Advanced Practice Nurse-Led Research: Challenges and Approaches to Digital Health Programs' Evaluation Using Big Data.

Advanced practice nurse leaders are in key positions within health systems to provide time and resources for implementation and evaluation of digital health services. As virtual monitoring programs become more embedded within nursing, nurse leaders and educators need to ensure that nurses are prepared to work within interprofessional teams to administer and evaluate them. This article discusses challenges and implementation strategy considerations for data curation and analysis using large datasets from the Medicaid population for research.

Grazing herbivores reduce herbaceous biomass and fire activity across African savannas.

Fire and herbivory interact to alter ecosystems and carbon cycling. In savannas, herbivores can reduce fire activity by removing grass biomass, but the size of these effects and what regulates them remain uncertain. To examine grazing effects on fuels and fire regimes across African savannas, we combined data from herbivore exclosure experiments with remotely sensed data on fire activity and herbivore density.

How Do Learners Receive Feedback on Note Writing? A Scoping Review.

Purpose: The literature assessing the process of note-writing based on gathered information is scant. This scoping review investigates methods of providing feedback on learners' note-writing abilities.

Method: Scopus and Web of Science were searched for studies that investigated feedback on student notes or reviewed notes written on an information or data-gathering activity in health care and other fields in August 2022.

Trees, carbon, and the psychology of landscapes.

Mitigating climate change while safeguarding biodiversity and livelihoods is a major challenge. However, rampant afforestation threatens biodiversity and livelihoods, with questionable benefits to carbon storage. The narrative of landscape degradation is often applied without considering the history of the landscape.

Automated Patient Note Grading: Examining Scoring Reliability and Feasibility.

Purpose: Scoring postencounter patient notes (PNs) yields significant insights into student performance, but the resource intensity of scoring limits its use. Recent advances in natural language processing (NLP) and machine learning allow application of automated short answer grading (ASAG) for this task. This retrospective study evaluated psychometric characteristics and reliability of an ASAG system for PNs and factors contributing to implementation, including feasibility and case-specific phrase annotation required to tune the system for a new case.

A trillion trees: carbon capture or fuelling fires?

Afforesting grassy systems for carbon gain using flammable plantation trees could shift the fire regime from lower intensity grass-fuelled fires to high-intensity crown fires. Future changes in climate will worsen this. We highlight the fire risk of trees planted for carbon and costs of fire protection using African examples.

Quantifying the environmental limits to fire spread in grassy ecosystems.

Modeling fire spread as an infection process is intuitive: An ignition lights a patch of fuel, which infects its neighbor, and so on. Infection models produce nonlinear thresholds, whereby fire spreads only when fuel connectivity and infection probability are sufficiently high. These thresholds are fundamental both to managing fire and to theoretical models of fire spread, whereas applied fire models more often apply quasi-empirical approaches.

Feedbacks in ecology and evolution.

Ecology and evolutionary biology have focused on how organisms fit the environment. Less attention has been given to the idea that organisms can also modify their environment, and that these modifications can feed back to the organism, thus providing a key factor for their persistence and evolution. There are at least three independent lines of evidence emphasizing these biological feedback processes at different scales: niche construction (population scale); alternative biome states (community scale); and the Gaia hypothesis (planetary scale).

The Use of Virtual Standardized Patients for Practice in High Value Care.

Introduction: This study examined the influence of high value care (HVC)-focused virtual standardized patients (VSPs) on learner attitudes toward cost-conscious care (CCC), performance on subsequent standardized patient (SP) encounters, and the correlation of VSP performance with educational outcomes.

Method: After didactic sessions on HVC, third-year medical students participated in a randomized crossover design of simulation modalities consisting of 4 VSPs and 3 SPs. Surveys of attitudes toward CCC were administered before didactics and after the first simulation method.

In Situ Simulation for Adoption of New Technology to Improve Sepsis Care in Rural Emergency Departments.

Objectives: The aims of the study were to evaluate whether in situ (on-site) simulation training is associated with increased telemedicine use for patients presenting to rural emergency departments (EDs) with severe sepsis and septic shock and to evaluate the association between simulation training and telehealth with acute sepsis bundle (SEP-1) compliance and mortality.

