Initial Training Research Articles

Understanding the factors influencing biosecurity adoption on smallholder poultry farms in Ghana: a qualitative analysis using the COM-B model and Theoretical Domains Framework.

Antimicrobial resistance (AMR) poses a significant global threat to public, animal, and environmental health, consequently producing downstream economic impacts. While top-down approaches to addressing AMR (e.g., laws regulating antimicrobial use) are common in high-income countries, limited enforcement capacities in low- and middle-income countries highlight the need for more bottom-up approaches. Within agriculture, efforts to apply bottom-up approaches to AMR have often focused on the promotion of biosecurity, which should reduce the need for antimicrobials by mitigating disease risk and limiting AMR transmission. Traditionally, efforts to encourage biosecurity adoption have emphasized training and awareness-raising initiatives. However, a growing body of research suggests a disconnect between knowledge and behavior, highlighting the existence of a knowledge-action gap. To understand the barriers and enablers patterning the knowledge-action gap in on-farm biosecurity uptake, we draw upon models from behavioral science. We analyzed in-depth interviews and two focus group discussions with smallholder poultry producers in Ghana to understand factors underlying the intention-action gap in adopting biosecurity. As an analytical framework, we draw upon the Theoretical Domains Framework in combination with the Capability-Opportunity-Motivation Behavioral Model. While smallholder poultry farmers in Ghana were aware of the importance of biosecurity practices, they struggled with consistent implementation. Financial constraints, challenges in adapting practices to the local context, and limited resources hindered adoption. Additionally, cognitive biases like prioritizing short-term gains and underestimating disease risks played a role. However, some farmers found motivation in professional identity and social influences. These findings highlight the need for designing biosecurity interventions that consider human behavioral factors and the context in which behavior occurs. This underscores the importance of collaboration across disciplines, including veterinary science and the social and behavioral sciences. Implications and recommendations for researchers and practitioners are discussed.

Collaborative leadership to empower nurses to implement ABCDE emergency nursing in an emergency department in Nepal

PurposeEmergency medicine can save lives and in 2018 the World Health Assembly passed resolution 72.16 ensuring the role of emergency care in all health systems. With a continued global shortage of emergency physicians, with many low-medium-income countries (LMIC) still to develop emergency medicine as a speciality, the role of emergency nurses is critical to deliver the WHO Emergency Care System Framework (WHO, 2018). Emergency medicine doctors play a critical role in collaborating with nurses, in emergency medicine where nurses are often the first clinicians are often the first clinicians to interact with patients in emergency care settings, making up the majority of health-care professionals in LMIC (Mamalelala, 2024). Yet emergency nursing has yet to become established in Nepal, where nurses are often recruited to emergency departments, without having received any training in emergency or critical care treatment and management. The purpose of this paper is to outline a collaborative leadership approach to co-design an airway, breathing, circulation, disability, exposure (ABCDE) structured approach to an emergency nursing training module designed for nurses to feel empowered in the emergency department and to report on its findings.Design/methodology/approachThis study draws upon mixed methodology research, enrolling 30 nurses (n = 30) from an emergency department in a tertiary hospital in Nepal through three stages of the project: Stage 1: training module co-design, collaborative leadership exploring the rationale for a training module and core features of design based on the ABCDE of emergency medicine; Stage 2: quantitative data were collected to assess baseline pre- and post-intervention knowledge and follow-up knowledge assessment at 30 and 45 days; Stage 3: qualitative data were collected with 24/30 (80%) nurses to evaluate the impact and application of the nurses ABCDE learning 7 months post-training. The qualitative survey was undertaken using online Google Forms.FindingsNurses were fully engaged in the co-design and collaboration of the development of an ABCDE training module which was delivered over 3 h. Full engagement was secured from all nurses in the department, and there were statistically significant advances in ABCDE emergency knowledge from the baseline, however, this knowledge began to decrease at 30 and 45 days. A follow-up qualitative survey was distributed to nurses seven months after training with an 80% return rate, which reported a range of examples of how nurses were continuing to apply their learning in practice.Originality/valueThis training module for emergency nurses was designed collaboratively from the “bottom up” in a tertiary hospital in Nepal, recognising the need to develop emergency nursing in the emergency department. The data revealed promising findings, while knowledge decreased from the post-training questionnaire, qualitative evidence revealed significant changes in practice, with the greatest reported change in the management of the airway. While this training module has made a difference in the quality of care provided, there is a need for a country-wide strategy in this area otherwise it is likely that such an initiative will only be developed by hospitals at a local level (Lecky, 2014). Education and training initiatives for nurses that focus on an evidence-based approach to clinical practice can bridge the workforce gap in the short term, however, the Government of Nepal must decide on establishing a recognised post-graduate sub-specialty in emergency nursing, the duration of training, who should be trained and what curriculum should be followed (Lecky, 2014).

