Cognitive Behavioral Therapy (CBT) Telehealth Augmented With a CBT Smartphone Application to Address Type 2 Diabetes Self-Management: A Randomized Pilot Trial.

PURPOSE: The purpose of the study was to investigate the feasibility and acceptability of phone-delivered cognitive behavioral therapy (CBT) combined with an adjunctive smartphone application CBT MobileWork-DM© to improve self-management of type 2 diabetes mellitus (T2DM). METHODS: Participants were 12 patients with T2DM on antihyperglycemic medication and had an A1C level of 8 or greater. A randomized controlled pilot study assessed treatment as usual (TAU) T2DM care versus a phone-delivered CBT (6, 8, or 12 weekly sessions) augmented with a CBT skills practice smartphone application. The CBT telehealth intervention addressed T2DM self-management and diabetes distress. Electronic and self-report medication taking, diabetes-related distress, and A1C were assessed at baseline and post-intervention. RESULTS: After 16 weeks, a decrease in A1C and distress levels was observed in all 3 CBT phone groups and TAU group. The group with the most improvement was the 12-week CBT group, which had the greatest mean decrease in A1C (-2.33) and diabetes distress (-31.67). The TAU group exhibited a mean decrease of -2.15 and -21 for A1C and diabetes distress, respectively. The overall rate of completion for phone CBT sessions across the 3 CBT groups was 83%. CONCLUSION: This study demonstrates that telehealth CBT augmented with a smartphone application is feasible and acceptable. Patients demonstrated improvements in both T2DM management and distress.

Caring in community nursing practice: Inductive content analysis reveals an inter-dynamic system between patients and nurses.

AIMS AND OBJECTIVES: To examine the understanding of caring in the practice of community nursing from the perspectives of patients and nurses. BACKGROUND: An increasing population of patients with chronic disease has produced a need for humanistic caring in communities. As a result, caring has become a core value of community nursing professionals. However, community nurses meet many difficulties in trying to practice person-centred care with their clients. Furthermore, most community nurses-especially in China-lack systematic education and training about caring because the practical meaning of caring in community practice is unknown. DESIGN: The qualitative study described herein employed inductive content analysis. METHODS: Eleven community patients with chronic disease and fifteen community nurses who were nominated as a caring nurse from different community clinics in Beijing, China, participated in thirty-one interviews during January to August in 2018. Nine documents from the interviewed nurses were collected. Both interview data and documents were analysed using strategies of inductive content analysis. The COREQ checklist was used. RESULTS: Patients and their corresponding nurses described a wide range of caring experiences that were generalised into 28 concepts. Caring emerged as an inter-dynamic system that comprised the foundation and quality of a caring relationship, the caring philosophy and behaviours of interactions, and positive feedback from caring interactions. A relationship-based framework of caring in community nursing practice was constructed. CONCLUSIONS: Identifying this systematic concept of caring provides insights that are applicable to the creation of targeted management, education and practice interventions to ultimately enhance the quality of community health care-in China or elsewhere. RELEVANCE TO CLINICAL PRACTICE: The systematic understanding of caring in community nursing practice will inform nurses in community health clinics, their educators and their managers on how to provide care to community patients and how to develop caring competence for community nurses.

Substance Use Patterns Among Adolescents: A Latent Class Analysis.

BACKGROUND: Substance use among adolescents remains a major public health concern, which is correlated with mortality. AIMS: The purpose of this study was to (1) examine risk factors predisposing adolescents to substance use and (2) identify patterns of simultaneous drug exploration among adolescents. METHOD: Data (N = 15,624; collected in 2015) were drawn from the Centers for Disease Control and Prevention, National Youth Risk Behavior Survey, which is a national school-based survey of 9th- to 12th-grade students to monitor health risk behaviors. Substance use was assessed using self-reported questionnaires, and latent class analysis and logistic regression were used for data analysis. RESULTS: Five latent patterns of substance use were identified: (1) abstinent (64%); (2) 1st-step social experimenter (25%) (i.e., used alcohol, e-cigarettes, and/or marijuana); (3) 2nd-step social experimenter (6%) (i.e., used alcohol, cigarettes, e-cigarettes, marijuana, synthetic marijuana, and/or prescription pills); (4) pill experimenter (4%), (i.e., used prescription pills); (5) full experimenter (2%) (i.e., likely to use all assessed substances). Gender, race, grade, and depressive mood were strong predictors of membership in a particular substance use class. CONCLUSION: Adolescents presenting for care may possess symptoms associated with various substances beyond those being managed. Mental health nurses can leverage these results in reducing adolescent substance use through primary and secondary prevention. A longitudinal study of not only substance use patterns but also the progression to substance use disorders among adolescents is warranted.

