Medicine and Health Sciences Commons^™

A Game-Theoretic Approach To Share The Costs Of Cooperating Healthcare Networks, Jay M. Lightfoot

Journal of International Technology and Information Management

The growing demand for healthcare services combined with the disarray in the health insurance market in the United States has created a situation where rival health networks are aggressively competing by building duplicate health facilities and providing redundant services in localized geographic regions. Unfortunately, this strategy can reduce the quality of patient care and decrease profits (Kaissi & Charland, 2013). A solution to this problem is for health networks to cooperate and share healthcare equipment, facilities, and personnel. Toward that end, this paper presents a game-theoretic method that can share these costs in a fair, efficient, and repeatable manner.

Mobile Iot Adoption As Antecedent To Care-Service Efficiency And Improvement: Empirical Study In Healthcare-Context, Samyadip Chakraborty, Vaidik Bhatt

Journal of International Technology and Information Management

Internet of things (IoT) is the buzzword and pioneering breakthrough approach highlighted in today’s industry 4.0, where the devices are seamlessly integrated with each other, sharing vital information in real-time sync. With the wearable IoT devices, the diagnostic readings and physical measurements of the patients can be shared with the physician on the go and suitable diagnosis can as well be shared with patient in the real-time on their own mobile devices through IoT applications. This study empirically examines the importance of m-IoT adoption on the information pervasiveness across the network and patient stakeholders and in turn investigating how efficiency …

Continuous Low-Intensity Ultrasound Attenuates Il-6 And Tnfα-Induced Catabolic Effects And Repairs Chondral Fissures In Bovine Osteochondral Explants, Neety Sahu, Hendrik J. Viljoen, Anuradha Subramanian

Department of Chemical and Biomolecular Engineering: Faculty Publications

Background: Cartilage repair outcomes are compromised in a pro-inflammatory environment; therefore, the mitigation of pro-inflammatory responses is beneficial. Treatment with continuous low-intensity ultrasound (cLIUS) at the resonant frequency of 5 MHz is proposed for the repair of chondral fissures under pro-inflammatory conditions.

Methods: Bovine osteochondral explants, concentrically incised to create chondral fissures, were maintained under cLIUS (14 kPa (5 MHz, 2.5 Vpp), 20 min, 4 times/day) for a period of 28 days in the presence or absence of cytokines, interleukin-6 (IL-6) or tumor necrosis factor (TNF)α. Outcome assessments included histological and immunohistochemical staining of the explants; and the expression of …

American White Pelican (Pelecanus Erythrorhynchos) Growth, Nutrition And Immunology, Treena L. Ferguson, Brian J. Rude, D. Tommy King

United States Department of Agriculture Wildlife Services: Staff Publications

Limited information about nutrition exists on American White Pelicans (Pelecanus erythrorhynchos) from hatching to fledging. To detail immunity, metabolism and nutrition of juvenile American White Pelicans, during 22-23 July 2011, 103 samples of regurgitate matter were collected at five Chase Lake, North Dakota, USA, and three Bitter Lake, South Dakota, USA, sub-colonies. Regurgitate sample nutrient content was significantly different for organic matter (P = 0.012), crude protein (P = 0.001), neutral detergent fiber (P = 0.014), acid detergent fiber (P = 0.005) and energy (P = 0.034) between North (n = 5) …

Isolation Of Rabies Virus From The Salivary Glands Of Wild And Domestic Carnivores During A Skunk Rabies Epizootic, Cornell University Jimenez, Terry R. Spraker, Jessica Anderson, Richard Bowen, Amy Gilbert

United States Department of Agriculture Wildlife Services: Staff Publications

Rabies is a fatal zoonotic disease of global importance. Rabies virus is shed in the saliva of infected hosts and is primarily transmitted through bite contact. Canine rabies has been eliminated from the US, but wildlife constitutes more than 90% of the reported cases of animal rabies in the US each year. In the US, several wild carnivore species are reservoirs of distinct variants of rabies virus (RV). After decades of apparent absence, the south-central skunk (SCSK) RV variant was detected in Colorado in 2007 and resulted in a large-scale epizootic in striped skunk (Mephitis mephitis) populations in northern Colorado …

Predation And Disease-Related Economic Impacts Of Wild Pigs On Livestock Producers In 13 States, Aaron M. Anderson, Chris Slootmaker, Erin Harper, Ryan S. Miller, Stephanie A. Shwiff