FACTORS AFFECTING THE ADOPTION OF ELECTRIC VEHICLES BY PUBLIC SERVICE VEHICLE OPERATORS IN KENYA

This research investigates the factors influencing the adoption of electric vehicles (EVs) among public service vehicle operators in Kenya. The study employs a descriptive survey design, encompassing 212 public vehicle operators in the country. The primary objectives include assessing the impact of cost, infrastructure development, knowledge, and social-cultural factors on the adoption of EVs by public service vehicle operators in Kenya. The study conducted in-depth interviews and focus group discussions with a selected subset of participants to gain deeper insights into the qualitative aspects of the study. The study reveals that cost, infrastructure development, knowledge, and social-cultural factors collectively influence the adoption landscape. High upfront costs and operational expenses pose significant barriers, emphasizing the need for financial incentives and supportive policies to make EVs more economically viable. Infrastructure development, particularly the establishment of a robust charging network, is crucial to alleviate range anxiety and enhance the practicality of EVs. Knowledge gaps among operators highlight the importance of educational programs and training initiatives to enhance understanding and promote the benefits of electric vehicles. Social-cultural factors, such as attitudes and perceptions, also shape adoption patterns, emphasizing the need for awareness campaigns to address misconceptions. In conclusion, a comprehensive strategy involving financial incentives, infrastructure development, knowledge dissemination, and cultural sensitization is recommended to foster the widespread adoption of electric vehicles in Kenya's public service transportation sector

Intrapreneurial Innovation in E-Commerce: Driving Fashion Business Growth

This study explores the application of intrapreneurship principles in the growth of the e-commerce fashion brand CultureBasic. Through qualitative methods, the research involved in-depth interviews with the company owner to investigate the impact of intrapreneurship on product innovation, customer orientation, and marketing strategies. The results show that intrapreneurship significantly enhances company performance through key mechanisms: skill development via continuous training and education initiatives, effective collaboration that emphasizes strategic discussions and team synergy, and proactive leadership that is inclusive and adaptive. These findings affirm that intrapreneurial practices not only help maintain competitive advantage but also relevance in the dynamic digital era. The implementation of intrapreneurial principles at CultureBasic has proven capable of sustainably boosting product innovation and developing dynamic marketing strategies, which in turn increases customer satisfaction and loyalty, providing significant competitive advantages. The potential impact of these results indicates that applying intrapreneurial principles can drive sustainable and innovative business success across various industries.

REMODELLING EDUCATION FOR STUDENTS IN NIGERIA BY PROVIDING RELEVANT SCIENCE, TECHNOLOGY, ENGINEERING, AND MATHEMATICS LEARNING (STEM).

Over the past thirty years, it is evident that there has been little change in the methodology of teaching Science, Technology, Engineering, And Mathematics (STEM) in Nigeria. Consequently, Nigerian students have lagged, encountering difficulties in science and math proficiency. Despite national reform initiatives aimed at enhancing the situation, the absence of uniformity and a unified effort has resulted in negligible alterations in instructional methods. This research examined data from student and teacher programs conducted by State Universal Basic Education Board (SUBEB). The focus was on two programs implemented over a two-year period: STEM Bootcamps for children and Teacher training initiatives. The results indicated that these programs successfully enhanced learning and forged a robust link to the real world. Even though it was their initial encounter with STEM pedagogy, both educators and students recognized its worth and found it advantageous in grasping the concepts addressed during the programs. These favorable outcomes sparked conversations about expanding the pilot programs and considering the ramifications for policy and future research.

Structured training initiative (STI) for caregivers of children on peritoneal dialysis: a prospective study of the impact on the rate of peritonitis.

