A systematic review of lethal means safety counseling interventions: impacts on safety behaviors and self-directed violence.

For lethal means safety counseling (LMSC) interventions to reduce population-level suicide rates, interventions must be deployed across many settings and populations. We conducted a systematic search in 6 databases to review the current state of LMSC interventions across study designs, settings, intervention providers, populations, and injury prevention levels (eg, universal). Eligibility criteria were as follows: any individual or group receiving an LMSC intervention involving a human-to-human component aiming to influence adult behaviors related to lethal suicide methods, and outcome assessment of storage behaviors and/or suicidal self-directed violence (SDV). Risk of bias was assessed using the Effective Public Health Practice Project quality assessment tool. A descriptive synthesis approach was used for analysis. Twenty-two studies were included that reported medication- and/or firearm-storage behaviors and/or SDV after LMSC. Of the 19 studies assessing behavioral change, 14 reported a significant improvement in safe storage behaviors, and all studies measuring acceptability reported that participants found the interventions favorable. The quality of evidence was limited. No studies were rated low risk of bias, and 77% were rated high risk of bias. There was substantial heterogeneity in the settings, populations, injury prevention levels, delivery methods, and intervention elements. Many included studies focused on caregivers of pediatric populations, and few studies assessed SDV outcomes. Higher-quality trials conducted across a variety of settings, particularly those focusing on adults at risk of suicide, are needed. This review was preregistered with the International Prospective Register of Systematic Reviews (no. CRD42021230668).

The Care and Management of Children and Young People with Ataxia Telangiectasia Provided by Nurses and Allied Health Professionals: a Scoping Review.

Ataxia telangiectasia (A-T) is a rare, multisystem progressive condition that typically presents in early childhood. In the absence of cure, people with A-T require coordinated multidisciplinary care to manage their complex array of needs and to minimize the disease burden. Although symptom management has proven benefits for this population, including improved quality of life and reduced complications, there is a need for guidance specific to the nursing and allied healthcare teams who provide care within the community. A scoping review, adopting the Joanna Briggs Institute methodology, was undertaken. It aimed to identify and map the available expertise from nursing and allied healthcare and management of children and young people with A-T ≤ 18 years of age. A rigorous search strategy was employed which generated a total of 21,118 sources of evidence, of which 50 were selected for review following screening by experts. A range of interventions were identified that reported a positive impact on A-T-related impairments, together with quality of life, indicating that outcomes can be improved for this population. Most notable interventions specific to A-T include therapeutic exercise, inspiratory muscle training, and early nutritional assessment and intervention. Further research will be required to determine the full potential of the identified interventions, including translatability to the A-T setting for evidence related to other forms of ataxia. Large gaps exist in the nursing and allied health evidence-base, highlighting a need for robust research that includes children and young people with A-T and their families to better inform and optimize management strategies.

An examination of retracted articles in nursing literature.

INTRODUCTION: The output of scholarly publications in scientific literature has increased exponentially in recent years. This increase in literature has been accompanied by an increase in retractions. Although some of these may be attributed to publishing errors, many are the result of unsavory research practices. The purposes of this study were to identify the number of retracted articles in nursing and reasons for the retractions, analyze the retraction notices, and determine the length of time for an article in nursing to be retracted. DESIGN: This was an exploratory study. METHODS: A search of PubMed/MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, and Retraction Watch databases was conducted to identify retracted articles in nursing and their retraction notices. RESULTS: Between 1997 and 2022, 123 articles published in the nursing literature were retracted. Ten different reasons for retraction were used to categorize these articles with one-third of the retractions (n = 37, 30.1%) not specifying a reason. Sixty-eight percent (n = 77) were retracted because of an actual or a potential ethical concern: duplicate publication, data issues, plagiarism, authorship issues, and copyright. CONCLUSION: Nurses rely on nursing-specific scholarly literature as evidence for clinical decisions. The findings demonstrated that retractions are increasing within published nursing literature. In addition, it was evident that retraction notices do not prevent previously published work from being cited. This study addressed a gap in knowledge about article retractions specific to nursing.

Starting From Scratch: Husbandry Techniques to Establish the First Population of 'Akikiki (Oreomystis bairdi) in Human Care Using Wild-Collected Eggs.