United States Department of Agriculture Wildlife Services: Staff Publications

We report the results of a survey on wild pigs (Sus scrofa) damage to livestock producers in 13 US states (Alabama, Arkansas, California, Florida, Georgia, Louisiana, Mississippi, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas). The survey was distributed by the USDA National Agricultural Statistical Service in the summer of 2017 to a sample of livestock producers in the 13-state region. Findings indicate that predation and disease-related damage can be substantial in certain states and for certain types of livestock. In particular, damage to cattle operations in Texas and Arkansas was substantially higher than damage in other states …

Taking The Bait: Species Taking Oral Rabies Vaccine Baits Intended For Raccoons, Betsy S. Haley, Are R. Berentsen, Richard M. Engeman

United States Department of Agriculture Wildlife Services: Staff Publications

Raccoon rabies in eastern USA is managed by strategically distributing oral rabies vaccine (ORV) baits. The attractiveness, palativity, density, and non-target species bait take affect ORV effectiveness. We examined raccoon and non-target species differences in investigating/removing fish-meal polymer and coated sachet baits applied to simulate two aerial bait distribution densities. Bait densities of 150 baits/km2 and 75 baits/km2 were evaluated, respectively, in zones expected to have high and low

Racc oon densities. Three primary non-target species visited baits: coyotes, white-tailed deer, and feral swine. The proportion of bait stations visited by raccoons during 1 week observation periods ranged from 50 …

In Situ Evaluation Of An Automated Aerial Bait Delivery System For Landscape-Scale Control Of Invasive Brown Treesnakes On Guam, Shane Siers, Will Pitt, John Eisemann, Larry Clark, Aaron B. Shiels, C. S. Clark, R. J. Gosnell, M. C. Messaros

United States Department of Agriculture Wildlife Services: Staff Publications

After decades of biodiversity loss and economic burden caused by the brown treesnake invasion on the Pacific island of Guam, relief hovers on the horizon. Previous work by USDA Wildlife Services (WS) and its National Wildlife Research Center (NWRC) demonstrated that brown treesnake numbers in forested habitats can be dramatically suppressed by aerial delivery of dead newborn mouse (DNM) baits treated with 80 mg of acetaminophen. However, manual bait preparation and application is impractical for landscape-scale treatment. WS, NWRC, and the US Department of the Interior have collaborated with Applied Design Corporation to engineer an automated bait manufacturing and delivery …

Persistence And Conspecific Observations Improve Problem-Solving Abilities Of Coyotes, Julie K. Young, Laura Touzot, Stacey P. Brummer

United States Department of Agriculture Wildlife Services: Staff Publications

Social learning has important ecological and evolutionary consequences but the role of certain factors, such as social rank, neophobia (i.e., avoidance of novel stimuli), persistence, and task-reward association, remain less understood. We examined the role of these factors in social learning by captive coyotes (Canis latrans) via three studies. Study 1 involved individual animals and eliminated object neophobia by familiarizing the subjects to the testing apparatus prior to testing. Studies 2 and 3 used mated pairs to assess social rank, and included object neophobia, but differed in that study 3 decoupled the food reward from the testing apparatus (i.e., altered …

Experimental Infections Of Norway Rats With Avian‑Derived Low‑Pathogenic Influenza A Viruses, Kaci K. Vandalen, Nicole M. Nemeth, Nicholas O. Thomas, Nicole L. Barrett, Jeremy W. Ellis, Heather J. Sullivan, Alan B. Franklin, Susan A. Shriner

United States Department of Agriculture Wildlife Services: Staff Publications

Influenza A viruses (IAVs) are a public-health, veterinary, and agricultural concern. Although wild birds are considered the primary reservoir hosts for most IAVs, wild-bird IAV strains are known to spill over into poultry, domestic or wild mammals, and humans. Occasionally, spillover events may result in adaptation or reassortment with other strains. Moreover, some IAV strains found in wild waterfowl mutate into highly pathogenic forms in poultry, causing tremendous economic losses. When domestic animals, wildlife, and humans dwell in close proximity to each other, such as may be the case with agricultural operations, wildlife may represent a potential risk for interspecies …

Movement Responses Inform Effectiveness And Consequences Of Baiting Wild Pigs For Population Control, Nathan P. Snow, Kurt C. Vercauteren

