Bisphenol A diglycidyl ether (BADGE) is a diepoxide product used in the synthesis of epoxy resins. Its genotoxic properties were strongly suggested by its ability to induce mutations and micronuclei, but the exact nature of the underlying DNA damage remains to be established. For this purpose, we first applied cellular tests (the Comet assay and 53BP1 immunostaining) to show that direct induction of strand breaks was not the favored genotoxic pathway for BADGE. Consequently, we investigated the formation of DNA adducts using UHPLC coupled with tandem mass spectrometry (UHPLC-MS/MS) analysis following enzymatic hydrolysis. Analyses using single-stage mass spectrometry, product ion scan, and neutral loss monitoring showed that BADGE readily formed monoadducts with DNA bases. The structural assignments were confirmed by the results of accurate thermal degradation studies, which showed that BADGE reacted with DNA like other aliphatic epoxides. We also obtained unambiguous evidence that the reaction of BADGE with DNA led to the formation of biadducts between nonadjacent bases. This was explained by the transient formation of monoadducts bearing a BADGE moiety with an unreacted epoxide group. A sensitive quantitative UHPLC-MS/MS assay was then developed for the detection of BADGE adducts in cellular DNA. All the adducts identified in isolated DNA were also detected in cellular DNA. The proportions between the monoadducts were similar, but the relative yield of biadducts was lower in cellular than in isolated DNA. A time-course study of the level of adducts in DNA also showed that BADGE adducts were substrates for the cellular repair machinery. The present results definitively show that BADGE is a DNA-damaging chemical. The detected adducts represent novel biomarkers of the genotoxicity of BADGE.
Social connection is essential for well-being, yet people often avoid interacting with strangers due to concerns about conversation quality or a lack of shared interests. This study investigates whether the Happy to Chat badge can act as a behavioural nudge to promote social connectedness. Using a nationally representative online sample of 1,738 adults in England (via YouGov), we tested whether wearing the badge influences perceptions of friendliness, trustworthiness, and interest in conversation, as well as social behaviours such as smiling, eye contact, nodding, and willingness to initiate a chat. Results show that badge wearers are perceived as significantly more friendly, trustworthy, and open to conversation, and are more likely to receive social acknowledgements, although wearing the badge did not significantly increase others' intention to initiate conversation. Age and gender effects were also observed, with older and female targets generally receiving more favourable social responses. These findings suggest that while the badge effectively promotes social recognition, it may be insufficient on its own to overcome deeper psychological barriers to initiating conversations with strangers. This paper confirms the effectiveness of the Happy to Chat badge as a nudge to promote social connectedness within communities and highlights its practical implications.
A recent meta-analysis concluded that the badge of status hypothesis is the most parsimonious explanation for an observed association between measures of aggression and the degree or area of coloration across animals. We argue that the premise for the conclusion that aggression and coloration are positively associated relies on a biased, largely incomplete and heterogeneous representation of the available evidence. In addition, we identified severe problems with the calculation and interpretation of the correlations and the heterogeneity, as well as with data extraction and the publication bias tests. Our re-analyses challenge the original conclusions. Once heterogeneity-which, in contrast to the original study, our re-analysis shows to be high-and publication bias are properly assessed and accounted for, we find low generality of the relationship between aggression and coloration across animals. In addition, our analyses suggest that evidence changes dramatically depending on the source of the effect size, with evidence obtained directly from correlations and mean group comparisons being statistically nonsignificant and largely different from evidence obtained by transforming inferential statistics (t, F, and χ 2), which raises strong methodological concerns. Furthermore, by re-extracting 11 out the 74 studies included in the original meta-analysis (15%), we found errors and inconsistencies that raise further concerns about the validity of the full dataset. We give directions to guide future meta-analytic efforts in this and other topics, showcasing common misunderstandings in systematic reviews and meta-analyses, including effect size calculation and transformation. We conclude that after 50 years since its conception, the jury is still out regarding the validity and generality of the badge of status hypothesis to explain individual differences in coloration traits across animals.
