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BackgroundSustained self-monitoring and self-management behaviors are crucial to maintain optimal health for individuals with type 2 diabetes mellitus (T2DM). As smartphones and mobile health (mHealth) devices become widely available, self-monitoring using mHealth devices is an appealing strategy in support of successful self-management of T2DM. However, research indicates that engagement with mHealth devices decreases over time. Thus, it is important to understand engagement trajectories to provide varying levels of support that can improve self-monitoring and self-management behaviors. ObjectiveThe aims of this study were to develop (1) digital phenotypes of the self-monitoring behaviors of patients with T2DM based on their engagement trajectory of using multiple mHealth devices, and (2) assess the association of individual digital phenotypes of self-monitoring behaviors with baseline demographic and clinical characteristics. MethodsThis longitudinal observational feasibility study included 60 participants with T2DM who were instructed to monitor their weight, blood glucose, and physical activity using a wireless weight scale, phone-tethered glucometer, and accelerometer, respectively, over 6 months. We used latent class growth analysis (LCGA) with multitrajectory modeling to associate the digital phenotypes of participants’ self-monitoring behaviors based on their engagement trajectories with multiple mHealth devices. Associations between individual characteristics and digital phenotypes on participants’ self-monitoring behavior were assessed by analysis of variance or the Chi square test. ResultsThe engagement with accelerometers to monitor daily physical activities was consistently high for all participants over time. Three distinct digital phenotypes were identified based on participants’ engagement with the wireless weight scale and glucometer: (1) low and waning engagement group (24/60, 40%), (2) medium engagement group (20/60, 33%), and (3) consistently high engagement group (16/60, 27%). Participants that were younger, female, nonwhite, had a low income, and with a higher baseline hemoglobin A1c level were more likely to be in the low and waning engagement group. ConclusionsWe demonstrated how to digitally phenotype individuals’ self-monitoring behavior based on their engagement trajectory with multiple mHealth devices. Distinct self-monitoring behavior groups were identified. Individual demographic and clinical characteristics were associated with different self-monitoring behavior groups. Future research should identify methods to provide tailored support for people with T2DM to help them better monitor and manage their condition. International Registered Report Identifier (IRRID)RR2-10.2196/13517

Purpose: There are an increasing number of techniques and tools to improve the capacity for children to relay their perceptions of their symptom experience while undergoing blood and marrow transplant (BMT). Network analysis (NA) is a tool that can illustrate associations between symptoms and the distress they cause. We aimed to develop a biopsychosocial assessment clinical analytic tool to examine symptom relationships for children undergoing BMT to find actionable relationships for intervention to improve clinical outcomes including mood. Design and Methods: This pilot study used an analytical mobile application tool to support a wide scope of 15 biopsychosocial symptom distress levels and five mood assessments. Children recorded their symptom distress and mood using the app. NA was used to explore relationships between symptom distress and mood. Results: Four children, 11–14 years old, undergoing BMT used the app daily during hospitalization. We found a strong presence of emotional distress and its associations symptom distress and mood. Multiple symptom associations were identified including associations between the set of symptoms difficulty breathing and fever (0.557), sad and worried (0.429). Of note, pain distress had a strong capacity to bridge other symptoms and was connected directly to many symptoms. Practice Implications: We found the significance of patient struggles with emotional and symptom distress and the importance of this relationship to other clinical outcomes. This provides valuable insights and an improved understanding of the child's symptoms. Our findings support early assessment, intervention, and improved symptom communication to enhance sense of well‐being and the child's care experience. [ABSTRACT FROM AUTHOR]

Opioid overdose deaths remain a major public health concern in the United States and led to the recent changes in regulations that allow nurse practitioners (NPs) to prescribe buprenorphine without the previously required Drug Addiction Treatment Act waiver. Previously, waiver requirements included 24 hours of opioid use disorder (OUD) and medications for OUD (MOUD) training. Although this training is no longer required, NPs need education related to providing nonstigmatizing care to individuals with OUD and safe MOUD prescribing practices. A combination of online didactic modules, in-person simulation activities, and experiential learning was provided to psychiatric mental health NP (PMHNP) and family NP (FNP) students enrolled in a Doctor of Nursing Practice (DNP) program. OUD was presented through a chronic care lens to normalize treatment and decrease stigma, and harm reduction principles were included to increase safe prescribing of MOUD. Fifty-six students completed the didactic training, 51 students participated in the simulation, and 11 students completed shadowing experiences with an experienced MOUD provider. Psychiatric mental health NP and FNP graduates of this DNP program have the knowledge and skills to provide MOUD to individuals struggling with OUD, thus potentially increasing access to care and decreasing overdose deaths. [ABSTRACT FROM AUTHOR]

While there is nothing new about academic dishonesty, how it is committed, prevented, and detected has been dramatically transformed by the advent of online technologies. This article briefly describes the concurrent emergence of online writing assistance services and Web-based plagiarism detection tools and examines the implications of both for student-faculty relations, faculty workload, and student learning. Finally, we provide three alternative strategies for deterring, detecting, and documenting all forms of plagiarism.