Conservation breeding programs can save species from extinction by establishing assurance populations that provide individuals for achieving species recovery goals in the wild. However, keeping animals in human care can result in the selection of phenotypes that may be suboptimal for post-release survival and reproduction. It is therefore essential that conservation breeding programs provide animals with naturalistic conditions that facilitate the performance of species-typical behaviors, an endeavor that is also a vital aspect of animal welfare. Here, we describe how we established a conservation breeding program for the 'Akikiki (Oreomystis bairdi), a Hawaiian honeycreeper that is facing imminent extinction in the wild. We share how we utilized the species' native habitat as a template for developing husbandry practices with a primary focus on how we simulate wild environmental conditions in enclosures, mimic naturalistic foraging experiences, and facilitate pair bonding and parental breeding behaviors.

Acrylate-Induced ß-H Elimination in Coordination Insertion Copolymerizaton Catalyzed by Nickel.

Polar monomer-induced ß-H elimination is a key elementary step in polar polyolefin synthesis by coordination polymerization but remains underexplored. Herein, we show that a bulky neutral Ni catalyst, 1Ph, is not only a high-performance catalyst in ethylene/acrylate copolymerization (activity up to ∼37,000 kg/(mol·h) at 130 °C in a batch reactor, mol % tBA ∼ 0.3) but also a suitable platform for investigation of acrylate-induced ß-H elimination. 4Ph-tBu, a novel Ni alkyl complex generated after acrylate-induced ß-H elimination and subsequent acrylate insertion, was identified and characterized by crystallography. A combination of catalysis and mechanistic studies reveals effects of the acrylate monomer, bidentate ligand, and the labile ligand (e.g., pyridine) on the kinetics of ß-H elimination, the role of ß-H elimination in copolymerization catalysis as a chain-termination pathway, and its potential in controlling the polymer microstructure in polar polyolefin synthesis.

Effect of heat treatment on protein quality of rapeseed protein isolate compared with non-heated rapeseed isolate, soy and whey protein isolates, and rice and pea protein concentrates.

BACKGROUND: Rapeseed protein isolate is used in the food industry, and heating is often used during rapeseed processing. However, the digestible indispensable amino acid score (DIAAS) for heat-treated rapeseed protein isolate is unknown. The present study aimed to test the hypothesis that heating rapeseed protein isolate improves protein quality resulting in DIAAS that is greater than for pea and rice protein concentrates, and comparable to that of soy and whey protein isolates. RESULTS: Standardized ileal digestibility (SID) of amino acids (AA), except leucine and methionine, was not different between heat-treated rapeseed protein isolate and soy protein isolate, but SID of most AA was greater (P < 0.001) for heat-treated rapeseed protein isolate than for brown rice protein concentrate, pea protein concentrate, rapeseed protein isolate and soy protein isolate, but not whey protein isolate. Non-heated rapeseed protein isolate had a reduced (P < 0.001) DIAAS for 6-month-old to 3-year-old children compared with soy protein isolate, but this was greater (P < 0.001) than for pea and brown rice protein concentrates. The DIAAS for heat-treated rapeseed protein isolate was greater (P < 0.001) than for non-heated rapeseed protein isolate for all age groups. Heat-treated rapeseed protein isolate and whey protein isolate had a DIAAS > 100 for individuals older than 3 years. CONCLUSION: Rapeseed protein isolate had a DIAAS comparable to soy protein isolate, but heat-treated rapeseed protein isolate and whey protein isolate had DIAAS ≥ 100, qualifying these proteins as 'excellent'. Rice and pea protein concentrates had DIAAS < 75. © 2023 Society of Chemical Industry.

Sustainability of the Collaborative Chronic Care Model in Outpatient Mental Health Teams Three Years Post-Implementation: A Qualitative Analysis.

