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Telehealth is becoming a vital option for increasing access to health care. Family Nurse Practitioners (FNPs) are often the primary providers for rural and disadvantaged populations. They may be the first to encounter patients experiencing depression and other psychiatric problems. This article describes a two-part simulated telehealth education initiative to build FNP student competencies in the use of telehealth technology to interview clients with depressive symptoms. In Part 1, students completed didactic modules that introduced them to telehealth concepts. In Part 2, they participated in a simulated telehealth encounter with a standardized patient experiencing depression. Preparation included a review of care of patients with depression and focused content on telehealth etiquette. After the encounter, they received feedback from the standardized patient, debriefed with faculty, and documented their simulated telehealth visit. The activity was evaluated through post-education surveys and a one-time focus group. Students were overwhelmingly positive regarding the relevance of the educational activity to their graduate preparation and future practice. Many shared suggestions for refinement of the activity. Integration into the current curriculum and use of existing resources increased the feasibility, cost-effectiveness, and potential for long-term sustainability of the educational initiative.

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OBJECTIVE: To increase clinician adherence to mammography screening guidelines. DESIGN: Quality improvement initiative. SETTING/LOCAL PROBLEM: At a nurse practitioner-led primary care practice, a chart audit of adherence to American Cancer Society mammography screening guidelines indicated a 12% adherence rate for clinicians writing mammography orders. PARTICIPANTS: Nurse practitioners providing care to women ages 40 years and older. INTERVENTION/MEASUREMENTS: The intervention was a screening checklist that was completed by the woman at registration and given to the clinician during the examination. The pre- and postintervention measurement was the percentage of mammogram orders. A Fisher exact test was used to examine changes from pre- to postintervention rates of adherence. RESULTS: After the intervention, the percentage of women for whom a mammogram was recommended and ordered was 69.6%, compared to 12% from the original chart audit. This change was statistically significant (p = .01). CONCLUSION: Clinicians must find efficient approaches to improve processes within their practice settings to ensure that preventive care recommendations are made during visits. Although the screening checklist was deemed useful, improvement in adherence rates is still needed, and a paperless system should be initiated.

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OBJECTIVE: To examine interest, resources, and preferences for weight loss programs among primary care patients with obesity. METHODS: Primary care patients having a BMI ≥30 kg/m2 were recruited in the summer and fall of 2018. Eligible patients were invited to complete an anonymous survey assessing sociodemographic factors, interest in weight loss, resources, and preferences for weight loss programs. Descriptive statistics were used for analysis. RESULTS: A total of 77 patients completed the anonymous survey. Nearly 90% of patients were interested in participating in a weight loss program and reported having a smartphone. Approximately 80% had high-speed internet and a device with videoconferencing capabilities, whereas only 40% had a tablet or laptop computer. On average, patients preferred weight loss programs delivered in-person and led by a nutritionist or personal trainer. Patients' top three preferences for weight loss content included goal setting, staying motivated, and finding ways to be more active. CONCLUSIONS: Although primary care patients with obesity were interested in weight loss programs, availability of resources and preferred program characteristics varied. PRACTICE IMPLICATIONS: This study provides insight on patient interest, resources, and preferences for weight loss programs that may help guide the development of future programs.

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Linear matrix inequalities were applied to design a mixed H2/H(infinity) feedback control compensator for a structural acoustic system. The compensator was designed to minimize the H2 norm of radiation filters while constraining the H(infinity) norm through the control path to be less than unity. A trade-off between minimizing sound power radiated and maximum rms gain in the control path resulted in a reliable and robust means of designing compensators for structural acoustic control.

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High resolution x-ray powder diffraction measurements on poled PbZr1-xTixO3 (PZT) ceramic samples close to the rhombohedral-tetragonal phase boundary (the so-called morphotropic phase boundary) have shown that for both rhombohedral and tetragonal compositions the piezoelectric elongation of the unit cell does not occur along the polar directions but along those directions associated with the monoclinic distortion. This work provides the first direct evidence for the origin of the very high piezoelectricity in PZT.

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This paper demonstrates active structural acoustic control using multiple input/output adaptive sensoriactuators combined with radiation filters and a feedback control paradigm. A new method of reduced order modeling/design of radiation filters termed radiation modal expansion (RME) is presented. For the experiments detailed in this paper, the RME technique reduced the modeling of the radiation matrix from 400 transfer functions to 6 transfer functions (multiplied by a constant transformation matrix). Experimental results demonstrate reductions of radiated sound power on the order of 5 dB over the bandwidth of 0-800 Hz.