Training caregivers performing PD is an important measure to prevent peritonitis. A low literacy rate hinders training in low-resource settings. We designed a structured training initiative (STI) and objective structured assessment (OSA) using visual and kinesthetic resources with minimal use of written resources. We studied the impact of STIs on caregivers' knowledge and practical skills and the rate of peritonitis. This prospective study conducted initial STI (iSTI) for caregivers of children initiating PD and retraining STI (rSTI) for those already on PD. OSA was administered after completion of training, and those scoring < 95% were retrained. Re-assessment was done at 3, 6, and 12months, and those who scored < 95% underwent re-training. The rate of PD peritonitis and the time to first peritonitis were compared between the STI group and the cohort on PD in our center who received standard training before STI (controls). Caregivers of 40 children were included. The median duration of iSTI and rSTI was 19.5 (18, 20) and 9 (9, 9.5) hrs, and the OSA scores were 97% (97%, 98%) and 96% (96%, 98%), respectively. Only 5% required retraining. There was a significant reduction in the rate of PD peritonitis (0.29 vs. 0.69 episodes/patient-year; p < 0.001) and longer time to peritonitis (189 vs. 69days; p < 0.001) in the STI group when compared to the controls (n = 32). STI was effective in training caregivers for peritoneal dialysis. There was a reduction in the rate of peritonitis and a longer time to first peritonitis in the STI cohort.

Multidisciplinary training initiative for postnatal clinical environments to increase staff’s confidence in managing babies requiring neonatal transitional care

Multidisciplinary training initiative for postnatal clinical environments to increase staff’s confidence in managing babies requiring neonatal transitional care

Literature Review on the Impact of Internal Management on Employee Performance in Enterprises

With the increasing competition among enterprises, the level of their own management and management ability largely determine their performance in business competition, and scholars in the field of business administration have long been concerned with this important issue. The main research question of this paper is how the internal management of enterprises affects the performance of employees. Firstly, this paper reviews the classical management theories; and then, it specifically analyses the impact of management tools such as enterprise training, salary management and welfare benefits on employee performance, and combines them with specific cases to analyse them, so that through the analysis of combining theory and practice, we can better promote the development and sustainable progress of enterprises.

Gender-based approaches for improving milk safety, value addition, and marketing among smallholder livestock farmers

In the context of Uganda, this study delves into gender-based strategies aimed at enhancing women’s engagement in milk safety, value addition, and marketing within smallholder livestock farming. The objectives were two-fold: first, to document the current practices of women in milk safety, value addition, and marketing channels; second, to examine the constraints, opportunities, and strategies related to the production of safe milk and milk products, along with accessing sustainable markets. Conducted in four sub-counties of the Kiruhura district, this research employed both qualitative participatory methods and structured questionnaires, including 12 focused group discussions and 20 key informant interviews with both women and men. Notably, 217 structured questionnaires were administered. The findings illuminate that women played a central role in milk processing, water provisioning, sanitation, and hygiene practices and were the primary contributors to milk value addition, particularly in the production of butter and ghee. Despite their active involvement, women face challenges in accessing adequate milk quantities, employ traditional labor-intensive procedures, and encounter difficulties in marketing their processed products. Men, often the household heads, held decision-making authority over milk consumption and controlled the selling of milk, contributing to gender disparities. Addressing these challenges necessitates comprehensive support, including training and capacity-building initiatives for both men and women in milk value addition, credit access, and market entry. The study underscores the potential for improved women’s access to milk quantities, particularly for butter and ghee production, to strengthen rural livelihoods and boost dairy production in Uganda.

Online Learning Resource Management System Utilization and College Students' Engagement at Zhongshan University

The study aimed to assess the extent of utilization of the Learning Resource Management System (LRMS) and its impact on student' engagement among 218 college students at ZhongShan College. Utilizing a descriptive correlational approach with a quantitative method, the study found that the students perceived a very high extent of utilization of LRMS, appreciating its clear instructions and regular access to reliable internet. Additionally, the students exhibited high engagement levels with the LRMS regarding online activities, academic relevance, collaboration, and social interaction. Notably, a significant relationship was observed between the extent of LRMS utilization and online academic relevance in students' engagement. The study suggests implementing training programs for students and teachers to enhance LRMS utilization, inform school policies, and promote awareness of its benefits. These findings lay the foundation for future training initiatives and policy enhancements within the educational institution.