United States Department of Agriculture Wildlife Services: Staff Publications

Wild pigs (Sus scrofa) damage agricultural and natural resources throughout their nearly global distribution. Subsequently, population control activities (e.g., trapping, shooting, or toxic baiting) frequently involve the deployment of bait to attract wild pigs. A better understanding of how wild pigs respond to bait sites can help maximize efficiency of baiting programs and identify any potential pitfalls. We examined the movement behaviors of 68 wild pigs during three stages of intensive baiting programs (i.e., 15 days each: prior, during, and post baiting) spread across two distinct study areas in southern and northern Texas, USA. We found that bait sites needed …

Raccoon (Procyon Lotor) Response To Ontario Rabies Vaccine Baits (Onrab) In St. Lawrence County, New York, Usa, Kerri Pedersen, Amy T. Gilbert, Kathleen M. Nelson, Daniel P. Morgan, Amy J. Davis, Kurt C. Vercauteren, Dennis Slate, Richard B. Chipman

United States Department of Agriculture Wildlife Services: Staff Publications

Oral rabies vaccination (ORV) campaigns have been conducted annually in the US over the past two decades to prevent raccoon (Procyon lotor) rabies, which is enzootic along the eastern region of the country from southeastern Canada to Alabama. Because raccoon rabies has been eliminated from neighboring Canadian provinces, continued detection of the variant in the US is of concern due to the potential for infected raccoons to cross the border via the St. Lawrence River. Ontario Rabies Vaccine Baits (ONRAB) containing a live, recombinant human adenovirus expressing the rabies virus glycoprotein have been under experimental use in the …

Taking The Bait: Species Taking Oral Rabies Vaccine Baits Intended For Raccoons, Betsy S. Haley, Are R. Berentsen, Richard M. Engeman

United States Department of Agriculture Wildlife Services: Staff Publications

Raccoon rabies in eastern USA is managed by strategically distributing oral rabies vaccine (ORV) baits. The attractiveness, palativity, density, and non-target species bait take affect ORV effectiveness. We examined raccoon and non-target species differences in investigating/removing fish-meal polymer and coated sachet baits applied to simulate two aerial bait distribution densities. Bait densities of 150 baits/km² and 75 baits/km² were evaluated, respectively, in zones expected to have high and low raccoon densities. Three primary non-target species visited baits: coyotes, white-tailed deer, and feral swine. The proportion of bait stations visited by raccoons during 1 week observation periods ranged from …

Potential Role Of Wildlife In The Usa In The Event Of A Foot-And-Mouth Disease Virus Incursion, Vienna R. Brown, Sarah N. Bevins

United States Department of Agriculture Wildlife Services: Staff Publications

Foot-and-mouth disease (FMD) is caused by foot-and-mouth disease virus (FMDV) which affects domestic and wild cloven-hoofed species. The FMD-free status of the USA and the tremendous economic impact of a virus incursion motivated the development of this evaluation of the potential role of wildlife in the event of a virus introduction. Additionally, this manuscript contains a summary of US vulnerabilities for viral incursion and persistence which focuses specifically on the possible role of wildlife. The legal movement of susceptible live animals, animal products, by-products and animal feed containing animal products pose a risk of virus introduction and spread. Additionally, the …

Trail Cameras Are A Key Monitoring Tool For Determining Target And Non-Target Bait-Take During Rodent Removal Operations: Evidence From Desecheo Island Rat Eradication, Aaron B. Shiels, D. Will, C. Figuerola-Hernández, K.J. Swinnerton, S. Silander, C. Samra, G.W. Witmer

United States Department of Agriculture Wildlife Services: Staff Publications

Efforts to remove invasive rodents (e.g. Rattus spp. and Mus musculus) from islands often use toxicant-laced baits containing the anticoagulants brodifacoum or diphacinone. Rodenticide baits are generally delivered through aerialor hand-broadcast, or in bait stations. These baits are not rodent-specific and are subject to non-target consumption or secondary exposure (e.g. an individual preying upon another individual that has consumed bait). During rodenticide applications, it is generally unknown which animals are visiting and consuming bait; and to quantify this, we recommend using trail cameras (e.g. Reconyx^tm motion-activated infra-red) positioned to monitor individual bait pellets. To demonstrate the importance and effectiveness …

