to improve key influences in the provision of THN. Dissemination of information to community pharmacists is a challenge. Implementation strategies addressing knowledge and targeting other levels of influence on intentions and behaviour are required.