Introduction: Given the increased prevalence of obesity and the existence of negative attitudes among health care providers toward patients with obesity (PWO), strategies are needed to assist nursing students in identifying and examining attitudes and beliefs related to the provision of care for individuals with obesity. Nursing school curricula should incorporate effective interventions for students in order to reduce stigmas and to modify negative attitudes and behaviors that interfere with quality nursing care for PWO. This article describes the process of developing and implementing an innovative bariatric sensitivity intervention (BSI) for prelicensure nursing students. Methods: The BSI includes six trigger films that address the multi-faceted aspects of caring for PWO and provoke reflection on obesity-related attitudes and beliefs, as well as a facilitated debrief. Conclusion: We discuss the practical aspects of video production and the successful use of multimedia instruction to affect prelicensure nursing students' behaviors. [ABSTRACT FROM AUTHOR]

Background: The purpose of this article is to describe the development, implementation, and evaluation of a Simulation Interprofessional Education (Sim‐IPE) activity for healthcare students from different disciplines (athletic training [AT] and nursing). The objective for the Sim‐IPE activity was to engage AT and prelicensure nursing students in a realistic healthcare scenario to enhance knowledge about one another's profession, develop interprofessional skills, collaborate with one another, and communicate effectively as a team as they performed care. Methods: This mixed methods study employed a one‐time posttest design for a convenience sample of AT and prelicensure nursing students following a simulation intervention. Students completed the Student Perceptions of Interprofessional Clinical Education‐Revised (SPICE‐R) survey and answered open‐ended response questions. Results: Thirteen students (N = 13) from Cohort 1 and 12 students (N = 12) from Cohort 2 completed the SPICE‐R survey. Most students strongly agreed/agreed for each of the SPICE‐R survey questions. Qualitative findings indicated the students positively perceived the Sim‐IPE activity as it helped them discover the value of interprofessional patient care. Discussion: The quantitative findings indicated that the students found the Sim‐IPE an effective learning methodology to achieve the objectives while the qualitative findings gave further insight into the students' perceptions of interprofessional teamwork and the value of the prebrief session conducted before the simulation. The findings will inform future Sim‐IPE activities involving additional groups of healthcare students. [ABSTRACT FROM AUTHOR]

This study of policy change examines the parallel strategies the administration of President George W. Bush has used to substantially alter the direction of forest policy during his first term. Using the Healthy Forests Initiative as a case study, this analysis explains how, by framing the problem of wildfires and forest health in terms of process and pointing blame at environmental groups misusing appeal procedures, the administration was able to emphasize process, rather than the content of existing forest policy. It also provided a reasonable explanation for the president to take a lead in seeking both legislative as well as regulatory change. We contend that the use of two parallel policymaking paths--legislative and administrative--enabled the president to pursue policy change more rapidly, and, from a strategic standpoint, more effectively, than by relying upon the legislative process alone. We offer that the Bush administration's approach to changing forest policy represents a redirection that is likely to serve as a template for further environmental policy change., In 2000, 122,827 wildfires burned 8.4 million acres of United States forests--including the highly publicized Cerro Grande fire in New Mexico in which 250 structures were destroyed. In 2002, 7.1 [...]

• Psychological safety in simulation enhances learning. • Simulation educators must foster psychological safety in simulation. • "STEPS" uses visual images to promote psychological safety in simulation. Creating and maintaining a psychologically safe and welcoming environment is an essential element in simulation-based teaching. The purpose of this project was to describe a novel tool the authors developed to visually enhance psychological safety. Using constructs related to psychological safety, the tool was designed and named "Simulation Tool to Enhance Psychological Safety" (STEPS). STEPS was designed by a core team of simulation education specialists and then evaluated by a convenience sample of prelicensure (n = 5) and advanced practice (n = 3) nursing simulation educator experts. Using open-ended responses, thes reviewers gave feedback and suggestions for improvement. Findings revealed that STEPS was positively evaluated as a visual aid to promote psychological safety. Reviewers offered suggestions for improving design features such as making it more inclusive of other disciplines and adding inspirational quotes. The reviewers unanimously agreed that STEPS would be a successful adjunct for promoting psychological safety in simulation. STEPS is an innovative visual aid to promote a psychologically safe learning environment. We plan to use the tool in simulations across nursing programs. [ABSTRACT FROM AUTHOR]