Black Bear Use Of Forest Roads In Western Washington, Gary W. Witmer

United States Department of Agriculture Wildlife Services: Staff Publications

Radiolocations (108) of 20 black bears were used to assess use or avoidance of 3 forest road types in western Washington. Distances of bears to each type of road were compared to distances of 108 random points using t-tests. Females and males avoided 2-lane roads, while only males avoided 1-lane roads, the most common road type in the area. Females, but not males, were located closer to overgrown, spur roads than expected. This road type has substantial cover of grasses, forbs, and berry-producing shrubs along with protective tree cover. This situation may provide easy travel for females along with security …

Home Range And Habitat Use Of West Virginia Canis Latrans (Coyote), Lauren M. Mastro, Dana J. Morin, Eric M. Gese

United States Department of Agriculture Wildlife Services: Staff Publications

Canis latrans (Coyote) has undergone a range expansion in the United States over the last century. As a highly opportunistic species, its home range and habitat use changes with ecological context. Coyotes were first reported in West Virginia in 1950 but were not commonly observed until the 1990s, and there is scant information on Coyotes in the region. We used telemetry data from 8 radiocollared Coyotes in West Virginia to estimate home-range size and third-order habitat selection. Home-range areas (95% utilization distributions; UDs) varied from 5.22 to 27.79 km2 (mean = 12.48 ± 2.61 km2), with highly concentrated use of …

The Role Of Scavenging In Disease Dynamics, Joaquín Vicente, Kurt C. Vercauteren

United States Department of Agriculture Wildlife Services: Staff Publications

Contents

Introduction................ 161

The Use of Animal Remains and the Exposure of Scavengers to Disease........ 163

The Relevance of Scavenging for Pathogens to Spread and Persist.......... 166

Human Related Factors Resulting in Increased Risk for Disease Transmission Through Scavenging.............. 170

Management of Scavenging to Reduce Disease Risks.............. 173

Restoration of Large Predators.................. 174

Elimination of Hunting of Scavengers............ 174

Destruction of Big Game and Domestic Animal Carcasses........... 174

Restoration of the Effects of Overabundance............. 175

Excluding Mammalian and Avian Scavengers from Natural Carrions.......... 176

Excluding Mammalian and Avian Scavengers from Vulture Restaurants........... 176

Conclusions and Future Perspectives........... 178

References............... 178

Using Unmanned Aerial Vehicles For Bird Harassment On Fish Ponds, Ciera A. Rhoades, Peter J. Allen, D. Tommy King

United States Department of Agriculture Wildlife Services: Staff Publications

The effects of aquaculture decline on piscivorous birds in the Mississippi Delta concern catfish farmers, with possible increases in fish loss and disease transmission. Piscivorous birds quickly habituate to most current methods of harassment (loud noises and visual disturbances) leading to increased depredation and disease. Our study was designed to test the efficacy of using unmanned aerial vehicles (UAVs) to effectively control piscivorous birds at fish farms. We hypothesized that a UAV would be more efficient at reducing the number of fish-eating birds on fish ponds than current forms of harassment. We conducted pre-treatment bird surveys, harassment observations, and post-treatment …

Locally Fixed Alleles: A Method To Localize Gene Drive To Island Populations, Jaye Sudweeks, Brandon Hollingsworth, Dimitri V. Blondel, Karl J. Campbell, Sumit Dhole, John D. Eisemann, Owain Edwards, John Godwin, Gregg R. Howald, Kevin P. Oh, Antoinette J. Piaggio, Thomas A.A. Prowse, Joshua V. Ross, J. Royden Saah, Aaron B. Shiels, Paul Q. Thomas, David W. Threadgill, Michael R. Vella, Fred Gould, Alun L. Lloyd

United States Department of Agriculture Wildlife Services: Staff Publications

Invasive species pose a major threat to biodiversity on islands. While successes have been achieved using traditional removal methods, such as toxicants aimed at rodents, these approaches have limitations and various off-target effects on island ecosystems. Gene drive technologies designed to eliminate a population provide an alternative approach, but the potential for drive-bearing individuals to escape from the target release area and impact populations elsewhere is a major concern. Here we propose the “Locally Fixed Alleles” approach as a novel means for localizing elimination by a drive to an island population that exhibits significant genetic isolation from neighboring populations. Our …

Hiv With Opportunistic Neuroinfection, Rahul Vyas, Rajendra Prasad

Digital Journal of Clinical Medicine

No abstract provided.