An analysis and evaluation of quality and behavioral change techniques among physical activity apps in China.

BACKGROUND: Physical activity (PA) smartphone applications (apps) featuring at least one behavioral change technique (BCT) are ubiquitous. Although BCTs in PA apps and their quality have been evaluated in Western countries, such research in China is new. This study (1) characterizes the extent that BCTs are implemented in Chinese PA apps and (2) evaluates their features and quality. METHODS: Of 5,253 PA apps identified in five Android app stores in China, 51 top-ranked PA apps with more than 2 million total downloads and user rating above 4 (out of 5) were selected and assessed; their BCTs were scored using the BCT taxonomy(V1), and app quality was evaluated with the Mobile App Rating Scale (MARS). Correlations among the number of BCTs, app quality, app features, app downloads, and user ratings were examined. RESULTS: Of the top-ranked apps, 62.7% allow behavioral tracking (i.e., pedometer), 9.8% promote Chinese dancing, and 17.6% offer monetary incentives. The average number of BCT categories included in the apps analyzed was 11 (SD = 3.51; range = 3-16), with the most common ones comprising feedback and monitoring (88.2%), goals and planning (82.4%), social support (81.4%), and reward and threat (80.4%). The average scores for objective and subjective quality of these apps were 3.90 (SD = 0.44) and 2.27 (SD = 0.61), respectively, as assessed by MARS. Moderate positive correlations were observed among the number of BCT incorporated, apps quality, app features, and their total downloads. CONCLUSIONS: Chinese PA apps vary in the number of BCTs incorporated, with goals setting, feedback, social support, and reward being typical. App objective quality is moderate, with relatively low subjective quality. Generally, higher quality PA apps in China include more BCTs with more app features and downloads. These findings can guide the development of PA apps to mitigate physical inactivity in China-and elsewhere.

Depression in the context of chronic diseases in the United States and China.

Depression is not only a major global public health concern, but also a common comorbidity among patients who experience chronic diseases, such as cancer, stroke, heart disease, diabetes, and chronic obstructive pulmonary disease. Yet the recognition and treatment varies widely around the world. This study (1) provides an integrated review of the literature on the prevalence of depression among patients with chronic diseases in China and the United States and its relationship to poorer health outcomes and (2) compares the differences in the percentages of patients receiving treatments for depression between the United States and China. Given the current situation, we recommended that primary care and specialty providers should be knowledgeable and alert regarding the signs of depression. Efforts should be directed to further implement integrated care based interventions to manage depression and improve quality of life among patients suffering chronic diseases in both China and the United States.

Liopropomaincandescens sp. nov. (Epinephelidae, Liopropominae), a new species of basslet from mesophotic coral ecosystems of Pohnpei, Micronesia.

A new species of the genus Liopropoma Gill found on the lower mesophotic coral ecosystem of Pohnpei, Micronesia, is herein described. Liopropomaincandescens sp. nov. differs from its congeners in coloration, number of lateral-line scales, number of pectoral fin rays, body depth, and snout length. Liopropomaincandescens sp. nov. is the 31st species in the genus. It was collected from a small rocky crevice in a steep slope at 130 m depth. Water temperature was 20 °C and benthic habitat was dominated by gorgonians, sponges and tunicates.

Moving towards a Network of Autonomous UAS Atmospheric Profiling Stations for Observations in the Earth's Lower Atmosphere: The 3D Mesonet Concept.

The deployment of small unmanned aircraft systems (UAS) to collect routine in situ vertical profiles of the thermodynamic and kinematic state of the atmosphere in conjunction with other weather observations could significantly improve weather forecasting skill and resolution. High-resolution vertical measurements of pressure, temperature, humidity, wind speed and wind direction are critical to the understanding of atmospheric boundary layer processes integral to air-surface (land, ocean and sea ice) exchanges of energy, momentum, and moisture; how these are affected by climate variability; and how they impact weather forecasts and air quality simulations. We explore the potential value of collecting coordinated atmospheric profiles at fixed surface observing sites at designated times using instrumented UAS. We refer to such a network of autonomous weather UAS designed for atmospheric profiling and capable of operating in most weather conditions as a 3D Mesonet. We outline some of the fundamental and high-impact science questions and sampling needs driving the development of the 3D Mesonet and offer an overview of the general concept of operations. Preliminary measurements from profiling UAS are presented and we discuss how measurements from an operational network could be realized to better characterize the atmospheric boundary layer, improve weather forecasts, and help to identify threats of severe weather.

