The impact of stigmatisation on adults with mental illnesses has been thoroughly demonstrated. However, little is known about experiences of stigmatisation among adolescents with mental illness. Through semi-structured interviews with 34 Danish adolescents (14-19 years) diagnosed with psychosis, this study explores adolescents\' experiences of psychosis stigma. On the basis of phenomenological analysis, we find that stigmatisation is widely experienced, and psychosis is generally regarded as more stigmatising than co-morbid mental illnesses. The participants engage in different strategies to manage possible stigma, especially strategies of (non-)disclosure. Disclosure is experienced as both therapeutic and normative, but also bears the risk of stigmatisation, and is therefore associated with numerous considerations. Being understood when disclosing is central to the participants, and lack of understanding from others is a continuous challenge. Nevertheless, participants experience benefits when feeling understood by people they confide in and can to a degree create the grounds for this through centralising aspects of their experiences of psychosis and mental illness. We argue that disclosure is both a stigma management strategy and a normative imperative, and that being understood or not is a challenge transcending stigma definitions.Clinical trial registration: Danish Health and Medicines Authority: 2612-4168. The Ethics Committee of Capital Region: H-3-2009-123. ClinicalTrials.gov: NCT01119014. Danish Data Protection Agency: 2009-41-3991.

BACKGROUND: Telemedicine has the potential to remove geographic and temporal obstacles to health care access. Whether and how telemedicine can increase health care access for underserved populations remains an open question. To address this issue, we integrated facilitated telemedicine encounters for the management of hepatitis C virus (HCV), a highly prevalent condition among people with opioid use disorder (OUD), into opioid treatment programs (OTPs). In New York State, OTPs are methadone-dispensing centers that provide patient-centered, evidence-based treatment for OUD. We investigated the integration and impact of facilitated telemedicine into OTP workflows in these settings.
OBJECTIVE: This study aims to understand OTP staff experiences with integrating facilitated telemedicine for HCV treatment into OTPs, including best practices and lessons learned.
METHODS: We conducted semistructured interviews with 45 OTP staff members (13 clinical, 12 administrative, 6 physicians, and 14 support staff members) at least one year after the implementation of facilitated telemedicine for HCV management. We used hermeneutic phenomenological analysis to understand OTP staff experiences.
RESULTS: We identified 4 overarching themes illustrating the successful integration of facilitated telemedicine for HCV care into OTPs. First, integration requires an understanding of the challenges, goals, and values of the OTP. As OTP staff learned about new, highly effective HCV therapies, they valued an HCV cure as a \"win\" for their patients and were excited about the potential to eliminate a highly prevalent infectious disease. Second, the integration of facilitated telemedicine into OTPs fosters social support and reinforces relationships between patients and OTP staff. OTP staff appreciated the ability to have \"eyes on\" patients during telemedicine encounters to assess body language, a necessary component of OUD management. Third, participants described high levels of interprofessional collaboration as a care team that included the blurring of lines between disciplines working toward a common goal of improving patient care. Study case managers were integrated into OTP workflows and established communication channels to improve patient outcomes. Fourth, administrators endorsed the sustained and future expansion of facilitated telemedicine to address comorbidities.
CONCLUSIONS: OTP staff were highly enthusiastic about facilitated telemedicine for an underserved population. They described high levels of collaboration and integration comparable to relevant integrative frameworks. When situated within OTPs, facilitated telemedicine is a high-value application of telemedicine that provides support for underserved populations necessary for high-quality health care. These experiences support sustaining and scaling facilitated telemedicine in comparable settings and evaluating its ability to address other comorbidities.
BACKGROUND: ClinicalTrials.gov NCT02933970; https://clinicaltrials.gov/study/NCT02933970.

BACKGROUND: Learning medication administration is essential for nursing students, but the first time can be stressful and shape their clinical development. Previous research primarily focused on student knowledge and technical aspects.
OBJECTIVE: This phenomenological study helped explore the lived experiences of nursing students and faculty during student\'s first medication administration in the clinical setting to gain a deeper understanding of their thoughts, feelings, and perspectives.
METHODS: Semi-structured interviews were conducted with female student and faculty informants (N = 12). Using a phenomenological study, data were analyzed using van Manen\'s hermeneutic six-step research activity method.
RESULTS: Five overarching themes were found: administrating medication, (un)preparedness for complexities in the clinical environment, transformative experience, overcoming fears, and reaping the rewards.
CONCLUSIONS: First-time medication experiences are greater than an exercise in skill proficiency and may be improved if faculty provides more structured learning experiences and take sufficient time for student preparation in relating medication knowledge to the skill, technology usage, and supporting students\' attitudes toward nurse-patient interactions. These are essential aspects of the medication administration learning process as nursing programs shift toward competency-based education. Clinical faculty also need support in their role as educators and to be facilitated to find this time, considering their multiple responsibilities.