Our goal was to investigate the sustainability of care practices that are consistent with the collaborative chronic care model (CCM) in nine outpatient mental health teams located within US Department of Veterans Affairs (VA) medical centers, three to four years after the completion of CCM implementation. We conducted qualitative interviews (N = 30) with outpatient mental health staff from each of the nine teams. We based our directed content analysis on the six elements of the CCM. We found variable sustainability of CCM-based care processes across sites. Some care processes, such as delivery of evidence-based psychotherapies (EBPs) and use of measurement-based care (MBC) to guide clinic decision-making, were robustly maintained or even expanded within participating teams. In contrast, other care processes-which had in some cases been developed with considerable effort-had not been sustained. For example, care manager roles were diminished in scope or eliminated completely in response to workload pressures, frontline care needs, or the COVID-19 pandemic. Similarly, processes for engaging Veterans more fully in decision-making had generally been scaled back. Leadership support in the form of adequate team staffing and time to conduct team meetings were seen as crucial for sustaining CCM-consistent care. Given the potential impact of leadership turnover on sustainability in mental health, future efforts to implement CCM-based mental health care should strive to involve multiple leaders in implementation and sustainment efforts, lest one key departure undo years of implementation work. Our results also suggest that implementing CCM processes may best be conceptualized as a partnership across multiple levels of medical center leadership.

Digestible indispensable amino acid score (DIAAS) is greater in animal-based burgers than in plant-based burgers if determined in pigs.

PURPOSE: Determine digestible indispensable amino acid score (DIAAS) for animal- and plant-based burgers and test the hypothesis that DIAAS calculated for a burger and a burger bun is additive in a combined meal. METHODS: Ten ileal cannulated gilts were fed experimental diets for six 9-d periods with ileal digesta being collected on d 8 and 9 of each period. Six diets contained a burger (i.e., 80% lean beef, 93% lean beef, 80% lean pork, Impossible Burger, or Beyond Burger) or a burger bun as the sole source of crude protein and amino acids. Three additional diets were based on a combination of the bun and 80% beef, pork, or Impossible Burger. A nitrogen-free diet was also used. The DIAAS for all ingredients and mixed meals was calculated for children from 6 months to 3 years and for individuals older than 3 years, and DIAAS for combined meals was predicted from individual ingredient DIAAS. RESULTS: The 93% lean beef and the pork burgers had greater (P < 0.05) DIAAS than the plant-based burgers for both age groups. The 80% lean beef burger had greater (P < 0.05) DIAAS than the plant burgers for children from 6 months to 3 years, and greater (P < 0.05) DIAAS than the Beyond Burger for individuals older than 3 years. There were no differences between the measured and predicted DIAAS. CONCLUSIONS: The protein quality of animal-based burgers is greater than that of plant-based burgers. However, for individuals older than 3 years, the Impossible Burger has comparable protein quality to the 80% lean beef burger. The DIAAS obtained from individual foods is additive in mixed meals.

Highly Active and Thermally Robust Nickel Enolate Catalysts for the Synthesis of Ethylene-Acrylate Copolymers.

The insertion copolymerization of polar olefins and ethylene remains a significant challenge in part due to catalysts' low activity and poor thermal stability. Herein we demonstrate a strategy toward addressing these obstacles through ligand design. Neutral nickel phosphine enolate catalysts with large phosphine substituents reaching the axial positions of Ni achieve activity of up to 7.7×103  kg mol-1 h-1 (efficiency >35×103  g copolymer/g Ni) at 110 °C, notable for ethylene/acrylate copolymerization. NMR analysis of resulting copolymers reveals highly linear microstructures with main-chain ester functionality. Structure-performance studies indicate a strong correlation between axial steric hindrance and catalyst performance.

Values for Digestible Indispensable Amino Acid Score (DIAAS) Determined in Pigs Are Greater for Milk Than for Breakfast Cereals, but DIAAS Values for Individual Ingredients Are Additive in Combined Meals.