Three new species of Chromis (Teleostei, Pomacentridae) from mesophotic coral ecosystems of the Philippines.

Three new species of Chromis (Perciformes, Pomacentridae) from the Philippines, collected between 75-150 m depth, are described by a combination of morphological features and their coloration. Chromisgunting sp. n. was found in Batangas and Oriental Mindoro, and differs from its congeners in body depth (2.1-2.2 in SL), and color of adults, light brown, with a silver area on the anterior end and a bilateral black margin along the exterior side of the tail. It is most similar to C.scotochiloptera, with a 5.3% genetic divergence in COI. Chromishangganan sp. n. was found around Lubang Island. Body depth (1.9-2.0 in SL) and adult coloration (yellowish with dark black outer margins on dorsal and anal fins) also separate this species from its congeners. It is most similar to C.pembae, with a 2.5% genetic divergence. Chromisbowesi sp. n. was found in Batangas, and also differs from its congeners by the combination of body depth (1.5-1.6 in SL), and color of adults (brownish grey in the dorsal side to whitish on the ventral side, with alternating dark and light stripes in the sides of body). It is most similar to C.earina, with a 3.6% genetic divergence in COI.

Prognathodesgeminus, a new species of butterflyfish (Teleostei, Chaetodontidae) from Palau.

A new species of the butterflyfish genus Prognathodes (Chaetodontidae) is described from two specimens collected at a depth of 116 m off Ngemelis Island, Palau. Prognathodesgeminus sp. n. is similar to P.basabei Pyle & Kosaki, 2016 from the Hawaiian archipelago, and P.guezei (Maugé & Bauchot, 1976) from the western Indian Ocean, but differs from these species in the number of soft dorsal-fin rays, size of head, body width, and body depth. There are also subtle differences in life color, and substantial differences in the mtDNA cytochrome oxidase I sequence (d ≈ 0.08). Although genetic comparisons with P.guezei are unavailable, it is expected that the genetic divergence between P.guezei and P.geminus will be even greater than that between P.geminus and P.basabei. It is named for the strikingly similar color pattern it shares with P.basabei.

Intercomparison of Small Unmanned Aircraft System (sUAS) Measurements for Atmospheric Science during the LAPSE-RATE Campaign.

Small unmanned aircraft systems (sUAS) are rapidly transforming atmospheric research. With the advancement of the development and application of these systems, improving knowledge of best practices for accurate measurement is critical for achieving scientific goals. We present results from an intercomparison of atmospheric measurement data from the Lower Atmospheric Process Studies at Elevation-a Remotely piloted Aircraft Team Experiment (LAPSE-RATE) field campaign. We evaluate a total of 38 individual sUAS with 23 unique sensor and platform configurations using a meteorological tower for reference measurements. We assess precision, bias, and time response of sUAS measurements of temperature, humidity, pressure, wind speed, and wind direction. Most sUAS measurements show broad agreement with the reference, particularly temperature and wind speed, with mean value differences of 1.6 ± 2 . 6 ∘ C and 0.22 ± 0 . 59 m/s for all sUAS, respectively. sUAS platform and sensor configurations were found to contribute significantly to measurement accuracy. Sensor configurations, which included proper aspiration and radiation shielding of sensors, were found to provide the most accurate thermodynamic measurements (temperature and relative humidity), whereas sonic anemometers on multirotor platforms provided the most accurate wind measurements (horizontal speed and direction). We contribute both a characterization and assessment of sUAS for measuring atmospheric parameters, and identify important challenges and opportunities for improving scientific measurements with sUAS.

Psychological Distress among Adolescents in Laos, Mongolia, Nepal, and Sri Lanka.