The Prevotella Copri Complex Comprises Four Distinct Clades Underrepresented In Westernized Populations, Adrian Tett, Kun D. Huang, Francesco Asnicar, Hannah Fehlner-Peach, Edoardo Pasolli, Nicolai Karcher, Federica Armanini, Paolo Manghi, Kevin Bonham, Moreno Zolfo, Francesca De Filippis, Cara Magnabosco, Richard Bonneau, John Lusingu, John Amuasi, Karl Reinhard, Thomas Rattei, Fredrik Boulund, Lars Engstrand, Albert Zink, Maria Carmen Collado, Dan R. Littman, Daniel Eibach, Danilo Ercolini, Omar Rota-Stabelli, Curtis Huttenhower, Frank Maixner, Nicola Segata

Karl Reinhard Publications

Prevotella copri is a common human gut microbe that has been both positively and negatively associated with host health. In a cross-continent metaanalysis exploiting >6,500 metagenomes, we obtained >1,000 genomes and explored the genetic and population structure of P. copri. P. copri encompasses four distinct clades (>10% inter-clade genetic divergence) that we propose constitute the P. copri complex, and all clades were confirmed by isolate sequencing. These clades are nearly ubiquitous and co-present in non-Westernized populations. Genomic analysis showed substantial functional diversity in the complex with notable differences in carbohydrate metabolism, suggesting that multi-generational dietary modifications may be …

Imaging Coprolite Taphonomy And Preservation, Karl Reinhard, Morgana Camacho, Breyden Geyer, Samantha Hayek, Chase Horn, Kaitlin Otterson, Julia Russ

Karl Reinhard Publications

The impact of coprolite taphonomy on parasite remains and aDNA recovery has been recognized. In general, coprolites from sites protected by geologic features such as caves and rock shelters exhibit the best preservation. In contrast, coprolites from open sites can be badly affected by taphonomic processes as shown by analyses of parasite eggs. For eggs, the impact of mites and free living nematodes has been quantified. Mites are associated with poor pinworm egg preservation. In other studies, percolation of water through sediments has a negative impact on egg recovery. We note that dietary remains can also decompose at open sites. …

Examining Sensory Ability, Feature Matching And Assessment-Based Adaptation For A Brain–Computer Interface Using The Steady-State Visually Evoked Potential, Jonathan S. Brumberg, Anh Nguyen, Kevin M. Pitt, Sean D. Lorenz

Department of Special Education and Communication Disorders: Faculty Publications

Purpose: We investigated how overt visual attention and oculomotor control influence successful use of a visual feedback brain-computer interface (BCI) for accessing augmentative and alternative communication (AAC) devices in a heterogeneous population of individuals with profound neuromotor impairments. BCIs are often tested within a single patient population limiting generalization of results. This study focuses on examining individual sensory abilities with an eye toward possible interface adaptations to improve device performance.

Methods: Five individuals with a range of neuromotor disorders participated in four-choice BCI control task involving the steady state visually evoked potential. The BCI graphical interface was designed to simulate …

"Continuing Life" Of Adolescents With Cancer Relapse Receiving Palliative Care("ชีวิตที่อยู่ต่อไป" ของผู้ป่วยวัยรุ่นโรคมะเร็งกลับเป็นซ้ำที่ได้รับการดูแลแบบประคับประคอง), Thipkasorn Wannaphak, Surasak Treenai

Journal of Nursing Research, Innovation, and Health

Objective: To describe the living of patients with cancer relapse who were received palliative care.Research Design: Qualitative research using Edmund Husserl phenomenology approach.Research Methodology: The key informants selected with purposive sampling were adolescents patients (boys and girls), diagnosed by doctors which they had leukemia lymphoma and central nervous system tumors. They were treated with chemotherapy for at least 1 year, perceived and received palliative care for at least 6 months. Data were collected by in-depth interviews based on means of Colaizzi until the information was saturated. A total of the key informants were 9 patients.Results: "Continuing life" is one of …