BACKGROUND: Breakfast cereals contain low-quality proteins and are often consumed with milk. The digestible indispensable amino acid score (DIAAS) has been used to evaluate protein quality, but it is not known if DIAAS obtained in individual foods is additive in combined meals. OBJECTIVES: The following hypotheses were tested: amino acids (AAs) in milk complement AAs in breakfast cereals to provide a balanced meal, and DIAAS in individual foods is additive in combined meals. METHODS: Six ileal cannulated gilts [body weight mean: 55.6 ± 3.7 (SD) kg] were allotted to a 6 × 6 Latin square with six 7-d periods. Ileal digesta were collected for 9 h on days 6 and 7 of each period. Three diets contained a breakfast cereal (i.e., cornflakes or quick oats) or dry milk as the sole source of AAs. Two additional diets contained a combination of dry milk and cornflakes or quick oats. A nitrogen-free diet was also used, and DIAAS was calculated for cornflakes, quick oats, dry milk, and the 2 combined meals for children aged 6 to 36 mo and individuals older than 36 mo through adulthood. For the combined meals, DIAAS was also predicted from the individual ingredient DIAAS. RESULTS: Dry milk had greater (P < 0.05) DIAAS (123 and 144) than quick oats (57 and 67), but cornflakes had less (P < 0.05) DIAAS (16 and 19) than the other ingredients. Both breakfast cereal-dry milk meals had DIAAS close to or greater than 100 for children aged 6 mo to 3 y and for older children, adolescents, and adults, but there were no differences between measured and predicted DIAAS. CONCLUSIONS: The combination of milk and breakfast cereals results in a meal that is balanced in indispensable AAs for humans, and DIAAS obtained from individual ingredients is additive in mixed meals.

Plant and soil nitrogen in oligotrophic boreal forest habitats with varying moss depths: does exclusion of large grazers matter?

The boreal forest consists of drier sunlit and moister-shaded habitats with varying moss abundance. Mosses control vascular plant-soil interactions, yet they all can also be altered by grazers. We determined how 2 decades of reindeer (Rangifer tarandus) exclusion affect feather moss (Pleurozium schreberi) depth, and the accompanying soil N dynamics (total and dissolvable inorganic N, δ15N), plant foliar N, and stable isotopes (δ15N, δ13C) in two contrasting habitats of an oligotrophic Scots pine forest. The study species were pine seedling (Pinus sylvestris L.), bilberry (Vaccinium myrtillus L.), lingonberry (V. vitis-idaea L.), and feather moss. Moss carpet was deeper in shaded than sunlit habitats and increased with grazer exclusion. Humus N content increased in the shade as did humus δ15N, which also increased due to exclusion in the sunlit habitats. Exclusion increased inorganic N concentration in the mineral soil. These soil responses were correlated with moss depth. Foliar chemistry varied due to habitat depending on species identity. Pine seedlings showed higher foliar N content and lower foliar δ15N in the shaded than in the sunlit habitats, while bilberry had both higher foliar N and δ15N in the shade. Thus, foliar δ15N values of co-existing species diverged in the shade indicating enhanced N partitioning. We conclude that despite strong grazing-induced shifts in mosses and subtler shifts in soil N, the N dynamics of vascular vegetation remain unchanged. These indicate that plant-soil interactions are resistant to shifts in grazing intensity, a pattern that appears to be common across boreal oligotrophic forests.

Pork Products Have Digestible Indispensable Amino Acid Scores (DIAAS) That Are Greater Than 100 When Determined in Pigs, but Processing Does Not Always Increase DIAAS.

BACKGROUND: Raw meat contains all indispensable amino acids (IAAs), but before human consumption, meat usually undergoes some degree of processing. Processing affects the 3-dimensional structure of proteins, which may affect amino acid (AA) digestibility and, therefore, overall protein quality. OBJECTIVES: The experiment aimed at determining digestible indispensable amino acid scores (DIAAS) for pork products, and to test the hypothesis that processing increases DIAAS. METHODS: Ten ileal cannulated gilts (body weight: 26.63 ± 1.62 kg) were randomly allotted to a 10 × 10 Latin square design with ten 7-d periods. Ileal digesta were collected for 9 h on days 6 and 7 of each period. Nine diets contained a single pork product (i.e., raw belly, smoked bacon, smoked-cooked bacon, non-cured ham, alternatively cured ham, conventionally cured ham, and loins heated to 63°C, 68°C, or 72°C) as the sole source of AAs. A nitrogen-free diet was formulated to determine basal endogenous losses of AAs, which enabled calculation of standardized ileal digestibility (SID) of AAs. DIAAS were subsequently calculated according to the FAO. RESULTS: All pork products had DIAAS >100 (as-is basis). Loin heated to 63°C had the greatest (P < 0.05) DIAAS for children 6 mo to 3 y and smoked-cooked bacon had the greatest (P < 0.05) DIAAS for children older than 3 y, adolescents, and adults. Raw belly, smoked bacon, and loins heated to 68°C and 72°C had a reduced (P < 0.05) DIAAS for both reference patterns compared with other proteins. Alternatively cured ham had greater (P < 0.05) DIAAS when compared with non-cured ham and conventionally cured ham. CONCLUSIONS: Bacon, ham, and loin are excellent proteins with DIAAS >100, and processing may sometimes, but not always, increase DIAAS.