Blacklegged ticks (Ixodes scapularis Say) pose an enormous public health risk in eastern North America as the vector responsible for transmitting 7 human pathogens, including those causing the most common vector-borne disease in the United States, Lyme disease. Species distribution modeling is an increasingly popular method for predicting the potential distribution and subsequent risk of blacklegged ticks, however, the development of such models thus far is highly variable and would benefit from the use of standardized protocols. To identify where standardized protocols would most benefit current distribution models, we completed the \"Overview, Data, Model, Assessment, and Prediction\" (ODMAP) distribution modeling protocol for 21 publications reporting 22 blacklegged tick distribution models. We calculated an average adherence of 73.4% (SD ± 29%). Most prominently, we found that authors could better justify and connect their selection of variables and associated spatial scales to blacklegged tick ecology. In addition, the authors could provide clearer descriptions of model development, including checks for multicollinearity, spatial autocorrelation, and plausibility. Finally, authors could improve their reporting of variable effects to avoid undermining the models\' utility in informing species-environment relationships. To enhance future model rigor and reproducibility, we recommend utilizing several resources including the ODMAP protocol, and suggest that journals make protocol compliance a publication prerequisite.

Combining ecological resilience theory with a phenomenological epistemology, we explored experiential, social, and cultural factors mediating resilience-building with participants from a village destroyed by the 2018 Fuego volcanic eruption in Guatemala. The purpose of the study is to find out what strategies displaced families and communities employ for living through the aftermath of a volcano eruption and for building psychological resilience. We conducted semistructured interviews with nine survivors of the Fuego eruption, now relocated and coping with the loss of community and family members killed in the disaster. Interpretive phenomenological analysis was used to analyze transcripts. The analysis produced four main themes: (i) individual and collective challenges, (ii) social support and protection, (iii) faith and culturally endorsed belief, and (iv) looking to the future. As well as learning more about how a community faced challenges presented by a volcano eruption, the current study has a degree of transferability, with implications for understanding how other communities experience and cope with such events.

BACKGROUND: Patients diagnosed with hematological malignancies residing in low-middle-income countries undergo significant physical and psychological stressors. Despite this, only 16% of them receive proper care during the terminal stages. It is therefore crucial to gain insight into the unique experiences of this population.
OBJECTIVE: To have a better understanding of the needs and experiences of adult patients with advanced hematological malignancy by exploring their perspectives.
METHODS: A qualitative interpretive design was employed to collect and analyze data using a phenomenological approach. The study involved in-depth interviews with ten participants aged between 49 and 65 years, utilizing a semi-structured approach.
RESULTS: Two primary themes emerged from the participants\' experiences of reaching the terminal stage of illness: \"Pain, Suffering, and Distress\" and \"Spiritual Coping.\" The first theme encompassed physical and emotional pain, suffering, and distress, while the second theme was centered on the participants\' spiritual coping mechanisms. These coping mechanisms included seeking comfort in religious practices, relying on spiritual support from family and friends, and finding solace in their beliefs and faith.
CONCLUSIONS: Patients with hematological malignancies in the terminal stages of their disease experience severe pain, considerable physical and psychosocial suffering, and spiritual distress. While they require support to cope with their daily struggles, their experiences often go unnoticed, leading to disappointment and loss of dignity. Patients mainly rely on their spirituality to cope with their situations. Healthcare providers must acknowledge these patients\' needs and provide more holistic and effective care.

The human papillomavirus (HPV) carries a significant health risk for people with a cervix. Among transgender and nonbinary people, however, testing and treatment for HPV can pose difficulties, and even be traumatic at times. This current study is part of a larger mixed methods study conducted in Michigan in 2020, and it explores the experiences of transmasculine and nonbinary people with at-home self-swabbing HPV test kits and knowledge of HPV transmission/screenings. Phenomenological methods were used by conducting virtual qualitative interviews with ten transmasculine and nonbinary individuals with cervixes, ages 23-59. Interviews were independently coded by members of the research team and a tabletop theming method was used. Four themes were generated from the data: 1) Multilevel barriers; 2) \"Get it done, so I know that I am safe\"; 3) Contrasting preferences for care; and 4) Community calls for change. The discussion focuses on the implications of these findings for improving sexual health care for the transgender and nonbinary community, along with directions for further research.