Enhancing inclusive entrepreneurial activity through community engagement led by higher education institutions

Purpose While supporting entrepreneurship through government intervention has become a global phenomenon, the OECD (2021) has identified that several communities (including women, youth, seniors, unemployed and immigrants) remain under-represented in terms of entrepreneurial activity. Inclusive entrepreneurship policies seek to enhance economic and social inclusion and emphasise the significant contribution that people from within these communities could make to local and regional development if appropriate support was offered. The purpose of this study is to examine how higher education institutions (HEIs) can co-create inclusive entrepreneurial training initiatives with local communities that support economic and social inclusion. Design/methodology/approach This in-depth qualitative study draws on the experiences of multiple stakeholders to highlight how an HEI can enhance entrepreneurial activity within under-represented and disadvantaged communities through its community engagement initiatives. The research was conducted through a revelatory case study of an Irish HEI that is newly constituted and is developing an inner-city campus with a focus on community benefit. Rich qualitative data were collected through semi-structured interviews and participant observation of an HEI community engagement initiative with disadvantaged communities. Thematic analysis methods were used in the processes of generating codes, categories and themes leading to the findings of this study. Findings The study identified that broadening the interpretation of entrepreneurial activity to value creation and developing enterprising behaviour has significant relevance for disadvantaged communities. These communities may not have the capacity to start a business yet might benefit from the personal development aspects of entrepreneurial education. Moreover, findings indicate how HEIs are uniquely positioned to develop inclusive entrepreneurial education initiatives to redress social inequalities in their regions. Originality/value As an original contribution to knowledge, this paper extends traditional education frameworks to identify individual, collective and system-level considerations in the design and development of inclusive entrepreneurial education initiatives. This study contributes an evidence-based framework to guide HEIs and their regional partners in the future development of inclusive, tailored support through entrepreneurial education.

A Modern Curriculum for Training Scientists in Model-Informed Drug Development: Progress Report on FDA Grant to Train Regulatory Scientists.

Under US Food and Drug Administration (FDA) grant (2U18FD005320-06), the Critical Path Institute (C-Path) and experienced private sector partners collaborated with global health organizations to create didactic video materials in an e-learning format on model-informed drug development (MIDD) topics relevant to a non-modeling audience. Several multinational pharmaceutical companies contributed case studies illustrating the application of the MIDD approach in practice. Training videos were created and divided into several modules: introducing the MIDD landscape for drug development and regulatory science, a review of various model types used for MIDD, discussions of how models inform drug development and regulatory decisions, future goals of MIDD, and discussions on the interconnectedness of models used for MIDD. Examples and vignettes from stakeholders and thought leaders were included. These educational materials fill a gap between academic and "on the job training" for regulators, academic, and industry scientists, delivering insights and value for those performing modeling and non-modelers reviewing the output of modeling and simulation work. A total of 13 hours of video content is currently available. A small panel of FDA reviewers is currently beta-testing the learning management system (LMS). Future efforts for this MIDD training initiative will include expansion of the content via an expanded and diverse faculty, 1:1 online mentorship sessions, and eventually broader access to this resource consistent with an open science approach and curriculum. The MIDD training LMS can accommodate a diverse learning ecosystem; further development may also accommodate different audiences in the future.

Professional Development of Teacher Educators: Unlocking Opportunities through Massive Open Online Courses

Development of any nation depends mainly on the standards of its educational institutions and the quality of education. Amidst this dynamic environment, Massive Open Online Courses have emerged as a potent tool for facilitating continuous learning and skill enhancement among professionals across diverse domains. Professional development of teacher educators stands as a cornerstone for fostering effective teaching practices and nurturing the next generation of educators. This research seeks to explore the myriad ways in which MOOCs can be leveraged to enhance the professional development of teacher educators. This democratization of education fosters inclusivity and equity in teacher training initiatives. This paper aims to contribute to a deeper understanding of how digital technologies can be harnessed to empower educators, enhance teaching and learning outcomes, and ultimately, transform the landscape of teacher education. This paper concludes that MOOCs have emerged as an asset in the professional development toolkit for teacher educators. MOOCs provide accessible platforms where educators can engage in self-directed learning, access a wealth of resources, and collaborate with peers worldwide, transcending the limitations of traditional professional development methods. Pedagogical strategies in MOOCs are essential for professional development as they enhance learning experiences and outcomes. The flexibility and accessibility of MOOCs, combined with well-designed pedagogical approaches, empower individuals to advance their careers, and maintain lifelong learning, ultimately contributing to professional growth and competence.