Most meat products have digestible indispensable amino acid scores that are greater than 100, but processing may increase or reduce protein quality.

An experiment was conducted to test the hypothesis that meat products have digestible indispensable amino acid scores (DIAAS) >100 and that various processing methods will increase standardised ileal digestibility (SID) of amino acids (AA) and DIAAS. Nine ileal-cannulated gilts were randomly allotted to a 9 × 8 Youden square design with nine diets and eight 7-d periods. Values for SID of AA and DIAAS for two reference patterns were calculated for salami, bologna, beef jerky, raw ground beef, cooked ground beef and ribeye roast heated to 56, 64 or 72°C. The SID of most AA was not different among salami, bologna, beef jerky and cooked ground beef, but was less (P < 0·05) than the values for raw ground beef. The SID of AA for 56°C ribeye roast was not different from the values for raw ground beef and 72°C ribeye roast, but greater (P < 0·05) than those for 64°C ribeye roast. For older children, adolescents and adults, the DIAAS for all proteins, except cooked ground beef, were >100 and bologna and 64°C ribeye roast had the greatest (P < 0·05) DIAAS. The limiting AA for this age group were sulphur AA (beef jerky), leucine (bologna, raw ground beef and cooked ground beef) and valine (salami and the three ribeye roasts). In conclusion, meat products generally provide high-quality protein with DIAAS >100 regardless of processing. However, overcooking meat may reduce AA digestibility and DIAAS.

Raw and roasted pistachio nuts (Pistacia vera L.) are 'good' sources of protein based on their digestible indispensable amino acid score as determined in pigs.

BACKGROUND: Pistachio nuts may be consumed as raw nuts or as roasted nuts. However, there is limited information about the protein quality of the nuts, and amino acid (AA) digestibility and protein quality have not been reported. Therefore, the objective of this research was to test the hypothesis that raw and roasted pistachio nuts have a digestible indispensable AA score (DIAAS) and a protein digestibility corrected AA score (PDCAAS) greater than 75, thereby qualifying them as a good source of protein. RESULTS: The standardized ileal digestibility (SID) of all indispensable AAs, except arginine and phenylalanine, was less in roasted pistachio nuts than in raw pistachio nuts (P < 0.05). Raw pistachio nuts had a PDCAAS of 73, and roasted pistachio nuts had a PDCAAS of 81, calculated for children 2-5 years, and the limiting AA in the PDCAAS calculation was threonine. The DIAAS values calculated for children older than 3 years, adolescents, and adults was 86 and 83 for raw and roasted pistachio nuts respectively. The limiting AA in both raw and roasted pistachio nuts that determined the DIAAS for this age group was lysine. CONCLUSION: The results of this research illustrate that raw and roasted pistachio nuts can be considered a good quality protein source with DIAAS greater than 75; however, processing conditions associated with roasting may decrease the digestibility of AAs in pistachio nuts. © 2020 Society of Chemical Industry.

Acyl-chain elongation drives ketosynthase substrate selectivity in trans-acyltransferase polyketide synthases.

Type I modular polyketide synthases (PKSs), which are responsible for the biosynthesis of many biologically active agents, possess a ketosynthase (KS) domain within each module to catalyze chain elongation. Acylation of the KS active site Cys residue is followed by transfer to malonyl-ACP to yield an extended ß-ketoacyl chain (ACP = acyl carrier protein). To date, the precise contribution of KS selectivity in controlling product fidelity has been unclear. Six KS domains from trans-acyltransferase (trans-AT) PKSs were subjected to a mass spectrometry based elongation assay, and higher substrate selectivity was identified for the elongating step than in preceding acylation. A close correspondence between the observed KS selectivity and that predicted by phylogenetic analysis was seen. These findings provide insights into the mechanism of KS selectivity in this important group of PKSs, can serve as guidance for engineering, and show that targeted mutagenesis can be used to expand the repertoire of acceptable substrates.