The Effect Of Integrated Exercise-Oriented Program On Fatigue In Persons With Chronic Kidney Disease Receiving Hemodialysis(ผลของโปรแกรมแบบบูรณาการที่เน้นการออกกำลังกายขณะฟอกเลือดต่ออาการเหนื่อยล้าในผู้ป่วยโรคไตเรื้อรังที่ได้รับการฟอกเลือดด้วยเครื่องไตเทียม), Patcharin Injan, Sunida Preechawong

Journal of Nursing Research, Innovation, and Health

Purpose: To study the effect of integrated program emphasizing exercise on fatigue in persons with chronic kidney disease receiving hemodialysis.Design: Quasi-experimental design.Method: The participants were fifty patients with chronic kidney disease receiving hemodialysis. The participants were divided into two groups: 25 experimental and 25 control groups. While the control group received the conventional nursing care, the experimental group participated in the integrated exercise-oriented program intradialytic exercise. The research instrument used for data collection was the Fatigue Severe Scale questionnaires which has a Cronbach's alpha coefficient of 0.85. Data were analyzed using Descriptive statistics, repeated measures ANOVA and independent t-test.Results:1) The …

Factors Affecting Exclusive Breastfeeding During 4-6 Week Postpartum Among Mothers With Pre-Pregnancy Overweight And Obese(ปัจจัยที่มีผลต่อการเลี้ยงลูกด้วยนมแม่อย่างเดียว 4-6 สัปดาห์หลังคลอด ในมารดาที่มีภาวะน้ำหนักเกินและอ้วนก่อนตั้งครรภ์), Nichaporn Tipsing, Siriwan Sangin, Piriya Suppasri

Journal of Nursing Research, Innovation, and Health

Purpose:The study aimed to study exclusive breastfeeding rate and investigate factors predicting exclusive breastfeeding during 4-6 week postpartum among mothers with pre-pregnancy overweight and obesity.Design: Descriptive predictive research.Methods:Participants consisted of 200 during 4-6 week postpartum among mothers with pre-pregnancy overweight and obesity who were followed up at obstetrical-gynecological out-patient departments at 3 Saiyairak (family-friendly) hospitals in Chonburi province including Chonburi hospital, Queen Savang Vadhana Memorial hospital and Banglamung hospital. Convenience sampling was used to recruit sample. Research instruments consisted of demographic and breastfeeding information, perceived benefit of breastfeeding questionnaire, perceived barrier of breastfeeding questionnaire, perceived self-efficacy of breastfeeding questionnaire and …

Improving Provider A1c Testing Frequency Adherence To Recommended Diabetes Guidelines, Susan Ann Simmons

Walden Dissertations and Doctoral Studies

The Appalachian region of the United States has a high prevalence of diabetes, placing residents with diabetes at risk for physical, psychological, social, and financial burdens. To compound the issue, primary care providers often do not adhere to the guidelines established by the American Diabetes Association (ADA) regarding the recommended frequency of testing hemoglobin A1C in patients with diabetes. Lewin's planned change theory guided the project. The purpose of this project was to measure the knowledge of the primary care providers before and after an educational intervention covering the ADA guidelines for A1C monitoring and testing and to assess compliance …

The Self-Perceived Cultural Competency Of Hiv Interventionists, Tonya Herring

Walden Dissertations and Doctoral Studies

Despite significant research and inroads with the human immunodeficiency virus (HIV), disparities in HIV infection continue to widen for African American (AA) men who have sex with men (MSM). In recent times, cultural competence has been receiving increased attention as a possible factor to enhance the quality of health messaging and lessening HIV disparities. However, there is a dearth of research specifically dedicated to AA MSM and culturally competent HIV health messages. To address this gap, this qualitative research was designed to investigate the self-perceived cultural competency among HIV counselors. The theoretical framework for the project was the PEN-3 cultural …

Validation Of Communication Simulation Scenarios For Nurse Preceptors, Karie Thurston

Walden Dissertations and Doctoral Studies

An expectation of the nurse preceptor role includes the ability to evaluate, deliver feedback, and coach new graduate nurses. A gap in nurse preceptors' communication skills can affect the safety-related behaviors and quality of care provided by new graduate nurses, thus affecting patient outcomes. To bridge this gap, robust training on delivering feedback and coaching is needed for preceptors. The purpose of this staff education project was to develop and validate 5 communication simulation scenarios for preceptor training. Mezirow's transformative learning theory and the National League for Nurses-Jeffries simulation theory were used to guide the project. A panel of nurse …