Simulated Basic Skills Training: Graduate Nursing Students Teaching Medical Students: A Work in Progress

For a number of years, Advanced Practice Nursing (APN) students have taught interested 1st year medical students to perform intramuscular injections prior to their participation in community flu clinics. When several 4th year medical students needed documentation of competency in intravenous (IV) cannulation prior to participating in an elective rotation at another institution, the Medical School\u27s Dean of Students called the Director of Interdisciplinary Partnerships in the Graduate School of Nursing to request assistance. In fact, all medical students need IV therapy training prior to graduation, not just those who seek out visiting clerkships at other medical schools. Integration of IV training into the Undergraduate Medical Education Surgery Clerkship Curriculum supports the clinical objectives of the Surgery Clerkship along with the developing use of simulation within in the medical school. This need led to the development of this interdisciplinary simulation education initiative. Presented at the 2008 Society on Simulation in Healthcare Conference

Type and Timing of Stream Flow Changes in Urbanizing Watersheds in the Eastern U.S.

Linking the type and timing of hydrologic changes with patterns of urban growth is essential to identifying the underlying mechanisms that drive declines in urban aquatic ecosystems. In six urbanizing watersheds surrounding three U.S. cities (Baltimore, MD, Boston, MA, and Pittsburgh, PA), we reconstructed the history of development patterns since 1900 and assessed the magnitude and timing of stream flow changes during watershed development. Development reconstructions indicated that the majority of watershed development occurred during a period of peak population growth, typically between 1950 and 1970. Stream flow records indicated significant increases in annual frequency of high-flow events in all six watersheds and increases in annual runoff efficiency in five watersheds. Annual development intensity during the peak growth period had the strongest association with the magnitude of changes in high-flow frequency from the pre- to post-development periods. Results suggest the timing of the peak growth period is particularly important to understanding hydrologic changes, because it can set the type of stormwater infrastructure installed within a watershed. In three watersheds there was a rapid (~10-15 years) shift toward more frequent high-flow events, and in four watersheds there was a shift toward higher runoff efficiency. Breakpoint analyses indicated these shifts occurred between 1969 and 1976 for high-flow frequency and between 1962 and 1984 for runoff efficiency. Results indicated that the timing of high-flow changes were mainly driven by the development trajectory of each watershed, whereas the timing of runoff-efficiency changes were driven by a combination of development trajectories and extreme weather events. Our results underscore the need to refine the causes of urban stream degradation to incorporate the impact of gradual versus rapid urbanization on hydrologic changes and aquatic ecosystem function, as well as to recognize that the dominant drivers of hydrologic changes are heterogeneous among urban watersheds and vary over time

Assessment of Regional Variation in Streamflow Responses to Urbanization and the Persistence of Physiography

Aquatic ecosystems are sensitive to the modification of hydrologic regimes, experiencing declines in stream health as the streamflow regime is altered during urbanization. This study uses streamflow records to quantify the type and magnitude of hydrologic changes across urbanization gradients in nine U.S. cities (Atlanta, GA, Baltimore, MD, Boston, MA, Detroit, MI, Raleigh, NC, St. Paul, MN, Pittsburgh, PA, Phoenix, AZ, and Portland, OR) in two physiographic settings. Results indicate similar development trajectories among urbanization gradients, but heterogeneity in the type and magnitude of hydrologic responses to this apparently uniform urban pattern. Similar urban patterns did not confer similar hydrologic function. Study watersheds in landscapes with level slopes and high soil permeability had less frequent high-flow events, longer high-flow durations, lower flashiness response, and lower flow maxima compared to similarly developed watersheds in landscape with steep slopes and low soil permeability. Our results suggest that physical characteristics associated with level topography and high water-storage capacity buffer the severity of hydrologic changes associated with urbanization. Urbanization overlain upon a diverse set of physical templates creates multiple pathways toward hydrologic impairment; therefore, we caution against the use of the urban homogenization framework in examining geophysically dominated processes

Sources and transport of nitrogen in arid urban watersheds

Urban watersheds are often sources of nitrogen (N) to downstream systems, contributing to poor water quality. However, it is unknown which components (e.g., land cover and stormwater infrastructure type) of urban watersheds contribute to N export and which may be sites of retention. In this study we investigated which watershed characteristics control N sourcing, biogeochemical processing of nitrate (NO3–) during storms, and the amount of rainfall N that is retained within urban watersheds. We used triple isotopes of NO3– (δ15N, δ18O, and Δ17O) to identify sources and transformations of NO3– during storms from 10 nested arid urban watersheds that varied in stormwater infrastructure type and drainage area. Stormwater infrastructure and land cover—retention basins, pipes, and grass cover—dictated the sourcing of NO3– in runoff. Urban watersheds were strong sinks or sources of N to stormwater depending on runoff, which in turn was inversely related to retention basin density and positively related to imperviousness and precipitation. Our results suggest that watershed characteristics control the sources and transport of inorganic N in urban stormwater but that retention of inorganic N at the time scale of individual runoff events is controlled by hydrologic, rather than biogeochemical, mechanisms