How Parkinson's Disease-Linked LRRK2 Mutations Affect Different CNS Cell Types.

LRRK2 is a relatively common genetic risk factor for Parkinson's disease (PD), with six coding variants known to cause familial PD. Non-coding variation at the same locus is also associated with sporadic PD. LRRK2 plays a role in many different intracellular signaling cascades including those involved in endolysosomal function, cytoskeletal dynamics, and Ca2+ homeostasis. PD-causing LRRK2 mutations cause hyperactive LRRK2 kinase activity, resulting in altered cellular signaling. Importantly, LRRK2 is lowly expressed in neurons and prominently expressed in non-neuronal cells in the brain. In this review, we will summarize recent and novel findings on the effects of PD-causing LRRK2 mutations in different nervous system cell types. This review will also provide novel insight into future areas of research at the intersection of LRRK2 cell biology, cell type specificity, and PD.

Addition of Spray-Dried Plasma in Phase 2 Diets for Weanling Pigs Improves Growth Performance, Reduces Diarrhea Incidence, and Decreases Mucosal Pro-Inflammatory Cytokines.

The hypothesis that pigs fed a low crude protein (CP) diet with 6% spray-dried plasma (SDP) in phase 1 will have improved growth and intestinal health if the phase-2 diet contains 2.5% SDP was tested. Three hundred weaned pigs were used. Growth performance, feces, blood, and intestinal tissue were evaluated. Pigs fed 6% SDP in phase 1 had improved average daily gain (ADG) and final body weight (BW), but had reduced villus-height-to-crypt-depth ratio in phase 2 if 2.5% SDP was included in the normal-CP diet (p < 0.05), but not in the low-CP diet. Diarrhea incidence was less (p < 0.05) with 2.5% SDP in the phase 2 diet and for the low-CP diet. Ileal mucosa interleukin-1α (IL-1α) and IL-1ß decreased (p < 0.05) for pigs fed the phase-1 diet with 6% SDP compared with pigs fed the diet without SDP. Addition of 2.5% SDP in phase 2 reduced (p < 0.05) IL-1ß compared with the diet without SDP. Although the combination of SDP and low CP did not affect intestinal health in phase 2, diarrhea incidence and pro-inflammatory cytokines were reduced in pigs fed SDP in phase 1 or phase 2 or if a low-CP diet was fed.

Bibliometric analysis of nursing education reviews.

BACKGROUND: While the number of reviews of nursing education research has increased over the years, bibliometric studies about these reviews are limited. OBJECTIVES: The purposes were to: (1) examine the number of reviews of nursing education research published from 2018 through 2022, (2) identify journals publishing these reviews, (3) identify the types and topics of reviews in nursing education, and (4) analyze how these reviews are labeled (standard versus nonstandard). DESIGN: This was a bibliometric study of reviews in nursing education. METHODS: The search for reviews in nursing education was done using CINAHL Complete via the EBSCO host platform and was limited to articles published in peer reviewed journals. The results were imported into EndNote, and the title or abstract was used to identify the review type. The categorized reviews were then exported into Microsoft Excel. The titles and abstracts were searched to identify reviews in nursing education, resulting in 600 articles analyzed in this study. The topics of the reviews were identified via natural language processing techniques based on the Medical Subject Headings biomedical vocabulary in the manual tags with each article. RESULTS: The number of reviews has steadily increased over the years. The top journal in which reviews were published was Nurse Education Today (n = 197). Nearly a quarter (n = 149, 24.8 %) of the reviews were integrative, followed by systematic (n = 117, 19.5 %), scoping (n = 117, 19.5 %), and literature (n = 85, 14.2 %). There were 12 main topics: most reviews were on simulation, followed by critical thinking methods and the academic achievement of nursing students. CONCLUSION: This study documented an increase in the number of reviews of nursing education research over the last five years. The most common type was an integrative review, followed by systematic, scoping, and literature. Reviews on simulation were most common.