A new compact three-element Extremity Ring Badge (ERB) dosemeter has been developed for extremity dose monitoring of Indian radiation workers. This three-element dosemeter is based on indigenously developed CaSO4:Dy-Teflon discs as a thermoluminescent detector placed between suitable filters in a plastic holder. The dosemeter is designed and calibrated to measure the dose equivalent in terms of operational quantity Hp(0.07) at finger location. It can measure the doses from gamma, beta, and low-energy X-ray radiations and distinguish the beam quality (photon/beta) as well. The design features and results of the experimental studies conducted towards development of ERB dosemeter are presented. The dosemeter demonstrated satisfactory performance in the European Radiation Dosimetry Group (EURADOS) interlaboratory exercise (IC2024ext). The response of all test dosemeters were well within the trumpet curve, as per IEO 14146:2018 criteria, which validates the dose evaluation algorithm used for estimation of Hp(0.07) in the IC2024ext exercise.
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Assembly quality is frequently assessed using independent measures of assembly span, contiguity, sequence composition, and completeness. Among contiguity metrics, contig, and scaffold N50 have perhaps gained the most traction, despite well-known limitations. Several authors have suggested considering the complete Nx curve rather than just the N50 value, but while using N90 values or considering the area under the Nx curve with auN statistics provide more complete measures of contiguity, they share the limitation of being unsuited to direct comparison across a range of genome sizes. We introduced snail plots to provide a genome-size-independent way to summarize a range of commonly used assembly metrics. Here, we demonstrate that easily learnt visual differences between snail plots allow simultaneous consideration of metrics across several key areas of assembly quality to rapidly identify high- and low-quality assemblies. We show that prominent features in snail plots of high-quality assemblies effectively highlight N50, N90, and auN contiguity statistics. As the presentation is scaled to the longest scaffold, we also show that plots can be compared effectively across a wide range of taxa and assembly sizes. We use the core features of a snail plot to derive a proportional measure of assembly quality based on auN, adjusted for non-ATGC bases and scaled to the length of the longest scaffold. We show that this "snail score" value corresponds closely to a qualitative assessment of overall assembly quality from visual interpretation of a snail plot and supports corrections for expected genome size.
Cytogenetic dosimetry (CD) provides biological evidence of radiation exposure and is particularly valuable in emergencies. However, its routine use in occupational protection remains limited globally. This study examines the barriers to institutionalization of CD within Brazil's occupational health and safety (OHS) framework. A qualitative analysis was conducted through a critical examination of international standards, Brazilian regulations, and scientific literature. The study mapped national guidelines, identified regulatory gaps, and evaluated the implications for worker health surveillance, with a specific focus on the potential role of CD. Our analysis shows that cytogenetic dosimetry is a technically feasible, accessible, and cost-effective method for biological monitoring. Its implementation in Brazilian occupational settings is constrained by the absence of standardized protocols, a lack of professional training among OHS practitioners, and low awareness of its clinical applicability. The findings from the Brazilian context highlight the need for updated OHS policies that integrate physical dosimetry with the biological effects of radiation, providing broader insights for advancing evidence-based occupational health policies and promoting a stronger global culture of radiation protection.
Gestational blood pressure (BP) is susceptible to exogenous exposures, including environmental chemicals. However, epidemiological evidence is lacking, particularly for the emerging contaminants. We quantified 31 urinary chemicals in early-pregnancy among 815 women from the Jiashan Birth Cohort in Zhejiang Province, China. We applied logistic regression, generalized estimating equation and Bayesian kernel machine regression (BKMR) models to analyze associations between 16 frequently detected compounds and gestational hypertension (GH), trimester-specific BP levels, and BP trajectories throughout pregnancy. Bisphenol A (2,3-dihydroxypropyl) glycidyl ether (BADGE-H2O), bisphenol A-bis(2,3-dihydroxypropyl) ether (BADGE-2H2O), and N-(1,3-dimethylbutyl)-N'-phenyl-p-phenylenediamine-quinone (6PPD-Q) were consistently associated with an increased risk of GH, elevated BP levels across all trimesters, and a greater likelihood of belonging to BP trajectory groups with a rising pattern. BKMR confirmed that the mixture exposure was associated with higher BP values across all trimesters, identifying BADGE-H2O as the predominant contributor. Bisphenol A (BPA) and 2-methylthio-benzothiazole (2-Me-S-BTH) also showed associations with elevated BP levels and altered BP trajectory membership, whereas inverse associations were preliminarily observed for propyl paraben (PrP), benzyl paraben (BzP), and 2-(Isopropylamino)-5-(phenylamino) cyclohexa-2,5-diene-1,4-dione (IPPD-Q). This study reported novel associations between early-pregnancy exposure markers of non-persistent chemicals, especially emerging contaminants (BADGE-H2O, BADGE-2H2O, and 6PPD-Q), and adverse maternal BP outcomes. These findings highlight the potential public health concern posed by these widespread environmental exposures, and underscore the importance of considering real-world mixture exposures. Further research is needed to validate these associations and to elucidate the underlying biological mechanisms.