PURPOSE: The purpose of this study was to explore psychological distress and examine the relationship between this distress and individual, family, and school factors among adolescents in four low- and middle-income countries (LAMICs) in Asia (i.e., Laos, Mongolia, Nepal, and Sri Lanka). METHODS: A total of 4,098 adolescents attending public schools in the four LAMICs were surveyed as part of the Healthy School Development Project, which aimed to develop school capacity for improving (1) health among all school members and (2) the school environment through tailored school health programs. Psychological distress, family factors (i.e., parental understanding and monitoring, and parental tobacco and alcohol use), and school factors (i.e., having close friends, not bullied, school attendance, and health education) were assessed using self-report questionnaires. Data were collected from September to November in 2012 and 2013. Data analysis comprised descriptive statistics, Chi-squared testing, and logistic regression. RESULTS: Over half of the participants were women (53.2%-64.1%), and 33.7% (in Sri Lanka) to 53.8% (in Laos) were aged older than 15 years. Approximately 32.9% reported the presence of psychological distress; moreover, 7.9%-13.2% reported suicidal ideation. Parental monitoring and being bullied were associated with psychological distress in all four countries. CONCLUSION: One-third of adolescents experience psychological distress across these four LAMICs, which poses a substantial public health issue. Adolescents can benefit from family and school-based approaches for screening, ameliorating, and preventing psychological distress.

Environmental and Sensor Integration Influences on Temperature Measurements by Rotary-Wing Unmanned Aircraft Systems.

Obtaining thermodynamic measurements using rotary-wing unmanned aircraft systems (rwUAS) requires several considerations for mitigating biases from the aircraft and its environment. In this study, we focus on how the method of temperature sensor integration can impact the quality of its measurements. To minimize non-environmental heat sources and prevent any contamination coming from the rwUAS body, two configurations with different sensor placements are proposed for comparison. The first configuration consists of a custom quadcopter with temperature and humidity sensors placed below the propellers for aspiration. The second configuration incorporates the same quadcopter design with sensors instead shielded inside of an L-duct and aspirated by a ducted fan. Additionally, an autopilot algorithm was developed for these platforms to face them into the wind during flight for kinematic wind estimations. This study will utilize in situ rwUAS observations validated against tower-mounted reference instruments to examine how measurements are influenced both by the different configurations as well as the ambient environment. Results indicate that both methods of integration are valid but the below-propeller configuration is more susceptible to errors from solar radiation and heat from the body of the rwUAS.

Tosanoidesannepatrice, a new basslet from deep coral reefs in Micronesia (Perciformes, Percoidei, Serranidae).

The new species Tosanoidesannepatrice sp. n. is described from four specimens collected at depths of 115-148 m near Palau and Pohnpei in Micronesia. It differs from the other three species of this genus in life color and in certain morphological characters, such as body depth, snout length, anterior three dorsal-fin spine lengths, caudal-fin length, and other characters. There are also genetic differences from the other four species of Tosanoides (d ≈ 0.04-0.12 in mtDNA cytochrome oxidase I). This species is presently known only from Palau and Pohnpei within Micronesia, but it likely occurs elsewhere throughout the tropical western Pacific.

Current Continuing Nursing Education Among Beijing Nurses: A Cross-Sectional Study.

BACKGROUND: Continuing nursing education (CNE) is an effective approach to maintain and elevate professional knowledge and skills for nurses. We sought to understand the attitudes and expectations of hospital nurses concerning current CNE in Beijing. METHOD: Hospital-employed nurses (N = 2,826) from 23 secondary and tertiary general hospitals in Beijing were surveyed using a self-administered questionnaire. RESULTS: A total of 72% to 88% of nurses recognized the practicality, helpfulness, importance, and support provided by the current CNE program in Beijing. Obtaining required CNE credits and improving overall comprehensive quality are the top two motivations for nurses to participate in CNE. The top two barriers to CNE are time constraints and the inability to receive timely training information. Expectations that nurses have for future CNE programs also are identified. CONCLUSION: The nurses surveyed have a positive attitude about the current CNE program; however, our survey revealed several barriers and needs concerning CNE that should be addressed from an organizational perspective. J Contin Educ Nurs. 2018;49(11):526-536.

Facilitators and barriers to using physical activity smartphone apps among Chinese patients with chronic diseases.