Extant simulation literature guides facilitators to tailor desired outcomes to the level of the learner, create psychologically safe and realistic learning environments, and provide a comprehensive simulation experience. Healthcare Simulation Standards of Best PracticeTM emphasize the role of a skilled facilitator in delivering effective healthcare simulation. However, there is a paucity of research evaluating the impact of facilitation upon learning outcomes in the simulation environment. This systematic review protocol outlines the identification, critical appraisal, and synthesis of the best available evidence to describe simulation facilitation and its impact upon healthcare learners' knowledge, skills, attitudes, and behaviors. An interprofessional committee of simulation educators will perform a systematic review under the guidance of a health science librarian using the Joanna Briggs Institute methodology. Peer-reviewed literature will be searched across seven databases. Abstracts deemed relevant in meeting the inclusion criteria will undergo full-text review. The systematic review will inform evidence-based practices related to the facilitation process to support the delivery of high-quality simulation that promote a culture of inclusion, trust, and safety. [ABSTRACT FROM AUTHOR]

Purpose: This study identified facilitators and barriers pertaining to the use of multiple mobile health (mHealth) devices (Fitbit Alta® fitness tracker, iHealth® glucometer, BodyTrace® scale) that support self‐management behaviors in individuals with type 2 diabetes mellitus (T2DM). Design: This qualitative descriptive study presents study participants' perceptions of using multiple mobile devices to support T2DM self‐management. Additionally, this study assessed whether participants found visualizations, generated from each participant's health data as obtained from the three separate devices, useful and easy to interpret. Methods: Semistructured interviews were completed with a convenience sample of participants (n = 20) from a larger randomized control trial on T2DM self‐management. Interview questions focused on participants' use of three devices to support T2DM self‐management. A study team member created data visualizations of each interview participant's health data using RStudio. Results: We identified two themes from descriptions of study participants: feasibility and usability. We identified one theme about visualizations created from data obtained from the mobile devices. Despite some challenges, individuals with T2DM found it feasible to use multiple mobile devices to facilitate engagement in T2DM self‐management behaviors. Discussion: As mHealth devices become increasingly popular for diabetes self‐management and are integrated into care delivery, we must address issues associated with the use of multiple mHealth devices and the use of aggregate data to support T2DM self‐management. Clinical Relevance: Real‐time patient‐generated health data that are easily accessible and readily available can assist T2DM self‐management and catalyze conversations, leading to better self‐management. Our findings lay an important groundwork for understanding how individuals with T2DM can use multiple mHealth devices simultaneously to support self‐management. [ABSTRACT FROM AUTHOR]

Objective: This study examined the perspectives on the use of data visualizations and identified key features seriously ill children, their parents, and clinicians prefer to see when visualizing symptom data obtained from mobile health technologies (an Apple Watch and smartphone symptom app).Materials and Methods: Children with serious illness and their parents were enrolled into a symptom monitoring study then a subset was interviewed for this study. A study team member created symptom data visualizations using the pediatric participant's mobile technology data. Semi-structured interviews were conducted with a convenience sample of participants (n = 14 children; n = 14 parents). In addition, a convenience sample of clinicians (n = 30) completed surveys. Pediatric and parent participants shared their preferences and perspectives on the symptom visualizations.Results: We identified 3 themes from the pediatric and parent participant interviews: increased symptom awareness, communication, and interpretability of the symptom visualizations. Clinicians preferred pie charts and simple bar charts for their ease of interpretation and ability to be used as communication tools. Most clinicians would prefer to see symptom visualizations in the electronic health record.Discussion: Mobile health tools offer a unique opportunity to obtain patient-generated health data. Effective, concise symptom visualizations can be used to synthesize key clinical information to inform clinical decisions and promote patient-clinician communication to enhance symptom management.Conclusions: Effectively visualizing complex mobile health data can enhance understanding of symptom dynamics and promote patient-clinician communication, leading to tailored personalized symptom management strategies. [ABSTRACT FROM AUTHOR]