Lignin, the most abundant aromatic biopolymer in nature, holds great promise for carbon-neutral materials development yet is limited by its inherent dark color and poor solvent stability. Transforming it into uniform lignin colloidal spheres (LCSs) with ordered arrays enables specific visible light reflection and thus presents tunable colors. However, industrial lignin-derived LCSs via self-assembly typically exhibit broad size distribution and poor solvent resistance. To address these challenges, we proposed a novel strategy combining solvent fractionation and surface covalent polymerization. Acetone/water fractionation effectively reduced lignin heterogeneity, narrowing LCSs size distribution. Bisphenol A diglycidyl ether (BADGE) was used as cross-linker to covalently polymerize hydroxyl groups, inhibiting LCSs dissolution. Two hybrid LCSs were fabricated: hy-LCSs via co-self-assembly of lignin and BADGE and hy@LCSs through subsequent surface cross-linking. Hy-LCSs20 (20 wt% BADGE) shows stability in pH 12 alkali and acetone/water, while hy@LCSs70 exhibited unprecedented alkaline resistance up to pH 14, far exceeding the highest reported value of pH 12 for lignin colloidal spheres to date. Critically, BADGE incorporation preserved monodispersity of both hy-LCSs20 and hy@LCSs70, enabling precise size control without compromising uniformity. After centrifugation to form ordered structures, both hy-LCSs20 and hy@LCSs70 reflect specific wavelengths with tunable colors, overcoming key barriers in lignin valorization.
The International Commission on Radiation Units and Measurements (ICRU), in collaboration with the International Commission on Radiological Protection (ICRP), has introduced new operational quantities in ICRU Report 95. Among these, the personal dose Hp addresses the significant limitations of the currently used Hp (10), which can overestimate the effective dose by up to a factor of 5.5 at photon energies below 70 keV. These changes necessitate a re-estimation of dosemeter response to evaluate potential modifications in dose algorithms and detector design. In this study, the performance of CaSO4:Dy thermoluminescent dosemeter (TLD) badges was investigated for the new operational quantity Hp and compared with the existing Hp (10). The badge response was simulated over photon energy range 12.3-1250 keV using the Monte Carlo Simulation code FLUKA and benchmarked against experimental validation. To correct for energy-dependent overestimation at lower photon energies, a new dose evaluation algorithm for Hp was developed based on disc dose ratio (R12). The disc dose ratio (R12) refers to the ratio of absorbed doses measured in CaSO₄:Dy TL discs D1 and D2 positioned under different filtration conditions within the badge and serves as an energy-sensitive parameter for correcting the over-response of the dosemeter in terms of Hp. The proposed algorithm demonstrated strong compliance with IEC 62387:2020 performance criteria (acceptance range 0.71-1.67), with 95% of estimated Hp values lying within 0.9-1.3 of the delivered dose. These results confirm that CaSO4:Dy TLD badges, when combined with the improved algorithm, are fully compatible with the new operational quantities recommended in ICRU Report 95, ensuring reliable application in personnel dosimetry.
Gamification has emerged as a transformative pedagogical strategy in health sciences education, offering innovative ways to enhance student engagement, motivation and competency development. This state-of-the-art commentary explores the integration of digital badges into the third-year Medicine and Surgery course for occupational therapy and physiotherapy students at a public university in South Africa. Originally introduced to address contextual and educational challenges, digital badges acted as engagement tools aligned with specific learning outcomes and professional competencies. The inclusion of badges was organically developed by lecturers in response to contextual challenges, including inconsistent face-to-face teaching, low engagement, limited interdisciplinary interaction in an online learning environment, and the need to prepare students for clinical practice in resource-constrained settings. Gamification elements were embedded in Moodle, the learning management system, to scaffold learning progression and support the core competencies outlined by the Health Professions Council of South Africa (HPCSA), including therapeutic and professional relationships, professionalism, communication and ethical practice. The introduction of gamification and badges may improve clinical, interdisciplinary, and communication skills among undergraduate students. Contextual relevance, inclusive design, and ongoing evaluation incorporating the students' voices are recommended in sound instructional design through active engagement with gamification practices in health sciences education.