BACKGROUND: Smartphones and their applications (apps) impact society and health care. With the growth of smartphone users and app downloads in China, patients with chronic diseases have access to a self-management strategy for physical activity. Although studies report physical activity apps improve the physical activity of patients, data is limited concerning their use of these apps. Therefore, this study investigated the current usage, willingness to use, and barriers to using physical activity apps of Chinese patients with chronic diseases. METHODS: We designed a questionnaire to collect data from chronic disease patients in a tertiary hospital in Beijing, which was sent to 250 patients in four departments. RESULTS: Two hundred eighteen questionnaires were returned (87.2% response rate). Most (92.7%) respondents owned a smartphone, 34.9% had used a physical activity app, and 18.8% were current users. Additionally, 53.7% were willing to use a physical activity app designed for them. Respondents more likely to use physical activity apps were younger (i.e., ≤ 44 years), more educated, current smartphone users, and previous users of physical activity apps; moreover, they believed they needed exercise, their disease required exercise instruction and support, and their physical status needed monitored when exercising (p < 0.05). Main barriers to using apps reported were insufficient function, difficulty of use, extra cost, and security issues. CONCLUSIONS: Our results indicate sizeable smartphone ownership among Chinese patients with chronic diseases; moreover, over half of our participants report they would use a physical activity app designed for them. This information can be leveraged by healthcare workers managing patients with chronic diseases.

Grammatonotus brianne, a new callanthiid fish from Philippine waters, with short accounts of two other Grammatonotus from the Coral Triangle.

In May 2014, a group of ichthyologists from the California Academy of Sciences and the Bishop Museum collecting fishes off the coast of Batangas, Luzon, Philippine Islands, obtained, in a depth of ca. 150 meters, four specimens of a species of Grammatonotus previously unknown to science. This new species, Grammatonotus brianne, is distinguishable from its described congeners by the following combination of characters: short anal-fin spines, rhomboid shaped caudal fin, lateral line usually disjunct, and live coloration. Herein we provide characters that distinguish callanthiids from other percoids and that distinguish Grammatonotus from Callanthias, the other genus in the family Callanthiidae, along with the description of the new species and short accounts of two other Grammatonotus, G. crosnieri and G. roseus, from the Coral Triangle.

Tosanoides obama, a new basslet (Perciformes, Percoidei, Serranidae) from deep coral reefs in the Northwestern Hawaiian Islands.

The new species Tosanoides obama is described from two specimens collected at a depth of 90-92 m off Kure Atoll and Pearl and Hermes Atoll, Northwestern Hawaiian Islands. It differs from the other two species of this genus in life color and in certain morphological characters, such as number of pored lateral-line scales, pectoral-fin rays, snout length, anterior three dorsal-fin spine lengths, dorsal-fin profile, and other characters. There are also substantial genetic differences from the other two species of Tosanoides (d ≈ 0.10 in mtDNA cytochrome oxidase I). The species is presently known only from the Northwestern Hawaiian Islands within the Papahanaumokuakea Marine National Monument.

Improving Chinese nursing students' communication skills by utilizing video-stimulated recall and role-play case scenarios to introduce them to the SBAR technique.

PURPOSE: Effective communication among healthcare workers is critically important for patient safety and quality care. The purpose of this pilot study was to evaluate outcomes of a workshop designed to teach Chinese nursing students to use the Situation-Background-Assessment-Recommendation (SBAR) communication tool and examine their attitudes toward utilizing SBAR as a communication tool. METHOD: A convenience sample of 18 master's degree nursing students at a Chinese university was introduced to SBAR through a workshop. The workshop combined the SBAR tool, video-stimulated recall and role-play case scenarios to illustrate potential positive and negative communication-related patient outcomes. Students completed a 12-item questionnaire before and after participating in the workshop. Four of the items examined the four elements of the SBAR tool (situation, background, assessment, recommendation, score range 0-20), and eight of the items evaluated students' self-perceived attitudes towards utilizing the SBAR tool in their clinical practice (score range 0-40). RESULTS: Pre- and post-workshop scores on the four elements of the SBAR tool demonstrate significant improvement in knowledge of SBAR (14.0±2.9 vs. 16.6±2.2, respectively; p=0.009). Pre- and post-workshop scores on the items testing students' self-perceived abilities also demonstrate significant improvement (26.9±3.5 vs. 32.6±4.5, respectively; p<0.01) in using SBAR. Total scores increased significantly from 40.9±5.0 to 49.2±5.9 (p<0.01). Moreover, 93.8% of the students agreed and strongly agreed that they would use SBAR during clinical practice. CONCLUSION: Participating in the SBAR workshop in combination with video-stimulated recall and role-play case scenarios significantly improved the Chinese nursing students' knowledge of SBAR and their self-perceived attitudes towards using SBAR tool. Future studies using a larger sample size and longer post-workshop follow-up are needed to confirm the long-term benefits of the workshop.