Reconceptualization of textbook with the metaverse: pre-service English teachers’ experiences and perceptions of designing TechBoox

The main purpose of this study is to investigate the possibility of designing English textbooks based on the concept of the metaverse and using the new term TechBoox, which is a combination of Technology and Boox (modified from book with a greater emphasis on box as a spatial concept). To achieve this goal, this study documents the creation of TechBoox by a group of 23 pre-service English as a Foreign Language teachers in their teacher training program, who have converted learning content and materials from elementary English paper and digital textbooks into a three-dimensional metaverse platform. Thereafter, the research analyzes the participants’ perceptions and experiences regarding TechBoox ideation and creation. This is done through a qualitative case study approach with refleciton papers and semi-structured interviews. The findings suggest, on the one hand, that TechBoox has the potential to overcome the limitations of the static and two-dimensional nature of traditional textbooks through constructability for enhanced immersion, as well as experiential learning via direct participation in avatar movements. On the other hand, the study identifies the technological limitations of the concept in generating immersive content, access devices, potential distractions, and the novelty effect, which highlights the important role of teachers in the metaverse. Based on the findings, this study highlights the critical role of teacher training initiatives of emerging technology integration in language eudcaiton.

Consensus paper on the management of acute isolated vertigo in the emergency department

Acute vertigo is defined as the perception of movement of oneself or the surroundings in the absence of actual motion and it is a frequent cause for emergency department admissions. The utilization of medical resources and the duration of hospital stay for this kind of symptom is high. Furthermore, the efficiency of brain imaging in the acute phase is low, considering the limited sensitivity of both CT and MRI for diagnosing diseases that are the causes of central type of vertigo. Relying on imaging tests can provide false reassurance in the event of negative results or prolong the in-hospital work-up improperly. On the other hand, clinical examinations, notably the assessment of nystagmus’ features, have proven to be highly accurate and efficient when performed by experts. Literature data point out that emergency physicians often do not employ these skills or use them incorrectly. Several clinical algorithms have been introduced in recent years with the aim of enhancing the diagnostic accuracy of emergency physicians when evaluating this specific pathology. Both the ‘HINTS and ‘STANDING’ algorithms have undergone external validation in emergency physician hands, showing good diagnostic accuracy. The objective of this consensus document is to provide scientific evidence supporting the clinical decisions made by physicians assessing adult patients with acute vertigo in the emergency department, particularly in cases without clear associated neurological signs. The document aims to offer a straightforward and multidisciplinary approach. At the same time, it tries to delineate benchmarks for the formulation of local diagnostic and therapeutic pathways, as well as provide a base for the development of training and research initiatives.

Optimizing Talent Management Strategies for Enhanced Employee Engagement and Satisfaction in Automotive Sector

Examining the impact of talent management on organizational performance is a crucial part of talent management practices in shaping the success and sustainability of modern organizations. Talent management encompasses a wide range of HR strategies and processes, including recruitment, development, retention and succession planning. Using a multidisciplinary approach, this study attempts to assess the direct and indirect effects of talent management on organizational performance. It examines various aspects of talent management, such as leadership development, employee engagement and training initiatives, to ensure their impact on outcomes such as revenue growth, profitability, productivity and innovation. The research also examines the mediating effects of factors such as organizational culture and external conditions to achieve a comprehensive analysis. The results of this study will be invaluable to organizational leaders, HR professionals and policy makers seeking to optimize their talent management strategies. By shedding light on the most effective talent management practices and their long-term effects, this study aims to provide practical recommendations to improve organizational effectiveness, foster innovation and maintain competitive advantage in an ever-evolving business environment.