Clinical research professionals are essential to the successful conduct of clinical trials yet training and retention of this workforce remain significant challenges, particularly with constrained budgets and declining indirect cost reimbursements. This study describes the implementation, and evaluation of a micro-credentialing program at an NCI-designated comprehensive cancer center. The CRC badge, developed through a collaboration between Rutgers School of Health Professions, Rutgers Cancer Institute, and the New Jersey Alliance for Clinical and Translational Science, offers self-paced, competency-based training aligned with the Joint Task Force for Clinical Trial Competency framework. Fifty-six clinical research staff were invited to complete the CRC Badge between May 2023 and May 2024. Survey data from the 38 completers (67%) demonstrated substantial self-reported learning gains across regulatory activities, research roles, and data management. Post-course results indicated that the CRC badge helped enhance onboarding efficiency and inspired interest in continued professional development. Administrative feedback confirmed improvements in staff readiness.
Effective translation relies on high performance teams integrating diverse disciplines to bring new drugs, medical devices, diagnostics or behavioral interventions into improved health. Despite substantial advancements informed by the Science of Team Science (SciTS), challenges remain in effective translational team (TT) operations, while limited institutional, scholarly, and practitioner legitimacy of team science expertise constrains efforts to address them. Here, we describe an essential member of the TT, the Team Science Professional (TSP). Serving as a team educator and facilitator of team interventions, the TSP plays a pivotal role in facilitating effective team performance. Current challenges faced by this nascent profession are defining career pathways and establishing competencies needed for expert performance. To address these challenges, the authors, representing a spectrum of academic universities organized as a special interest group (SIG) of the Association of Clinical and Translational Science (ACTS), propose a suite of individualized, standardized and pathway-selective micro-credentials (digital badges). Digital badges in "Team Science (TS) Fundamentals," "TS Practitioner," "TT Trainer" and "TT Intervention Expert" are described, along with preliminary feasibility and usability evaluations of the submission process. These stackable credentials provide a customizable, portable recognition of skills and help advance career pathways for TSPs. In so doing, the Digital Badge Initiative will enhance the capacity of translational science "Hubs" such as those supported by Clinical and Translational Science Awards to conduct effective and rigorous translation. Moving forward, the ACTS TSP SIG will be examining the impact of digital badging on standardization and its effect on career recognition and retention.
Early adoption of innovation is important for the implementation of evidence-based practices. Care of older adults using Age-Friendly practices optimizes the What Matters, Medication, Mobility, and Mentation (4Ms) framework. Within the first year of availability, over 1900 individuals acquired Age-Friendly pharmacist recognition. The purpose of this study is to characterize the demographics, preparedness, motivation, and professional association affiliation of pharmacists who received Age-Friendly recognition. A quantitative survey was administered to all participants as the last of four steps in Age-Friendly pharmacist recognition. The target population was Age-Friendly pharmacists who self-administer the online questionnaire. New practitioners (within 6 years of graduation) and pharmacists with 6+ (6+) years of practice were compared using descriptive statistics. Between March 2025 and February 2026, 1953 individuals received Age-Friendly Pharmacist recognition, 285 (15.4% of cohort) of whom were new practitioners with a mean age of 29.7 ± 4.4 years and 74.4% female. The 6+ group comprised 1567 (84.6% of cohort) pharmacists, mean age 45.3 ± 9.1 years, and 74.6% female. One quarter of new practitioners and 57.4% of the 6+ group were board-certified. Of those who were board-certified, 34% of new practitioners were board-certified in geriatrics and pharmacotherapy, whereas geriatrics certification was prevalent (82.2%) in the 6+ group. Improving the quality of care was the primary motivation to seek Age-Friendly recognition for both groups, followed by free continuing education, a digital badge, and advancing their skill set. New practitioners learned about Age-Friendly recognition from employers (46.7%), peers (39.1%), and social media (18.6%), whereas the 6+ group learned about Age-Friendly on the ASCP website (43.3%). For both groups, employers played an important role in disseminating information about and in supporting pharmacists to achieve Age-Friendly recognition. Highly qualified pharmacists were motivated to seek Age-Friendly recognition by a desire to improve the quality of care for older adults, free continuing education, a digital badge, and to advance their skill set.