Methods: This was a quasi-experimental study of patients presenting to 2 rural EDs with severe sepsis and/or septic shock before and after rollout of in situ simulation training that included education on sepsis management and the use of telehealth. Unadjusted and adjusted analyses were conducted to describe the association of simulation training with sepsis process of care markers and with mortality.

Lineage-based functional types: characterising functional diversity to enhance the representation of ecological behaviour in Land Surface Models.

Process-based vegetation models attempt to represent the wide range of trait variation in biomes by grouping ecologically similar species into plant functional types (PFTs). This approach has been successful in representing many aspects of plant physiology and biophysics but struggles to capture biogeographic history and ecological dynamics that determine biome boundaries and plant distributions. Grass-dominated ecosystems are broadly distributed across all vegetated continents and harbour large functional diversity, yet most Land Surface Models (LSMs) summarise grasses into two generic PFTs based primarily on differences between temperate C grasses and (sub)tropical C grasses.

A novel in situ simulation framework for introduction of a new technology: the 3-Act-3-Debrief model.

Background: New technologies for clinical staff are typically introduced via an "in-service" that focuses on knowledge and technical skill. Successful adoption of new healthcare technologies is influenced by multiple other factors as described by the Consolidated Framework in Implementation Research (CFIR). A simulation-based introduction to new technologies provides opportunity to intentionally address specific factors that influence adoption.

Sepsis Alerts in Emergency Departments: A Systematic Review of Accuracy and Quality Measure Impact.

Introduction: For early detection of sepsis, automated systems within the electronic health record have evolved to alert emergency department (ED) personnel to the possibility of sepsis, and in some cases link them to suggested care pathways. We conducted a systematic review of automated sepsis-alert detection systems in the ED.

Methods: We searched multiple health literature databases from the earliest available dates to August 2018.

Savanna tree evolutionary ages inform the reconstruction of the paleoenvironment of our hominin ancestors.

Ideas on hominin evolution have long invoked the emergence from forests into open habitats as generating selection for traits such as bipedalism and dietary shifts. Though controversial, the savanna hypothesis continues to motivate research into the palaeo-environments of Africa. Reconstruction of these ancient environments has depended heavily on carbon isotopic analysis of fossil bones and palaeosols.

On the Three Major Recycling Pathways in Terrestrial Ecosystems.

Plants are the largest biomass component of most terrestrial ecosystems, and litter decomposition is considered the dominant process by which nutrients return to plants. We show that in terrestrial ecosystems, there are three major pathways by which plant biomass is degraded into forms that release nutrients again available to plants: microbial decomposition; vertebrate herbivory; and wildfires. These processes act at different spatial and temporal scales, have different niches, and generates different ecological and evolutionary feedbacks.

A Rare De Novo Myoepithelial Carcinoma Ex Pleomorphic Adenoma in a Young Woman.

Carcinoma ex pleomorphic adenoma, an uncommon neoplasm of the parotid gland, accounts for less than 4% of salivary gland tumors. It arises from a benign pleomorphic adenoma presenting in the sixth to eighth decades of life. We present this as a unique account of a primary parotid gland carcinoma, arising from myoepithelial cells, without a known precursor lesion, in a 28-year-old woman.

Mismatches between demographic niches and geographic distributions are strongest in poorly dispersed and highly persistent plant species.

The ecological niche of a species describes the variation in population growth rates along environmental gradients that drives geographic range dynamics. Niches are thus central for understanding and forecasting species' geographic distributions. However, theory predicts that migration limitation, source-sink dynamics, and time-lagged local extinction can cause mismatches between niches and geographic distributions.

Alternative Biome States in Terrestrial Ecosystems.

There is growing interest in the application of alternative stable state (ASS) theory to explain major vegetation patterns of the world. Here, we introduce the theory as applied to the puzzle of nonforested (open) biomes growing in climates that are warm and wet enough to support forests (alternative biome states, ABSs). Long thought to be the product of deforestation, diverse lines of evidence indicate that many open ecosystems are ancient.