OBJECTIVE: The study aimed to characterize the experiences of primary caregivers of children with medical complexity (CMC) in engaging with other members of the child\'s caregiving network, thereby informing the design of health information technology (IT) for the caregiving network. Caregiving networks include friends, family, community members, and other trusted individuals who provide resources, information, health, or childcare.
METHODS: We performed a secondary analysis of two qualitative studies. Primary studies conducted semi-structured interviews (n = 50) with family caregivers of CMC. Interviews were held in the Midwest (n = 30) and the mid-Atlantic region (n = 20). Interviews were transcribed verbatim for thematic analysis. Emergent themes were mapped to implications for the design of future health IT.
RESULTS: Thematic analysis identified 8 themes characterizing a wide range of primary caregivers\' experiences in constructing, managing, and ensuring high-quality care delivery across the caregiving network.
CONCLUSIONS: Findings evidence a critical need to create flexible and customizable tools designed to support hiring/training processes, coordinating daily care across the caregiving network, communicating changing needs and care updates across the caregiving network, and creating contingency plans for instances where caregivers are unavailable to provide care to the CMC. Informaticists should additionally design accessible platforms that allow primary caregivers to connect with and learn from other caregivers while minimizing exposure to sensitive or emotional content as indicated by the user.
CONCLUSIONS: This article contributes to the design of health IT for CMC caregiving networks by uncovering previously underrecognized needs and experiences of CMC primary caregivers and drawing direct connections to design implications.

Heartland virus (HRTV) disease is an emerging tickborne illness in the midwestern and southern United States. We describe a reported fatal case of HRTV infection in the Maryland and Virginia region, states not widely recognized to have human HRTV disease cases. The range of HRTV could be expanding in the United States.

In the past few decades, hydrothermal vent research has progressed immensely, resulting in higher-quality samples and long-term studies. With time, scientists are becoming more aware of the impacts of sampling on the faunal communities and are looking for less invasive ways to investigate the vent ecosystems. In this perspective, imagery analysis plays a very important role. With this study, we test which factors can be quantitatively and accurately assessed based on imagery, through comparison with faunal sampling. Twelve instrumented chains were deployed on the Atlantic Eiffel Tower hydrothermal edifice and the corresponding study sites were subsequently sampled. Discrete, quantitative samples were compared to the imagery recorded during the experiment. An observer-effect was tested, by comparing imagery data gathered by different scientists. Most factors based on image analyses concerning Bathymodiolus azoricus mussels were shown to be valid representations of the corresponding samples. Additional ecological assets, based exclusively on imagery, were included.

Environmental integrated assessments are often carried out via the aggregation of a set of environmental indicators. Aggregated indices derived from the same data set can differ substantially depending upon how the indicators are weighted and aggregated, which is often a subjective matter. This article presents a method of generating aggregated environmental indices in an objective manner via Monte Carlo simulation. Rankings derived from the aggregated indices within and between three Monte Carlo simulations were used to evaluate the overall environmental condition of the study area. Other insights, such as the distribution of good or bad values of indicators at a watershed and/or a subregion, were observed in the study.

OBJECTIVE: To describe the experiences of ethical concerns by clinical nurses as they transitioned into their new role in hospital case management. Through this study, an attempt was made to explore experiences of ethical concerns and identify the implications for organizational ethics.
METHODS: In this study, nurse case managers practicing in the acute hospital setting, military, not-for-profit community, and teaching hospitals were interviewed. The majority of the nurse case manager participants were engaged in hospital discharge planning and utilization review activities.
METHODS: An interpretive phenomenological approach was used to identify the themes inherent in ethical concerns and articulate them within the context of hospital nurse case management. Fifteen participants were interviewed to obtain a qualitative description of the nurse case managers\' lived experiences of ethical dilemmas and how they were resolved.
RESULTS: Nurse case managers\' perceptions of solutions/options to resolve such ethical dilemmas were explored. As nurses transition into the expanded role of case management in the present healthcare delivery system, they frequently face situations demanding ethical choices and judgments to accommodate diverse patient interests and needs. These ethical decisions required in daily practice in case management represent ethical dilemmas to nurses. The insights derived from the analysis of the interviews have implications for nursing practice, education, policy, ethics, and research; recommendations for organizations employing nurse case managers in terms of recruitment, orientation, training, and continued need for educational support are identified.
CONCLUSIONS: 1. The clinical decisions required in daily practice of case management represented challenges to the nurses. This highlights the critical role of adequate educational orientation to case management for beginning case managers. 2. Nurse case managers should be cognizant of the \"disconnect\" that could occur between their obligations to the organizations that employ them and the healthcare needs of the patients that they advocate for. 3. Aside from the importance of linking patient care outcomes with accountability, nurse case managers may need to advocate for policy change and system reform.

Environmental indicators are often aggregated into a single index for various purposes in environmental studies. Aggregated indices derived from the same data set can differ, usually because the aggregated indices\' sensitivities are not thoroughly analyzed. Furthermore, if a sensitivity analysis is carried out, it is not presented in a transparent fashion to policy decision-makers. This paper presents a method of generating various aggregated environmental indices and analyzing their sensitivities via the use of the fuzzy set concept. Results show that several insights into the environmental conditions of the study area (e.g., the distribution of good or bad values of indicators at a watershed and or across the region) can be revealed in the sensitivity analysis of aggregated indices.

The team approach to case management (CM) has proven to be an effective method of providing quality outcomes, reducing fragmentation of care, improving communication, and reducing cost. Often CM teams consist of the patient, family/caregiver, physician, case manager, other health care personnel, clergy, home health agencies, employers, and health-plan administrators. This article focuses on the CM process implemented within a former TRICARE region to bridge the gap between the primary care manager (PCM) and CM. It discusses how the TRICARE Mid-Atlantic region identified and resolved barriers effecting collaboration between the PCM and CM.

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