Voting is increasingly acknowledged as a social determinant of health. Voter turnout is correlated with self-reported health and influences other social determinants, such as housing and education. Vot-ER, a nonprofit, nonpartisan organization, focuses on promoting voter engagement within health care settings. This article details a strategy implemented at a large academic medical center to encourage voter registration among both patients and staff. Two internal medicine physicians, after completing the Vot-ER Civic Health Fellowship, utilized existing academic platforms, specifically Grand Rounds presentations to various departments, to emphasize the importance of civic health and introduce Vot-ER tools. This approach successfully engaged colleagues and established a network of health care providers dedicated to voter engagement. To evaluate the initiative, institution-specific QR codes on Vot-ER badge cards were tracked. Between June 2022 and October 2025, 1,282 badge scans resulted in 489 voter registrations. Building on this success and in alignment with the Association of American Medical Colleges' guidance, an official Vot-ER student organization was formed in September 2023 to further increase voter registration and policy awareness among students and staff. Key lessons learned include the importance of understanding institutional culture and leveraging personal relationships to gain support and legitimacy for such initiatives. This strategy demonstrates a practical approach to integrating civic health into health care practice, with implications for improving community health outcomes through increased voter participation.
Across three preregistered experiments (total N = 1,135), we tested whether an inductive learning (IL) intervention improved participants' news veracity discernment (i.e., ability to distinguish between true and false news). IL involves learning categories by observing or classifying exemplars. Therefore, in this research, IL involved observing true and false news headlines and classifying them as either "true" or "false," with immediate feedback on accuracy. In Experiment 1 (N = 214), the IL intervention significantly improved participants' news veracity discernment compared to the control, but the Bayesian evidence was only anecdotal. In Experiment 2 (N = 483), we incorporated game-design elements into the IL intervention, including performance-contingent badges. Unexpectedly, the effect of the IL intervention decreased. We reasoned that, because the IL intervention involved easy-to-hard classification training, the provision of performance-contingent badges inadvertently made participants more aware of their declining performance. This awareness may have undermined their motivation to learn as the training progressed. Therefore, in Experiment 3 (N = 438), we implemented hard-to-easy classification training instead, and the IL intervention significantly improved participants' news veracity discernment, now with strong Bayesian evidence. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Environmental pollutants are persistent chemicals that pose substantial risks to human health, contributing to global mortality and economic burden. In real-world situations, exposure rarely occurs to single compounds; instead, people are chronically exposed to complex mixtures at low concentrations. However, most regulatory frameworks still rely on single-substance risk assessments, potentially underestimating the hazards associated with combined exposures. This study investigated the cytotoxic interactions of binary mixtures of five environmentally relevant pollutants: bisphenol A (BPA), bisphenol A diglycidyl ether (BADGE), dibutyl phthalate (DBP), di(2-ethylhexyl) phthalate (DEHP), and perfluorooctanoic acid (PFOA), using the human lymphoblast cell line NALM-6. Cells were exposed for 72 h to each compound individually and to all possible binary combinations, reflecting concentrations reported in human plasma or serum. Cell viability was assessed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, and interactions were analyzed using the Bliss model of independence and two-way analysis of variance (ANOVA). Intracellular reactive oxygen species were measured using the 2',7'-dichlorodihydrofluorescein diacetate (DCFH-DA) probe to explore the involvement of oxidative stress. Synergistic interactions were observed under specific conditions, although not all statistically identified interactions corresponded to biologically significant effects. The BPA-DBP combination produced the highest cytotoxicity when both pollutants were present at 100 nM (31%), consistent with a strong synergistic effect. A similar pattern was observed for BADGE-BPA. ROS production was partially associated with cytotoxicity in these selected mixtures. Overall, these findings highlight the importance of distinguishing statistical synergy from toxicological relevance.