Lessons learnt from the implementation of the Covid-19 vaccination programme in the Southwest of England.

BACKGROUND: Vaccination remains one of the most successful public health interventions in preventing severe disease and death. The roll-out of Covid-19 vaccination programmes has helped protect billions of people around the world against Covid-19. Most of these programmes have been unprecedented in terms of scale and resources, and have been implemented at times of significant humanitarian crisis. This study aims to outline the lessons learnt from the implementation of a regional Covid-19 vaccination programme. These will help inform emergency preparedness and future crisis management. METHODS: This qualitative study sought to explore the key drivers to the successful implementation of the Covid-19 vaccination programme in a region in the Southwest of England, applying the Normalisation Process Theory lens (NPT) to examine multi-stakeholder perspectives. Data collection involved semi-structured interviews with 75 participants. Document analysis was also used to corroborate the findings emerging from the interviews. Inductive thematic analysis of the data was used to identify the key drivers for the successful implementation of the programme. The NPT lens was then applied to map the themes identified to the domains and constructs of the framework. RESULTS: Ten key drivers to the successful implementation of the Covid-19 vaccination programme locally were identified, including: the clarity and consistency of the programme's goal; the diverse representation of stakeholders within the programme leadership team and the mechanisms created by this team to ensure psychological safety, autonomy, operational flexibility and staff empowerment; Communication and data specialists' input, and collaboration with local communities to maximise the reach of the programme; and allocating funding to tackle health inequalities. CONCLUSIONS: This study highlights the lessons learnt from the implementation of the Covid-19 vaccination programme at a local level, and the mechanisms that can be used in future crises to respond efficiently to the needs of individuals, communities and governments.

Sustaining the collaborative chronic care model in outpatient mental health: a matrixed multiple case study.

BACKGROUND: Sustaining evidence-based practices (EBPs) is crucial to ensuring care quality and addressing health disparities. Approaches to identifying factors related to sustainability are critically needed. One such approach is Matrixed Multiple Case Study (MMCS), which identifies factors and their combinations that influence implementation. We applied MMCS to identify factors related to the sustainability of the evidence-based Collaborative Chronic Care Model (CCM) at nine Department of Veterans Affairs (VA) outpatient mental health clinics, 3-4 years after implementation support had concluded. METHODS: We conducted a directed content analysis of 30 provider interviews, using 6 CCM elements and 4 Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) domains as codes. Based on CCM code summaries, we designated each site as high/medium/low sustainability. We used i-PARIHS code summaries to identify relevant factors for each site, the extent of their presence, and the type of influence they had on sustainability (enabling/neutral/hindering/unclear). We organized these data into a sortable matrix and assessed sustainability-related cross-site trends. RESULTS: CCM sustainability status was distributed among the sites, with three sites each being high, medium, and low. Twenty-five factors were identified from the i-PARIHS code summaries, of which 3 exhibited strong trends by sustainability status (relevant i-PARIHS domain in square brackets): "Collaborativeness/Teamwork [Recipients]," "Staff/Leadership turnover [Recipients]," and "Having a consistent/strong internal facilitator [Facilitation]" during and after active implementation. At most high-sustainability sites only, (i) "Having a knowledgeable/helpful external facilitator [Facilitation]" was variably present and enabled sustainability when present, while (ii) "Clarity about what CCM comprises [Innovation]," "Interdisciplinary coordination [Recipients]," and "Adequate clinic space for CCM team members [Context]" were somewhat or less present with mixed influences on sustainability. CONCLUSIONS: MMCS revealed that CCM sustainability in VA outpatient mental health clinics may be related most strongly to provider collaboration, knowledge retention during staff/leadership transitions, and availability of skilled internal facilitators. These findings have informed a subsequent CCM implementation trial that prospectively examines whether enhancing the above-mentioned factors within implementation facilitation improves sustainability. MMCS is a systematic approach to multi-site examination that can be used to investigate sustainability-related factors applicable to other EBPs and across multiple contexts.