While virtual care services existed prior to the emergence of COVID-19, the pandemic catalyzed a rapid transition from in-person to virtual care service delivery across the Canadian health care system. Virtual care includes synchronous or asynchronous delivery of health care services through video visits, telephone visits, or secure messaging. Patient advisors are people with patient and caregiving experiences who collaborate within the health care system to share insights and experiences in order to improve health care.
This study aimed to understand patient advisors\' perceptions related to virtual care and potential impacts on health care quality.
We adopted a phenomenological approach, whereby we interviewed 20 participants who were patient advisors across Canada using a semistructured interview protocol. The protocol was developed by content experts and medical education researchers. The interviews were audio-recorded, transcribed verbatim, and analyzed thematically. Data collection stopped once thematic saturation was reached. The study was conducted at Queen\'s University, Kingston, Ontario. We recruited 20 participants from 5 Canadian provinces (17 female participants and 3 male participants).
Six themes were identified: (1) characteristics of effective health care, (2) experiences with virtual care, (3) modality preferences, (4) involvement of others, (5) risks associated with virtual care encounters, and (6) vulnerable populations. Participants reported that high-quality health care included building relationships and treating patients holistically. In general, participants described positive experiences with virtual care during the pandemic, including greater efficiency, increased accessibility, and that virtual care was less stressful and more patient centered. Participants comparing virtual care with in-person care reported that time, scheduling, and content of interactions were similar across modalities. However, participants also shared the perception that certain modalities were more appropriate for specific clinical encounters (eg, prescription renewals and follow-up appointments). Perspectives related to the involvement of family members and medical trainees were positive. Potential risks included miscommunication, privacy concerns, and inaccurate patient assessments. All participants agreed that stakeholders should be proactive in applying strategies to support vulnerable patients. Participants also recommended education for patients and providers to improve virtual care delivery.
Participant-reported experiences of virtual care encounters were relatively positive. Future work could focus on delivering training and resources for providers and patients. While initial experiences are positive, there is a need for ongoing stakeholder engagement and evaluation to improve patient and caregiver experiences with virtual care.

OBJECTIVE: Informal caregivers need to support their loved ones while performing caregiving responsibilities. A phenomenological qualitative study was done to understand the role of social support accessible for stroke caregivers.
METHODS: The respondents were enrolled from different organizations or support groups who were conducting activities specifically for stroke victims and/or their caregivers. Data collection was concluded after 10 participants were interviewed as no new major themes were discovered. Hence, saturation of data was obtained with a sample of 10 respondents.
RESULTS: Two themes were identified from the interviews: \"Response to Stroke\" and \"Stress and Coping\". Categories in theme one \"Response to Stroke\" were \"Work Life Balance\", \"Reaction of Other People or Family to Stroke\", and \"Expectations and Responsibility from Caregivers\". Categories in theme two \"Stress and Coping\" were \"Impact of Stroke on Abilities of Victim\", \"Stressors and Concerns for the Caregivers\", \"Strategies used by Caregivers to Cope with Stress\", and \"Role of Support Group and Social Support to Stroke Caregiver and Care Recipient\".
CONCLUSIONS: Stroke can lead to stress that can alter the responsibilities of caregivers of stroke victims. The role of social support and support groups was found to be critical for family caregivers to cope with caregiving issues.

As smart structures are becoming increasingly ubiquitous in our daily life, the need for efficient modeling electromechanical coupling devices is also rapidly advancing. Smart structures are often made of piezoelectric materials such as lead zirconate titanate (PZT), which exhibits strong nonlinear behavior known as hysteresis effect under a large applied electric field. There have been numerous modeling techniques that are able to capture such an effect; some techniques are suitable for obtaining physical insights into the micro-structure of the material, while other techniques are better-suited to practical structural analyses. In this paper, we aim to achieve the latter. We propose a simplified phenomenological macroscopic model of a nonlinear ferroelectric actuator. The assumption is based on the direct relation between the irreversible strain and irreversible electric field, and the consequently irreversible polarization. The proposed model is then implemented in a finite element framework, in which the main features such as local return mapping and the tangent moduli are derived. The outcomes of the model are compared and validated with experimental data. Therefore, the development presented in this paper can be a useful tool for the modeling of nonlinear ferroelectric actuators.