Cytarabine (Ara-C) remains the cornerstone of remission-induction and consolidation chemotherapy for acute myeloid leukemia (AML) and related hematological malignancies. Despite more than six decades of clinical use, its multi-organ toxicity continues to be managed almost exclusively through dose attenuation and supportive care, with no approved upstream pharmacological prevention strategy available. This scoping review aimed to systematically map the breadth and nature of pharmacological agents tested in vivo for their capacity to mitigate cytarabine-induced multi-organ toxicity, to characterize their mechanisms of action and organ targets, and to identify evidence gaps and agents with translational potential. The review was designed and reported in accordance with the PRISMA-ScR checklist. A structured electronic search was conducted across PubMed/MEDLINE, Scopus, Cochrane Library and Embase, and Web of Science from database inception to 15 July 2025. Eligible studies were restricted to full-text, peer-reviewed, English-language research involving in vivo mammalian models administered cytarabine as the principal toxin, with at least one pharmacological co-intervention and at least one quantitative or histopathological organ-injury outcome. From 5701 retrieved records, 36 eligible in vivo mammalian studies (spanning 1964-2024) were identified. Included studies addressed neurotoxicity (n = 6), gastrointestinal mucositis (n = 9), ocular toxicity (n = 3), hepatotoxicity (n = 3), bone marrow suppression (n = 4), chemotherapy-induced alopecia (n = 5), and reproductive and developmental toxicity (n = 4). Five recurring mechanistic strategies were identified across the heterogeneous agents tested: redox buffering (N-acetylcysteine, α-lipoic acid, rutin, swertiamarin, α-tocopherol), mitochondrial preservation (betanin, thymoquinone, vitamin D, sodium zinc dihydrolipoylhistidinate [DHLHZn]), tissue-microenvironment reprogramming (apraglutide, BADGE, plerixafor, short-chain fatty acids, β-glucan), molecular antagonism (deoxycytidine, dCMP), and immunomodulation (lienal peptide, IL-1β, AHCC). This scoping review provides the first systematic cartography of pharmacological mitigation strategies for cytarabine-induced multi-organ toxicity. Five mechanistic pathways converge across eight organ systems, with apraglutide and N-acetylcysteine representing the most clinically translatable candidates. Plerixafor and PPARγ blockade by BADGE constitute high-priority candidates for bone marrow niche protection, while the deoxycytidine antagonism principle warrants formal pharmacokinetic evaluation. The complete absence of cardiotoxicity mitigation data defines the most critical gap for future research.
BACKGROUND: The cluster randomized controlled trial interprof ACT evaluated the effects of a complex intervention designed to improve collaboration between general practitioners (GPs) and registered nurses (RNs) in nursing homes (NHs). The intervention includes six components (“Name badges”, “Mandatory availability rules”, “Designated contact persons”, “Standardized GPs’ home visits”, “Pro re nata medication”, “Shared goal setting”). The findings showed a nonsignificant reduction in hospital admissions in the intervention group (IG) compared to the control group (CG) within twelve months. The aims of this process evaluation were to describe (1) the dose, reach and fidelity of implementation (“implementation performance”), (2) the effects on the quality of RN-GP collaboration, and (3) potential moderating factors. METHODS: Process evaluation with a mixed-methods triangulation design involving all clusters (17 NHs per IG and CG) and 323 nursing home residents (NHRs) (n = 166 IG, n = 157 CG): We collected quantitative and qualitative data from multiple perspectives (e.g., RNs, GPs, NHRs) at several measurement points. We quantitatively compared groups by means of medians, interquartile ranges, proportions (all outcome domains) or Mann‒Whitney U tests (implementation performance) and analyzed qualitative data inductively via content analysis. The key findings were triangulated narratively and via a joint display. RESULTS: Compared to those in the CG, we noted relevant improvements in the implementation of “Name badges”, “Mandatory availability rules”, “Designated contact persons” and “Pro re nata medication” in ≥50% of the IG clusters, of which the group difference for “Mandatory availability rules” reached statistical significance. The implementation performance of IG clusters was moderated by resource-related and other organizational attributes of NHs and GP offices and attributes of involved professionals, especially their attitudes and awareness. Implementation of the components induced greater standardization of care processes together with positive changes in interprofessional communication and coordination among GPs and RNs. CONCLUSIONS: Implementation of the interprof ACT components varied between components and NHs but showed potential for improving RN-GP collaboration. The standardization of shared care procedures emerged as a key mediator for improvement. For larger and more sustainable implementation we recommend a stronger focus on locally available resources and communication of potential benefits for all involved parties. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03426475; registered 07 February 2018, https://www.clinicaltrials.gov/study/NCT03426475?lead=NCT03426475%26;rank=1 .