Nexuses between induction training and on the-job-training on employee job performance: the mediating role of organizational culture

Purpose The study aims to explore the mediating role of organizational culture in the relationship between on-the-job training (OJT), induction training and employee job performance. This study is conceptually grounded in Albert Bandura’s Social Cognitive Theory. The function that organizational culture plays as a mediator in the links between employee performance and on-the-job training and induction is a unique aspect of this study. Design/methodology/approach An industry-wide representation was ensured in the study by using a stratified random sampling technique to choose participants. The main characteristics pertaining to organizational culture, training initiatives and worker job performance were measured by using validated scales from earlier studies. For the purpose of validating the measurement model, factor loadings, internal consistency reliability and discriminant validity were evaluated through the use of partial least squares structural equation modelling in SmartPLS. Findings In support of Bandura’s Social Cognitive Theory, the study’s results show a strong association between work performance, organizational culture, on-the-job training and induction training. The study highlights the positive synergistic effect that supportive organizational culture and well-designed training programmes have on improving employee job performance. The unique contribution of this study is the provision of empirical support for these correlations across a wide range of industries, highlighting the crucial roles that organizational culture plays in promoting employee success. Originality/value Authors’ knowledge of how organizations may create environments that maximize worker productivity and potential is expanded by the study’s practical insights.

Predicting Employee Promotion using Machine Learning

Training and development are key components of professional development for people to improve their capacity. Professional development programs are typically organized around personal information like as background, personal goals, and work experience, as well as corporate objectives and job requirements. Individual employee classification is required to promote tailored training in the professional development process. As a result, this study provides a classification approach for employee classification in order to facilitate tailored training in enterprises. Machine learning methods such as Decision Tree, Random Forest, and Support Vector Machine are investigated. To cope with imbalance data, the Synthetic Minority Oversampling Technique (SMOTE) approach is applied. In this work, the open data form kaggle is used. The training and testing data are combined to generate the data for technique validation. There are three gropes: 80:20, 70:30, and 60:40. According to the classification results, the SMOTE can increase classification performance for all classifiers. Furthermore, random forest has the highest categorization accuracy.

The paradigm shift in science education: Namibian science teachers’ perceptions and experiences with inquiry-based instruction

This study explored Namibian science teachers’ perceptions of and approaches towards integrating inquiry-based instruction in science education. A survey questionnaire with 133 participants determined their opinions, attitudes, and beliefs revealing a strong preference for inquiry-based methods, with an average rating of 4.36 on a five-point Likert scale. Teachers emphasised its effectiveness in engaging learners, fostering critical thinking, and connecting scientific principles to real-world scenarios. The study examines key factors that impact the enactment of inquiry-based instruction, including teachers’ prior experiences, understanding of inquiry, and philosophical viewpoints on the nature of science. The findings from this study showed that the allocation of time in the curriculum, the behaviour of learners, and the availability of resources were recognised as important factors impeding the successful implementation of inquiry-based instruction. The study suggests tailored professional development to address challenges and enhance teachers’ ability to embrace inquiry-based practices effectively. These insights contribute to understanding determinants influencing innovative pedagogical approaches in Namibian science classrooms, informing educational policies and initiatives for teacher training in the country.

Trends in Continuation of Long-Acting Reversible Contraception Among Adolescents Receiving Medicaid

PurposeDespite increasing use of long-acting reversible contraception (LARC) among U.S. adolescents, there is limited literature on factors affecting intrauterine device (IUD) or subdermal implant use. This study aimed to describe statewide rates, and associated patient and provider factors of adolescent IUD or implant initiation and continuation. MethodsThis retrospective cohort study used N.C. Medicaid claims data. 10,408 adolescents were eligible (i.e., 13–19 years, female sex, continuous Medicaid enrollment, had an IUD or implant insertion or removal code from January 1, 2013, to October 1, 2015). Bivariate analyses assessed differences in adolescents using IUD versus implant. Kaplan-Meier curves were created to assess IUD or implant discontinuation through December 31, 2018. ResultsAdolescents initiated 8,592 implants and 3,369 IUDs (N = 11,961). There were significant differences in nearly all provider and patient factors for those who initiated implants versus IUDs. 16% of implants and 53% of IUDs were removed in the first year. Younger (i.e., age <18 years old), Hispanic, and Black adolescents had higher adjusted continuation of implants compared with older and White adolescents, respectively (both p < .001). Those whose IUD was inserted by an obstetrician/gynecologist provider had lower continuation of IUDs compared with non-obstetrician/gynecologist providers (p < .001). DiscussionWe found that age-related, racial, and ethnic disparities exist in both implant and IUD continuation. Practice changes to support positive adolescent experiences with implant and IUD insertion and removals are needed, including patient-centered health care provider training in contraception counseling, LARC initiation and removal training for adolescent-facing providers, and broader clinic capacity for LARC services.