Background and Objectives: The high level of acceptance and consistent use of smartphones by children and adolescents present new opportunities to monitor and collect health data. For acutely ill children and adolescents, collecting symptom data via smartphone applications (apps) provides patient-reported data that can be collected daily and offers the potential to provide a more comprehensive picture of the symptom experience. The purpose of this study was to employ user-centered design principles and medical professional input in order to obtain feedback and insight into redesigning our Technology Recordings for better Understanding Blood and Marrow Transplant (TRU-PBMT) app. This redesigned app will be used for children and adolescents with cancer or undergoing blood and marrow transplantation. Method: We interviewed six pediatric blood and marrow transplant patients (ages 10-17 years) who had pilot tested the app, and we surveyed 30 pediatric oncology clinicians. Results: Interview feedback from previous app users and survey feedback from clinicians guided the app redesign. We incorporated suggestions to make the app more engaging, meaningful, personal, and motivating in order to increase symptom reporting. We added emojis to the symptom tracker, a mood scale, and personalized symptom graphs. Conclusion: Leveraging mobile health technologies may be a useful and acceptable approach to obtain symptom data; however, design and software development needs to be evidenced-based and informed by user needs. Our approach using patient and clinician feedback was valuable in the redesign of the TRU-PBMT app and will contribute to symptom research for acutely ill children and adolescents. [ABSTRACT FROM AUTHOR]

Abstract Purpose Our investigative team is integrating mobile health technologies into pediatric blood and marrow transplant (PBMT) care. We aim to evaluate whether patient-generated health data can be used to monitor health status and enhance symptom management. While there are numerous health-related apps, none address the symptoms or care needs specific to PBMT patients. This article describes development of the Technology Recording to better Understand Pediatric Blood and Marrow Transplant (TRU-PBMT) mobile application. Design and Methods A one-time survey was distributed to PBMT clinicians, caregivers, and outpatients to elicit feedback and suggestions for the app's design. Results Feedback from clinicians (n = 23), caregivers (n = 5), and PBMT outpatients (n = 4) indicated the app would be acceptable and useable with this group of patients between eight and eighteen years of age. Suggestions from respondents included: making the app language and graphics more child-friendly; adding symptoms such as fatigue, mucositis, bleeding; and a visual stool chart. Conclusion Patient, caregiver, and clinician feedback was valuable in creation of the TRU-PBMT app. We designed a pediatric friendly, PBMT-symptom-specific app, which we will test in future studies. Implications for Practice This app facilitates patient-generated health data collection and informs health care plans. Highlights • Mobile technology can be used to obtain patient generated health data. • Designing and customizing an app allows for disease specific symptom data collection to inform patient care decisions. • Feedback from patients, caregivers, and clinicians was valuable in the TRU-PBMT app development. [ABSTRACT FROM AUTHOR]

State wildlife conservation programs provide a strong foundation for biodiversity conservation in the United States, building on state wildlife action plans. However, states may miss the species that are at the most risk at rangewide scales, and threats such as novel diseases and climate change increasingly act at regional and national levels. Regional collaborations among states and their partners have had impressive successes, and several federal programs now incorporate state priorities. However, regional collaborations are uneven across the country, and no national counterpart exists to support efforts at that scale. A national conservation-support program could fill this gap and could work across the conservation community to identify large-scale conservation needs and support efforts to meet them. By providing important information-sharing and capacity-building services, such a program would advance collaborative conservation among the states and their partners, thus increasing both the effectiveness and the efficiency of conservation in the United States. [ABSTRACT FROM AUTHOR]

While there is nothing new about academic dishonesty, how it is committed, prevented, and detected has been dramatically transformed by the advent of online technologies. This article briefly describes the concurrent emergence of online writing assistance services and Web-based plagiarism detection tools and examines the implications of both for student-faculty relations, faculty workload, and student learning. Finally, we provide three alternative strategies for deterring, detecting, and documenting all forms of plagiarism. [ABSTRACT FROM AUTHOR]

Compares the administrative appeals of the U.S. Department of Agriculture Forest Service projects. Role of the administrative process in challenging a wide range of forest projects; Percentage of appeals that the agency denied; Issue of how the Forest Service designates and defines activities within a project.

Background: Studies show that students who use fidelity-based simulation technology perform better and have higher retention rates than peers who learn in traditional paper-based training. Augmented reality is increasingly being used as a teaching and learning tool in a continual effort to make simulations more realistic for students. Objective: The aim of this project was to assess the feasibility and acceptability of using augmented reality via Google Glass during clinical simulation scenarios for training health science students. Methods: Students performed a clinical simulation while watching a video through Google Glass of a patient actor simulating respiratory distress. Following participation in the scenarios students completed two surveys and were questioned if they would recommend continued use of this technology in clinical simulation experiences. Results: We were able to have students watch a video in their field of vision of a patient who mimicked the simulated manikin. Students were overall positive about the implications for being able to view a patient during the simulations, and most students recommended using the technology in the future. Overall, students reported perceived realism with augmented reality using Google Glass. However, there were technical and usability challenges with the device. Conclusions: As newer portable and consumer-focused technologies become available, augmented reality is increasingly being used as a teaching and learning tool to make clinical simulations more realistic for health science students. We found Google Glass feasible and acceptable as a tool for augmented reality in clinical simulations. [ABSTRACT FROM AUTHOR]