Assessing vegetation reestablishment on disturbed high mountain lakeshores following historic dam removal in Rocky Mountain National Park, Colorado, USA

2016 Spring.Includes bibliographical references.Dam removal has entered the public spotlight in recent years, due to growing safety, economic, and environmental concerns related to dams. Removal is increasingly seen as a way to address not only the risks associated with aging and/or obsolete dams, but also as a tool for ecological restoration. In 1982, then-79-year-old Lawn Lake Dam in Rocky Mountain National Park failed, resulting in three deaths, and extensive monetary damages and destruction of natural resources within the Park. This was followed by a policy decision to remove three dams in the Park between 1988 and 1990, returning the former reservoirs to their previous natural lake water levels, and re-exposing nearly 13 hectares of scoured shoreline, completely denuded of vegetation by approximately 80 years of inundation. The disturbed lakeshore areas were left to undergo passive restoration. In the years immediately following dam removal, one short-term (3 year) revegetation study was conducted at Lawn Lake, and informal observational data were gathered by NPS personnel at a handful of plots established at the disturbed lakeshores of Bluebird, Sandbeach, and Pear Lakes. However, no further published analyses of data were made available, and until 2014 the vegetation at these lakeshores had not been surveyed to determine longer-term effects of damming and dam removal to reestablished vegetation. The goal of this study was to identify any persisting effects of historic damming and subsequent dam removal on vegetation characteristics such as species richness and diversity and community composition in the previously submerged lake margin areas surrounding the formerly dammed lakes, as well as the more elevated surrounding areas that had not been inundated. To do this, in July to September of 2014 I conducted surveys of vascular plant cover by species in 150 plots at nine high mountain lakes, including the four formerly dammed lakes and five undammed reference lakes. Site-specific environmental variables slope, aspect, elevation, elevation above current waterline, and soil texture were recorded at each plot. Plots were categorized as “elevated” or “lake margin” based on an elevation cutoff from the current waterline, to separate plots that had been previously submerged at dammed lake sites from more elevated sites that had not. I analyzed data from plots in each category for the effect of lake type (formerly dammed or reference) by fitting linear mixed models to species richness and diversity response. I performed a hierarchical cluster analysis that identified eight distinct vegetation communities, and performed non-metric multi-dimensional scaling (NMS) to explore relationships between vegetation community composition and site-specific measured environmental variables. No significant differences in vegetation characteristics of the elevated areas were found between formerly dammed and reference lakes. In previously submerged areas of formerly dammed lakes, however, species richness was significantly higher, compared to the similarly-located lake margin areas surrounding reference lakes (+3.361, χ2=8.919, p-val=0.003). All eight identified vegetation communities occurred at both formerly dammed and reference lakes. Slope and elevation were the measured environmental variables most strongly correlated with NMS axes (cumulative r2 values of 0.18 and 0.086), indicating that they are the most influential measured environmental variables in structuring plant communities at these study sites

Lymphoma Therapy and Adverse Events: Nursing Strategies for Thinking Critically and Acting Decisively

BACKGROUND: Multiple treatment options, combined with disease heterogeneity, have created nursing challenges in the management of adverse events (AEs) during antilymphoma therapy. Testing has revealed that less than half of participating nurses correctly graded peripheral neuropathy and neutropenia related to antilymphoma regimens. OBJECTIVES: This article identifies nursing challenges in the management of AEs associated with therapy for lymphomas and describes how strategies in critical thinking can help meet those challenges. METHODS: A comprehensive literature search in oncology nursing, nursing education, and critical thinking was conducted; participant responses to pre- and post-tests at nursing education programs were evaluated; and a roundtable meeting of authors was convened. FINDINGS: Oncology nurses can cultivate critical thinking skills, practice thinking critically in relation to team members and patients, leverage information from the Patient-Reported Outcomes Common Terminology Criteria for Adverse Events, and manage workflow to allow more opportunity for critical thinking

Organizational culture and climate as moderators of enhanced outreach for persons with serious mental illness: results from a cluster-randomized trial of adaptive implementation strategies

Abstract Background Organizational culture and climate are considered key factors in implementation efforts but have not been examined as moderators of implementation strategy comparative effectiveness. We investigated organizational culture and climate as moderators of comparative effectiveness of two sequences of implementation strategies (Immediate vs. Delayed Enhanced Replicating Effective Programs [REP]) combining Standard REP and REP enhanced with facilitation on implementation of an outreach program for Veterans with serious mental illness lost to care at Veterans Health Administration (VA) facilities nationwide. Methods This study is a secondary analysis of the cluster-randomized Re-Engage implementation trial that assigned 3075 patients at 89 VA facilities to either the Immediate or Delayed Enhanced REP sequences. We hypothesized that sites with stronger entrepreneurial culture, task, or relational climate would benefit more from Enhanced REP than Standard REP. Veteran- and site-level data from the Re-Engage trial were combined with site-aggregated measures of entrepreneurial culture and task and relational climate from the 2012 VA All Employee Survey. Longitudinal mixed-effects logistic models examined whether the comparative effectiveness of the Immediate vs. Delayed Enhanced REP sequences were moderated by culture or climate measures at 6 and 12 months post-randomization. Three Veteran-level outcomes related to the engagement with the VA system were assessed: updated documentation, attempted contact by coordinator, and completed contact. Results For updated documentation and attempted contact, Veterans at sites with higher entrepreneurial culture and task climate scores benefitted more from Enhanced REP compared to Standard REP than Veterans at sites with lower scores. Few culture or climate moderation effects were detected for the comparative effectiveness of the full sequences of implementation strategies. Conclusions Implementation strategy effectiveness is highly intertwined with contextual factors, and implementation practitioners may use knowledge of contextual moderation to tailor strategy deployment. We found that facilitation strategies provided with Enhanced REP were more effective at improving uptake of a mental health outreach program at sites with stronger entrepreneurial culture and task climate; Veterans at sites with lower levels of these measures saw more similar improvement under Standard and Enhanced REP. Within resource-constrained systems, practitioners may choose to target more intensive implementation strategies to sites that will most benefit from them. Trial registration ISRCTN: ISRCTN21059161 . Date registered: April 11, 2013.https://deepblue.lib.umich.edu/bitstream/2027.42/144775/1/13012_2018_Article_787.pd

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Cluster randomized adaptive implementation trial comparing a standard versus enhanced implementation intervention to improve uptake of an effective re-engagement program for patients with serious mental illness

Abstract Background Persons with serious mental illness (SMI) are disproportionately burdened by premature mortality. This disparity is exacerbated by poor continuity of care with the health system. The Veterans Health Administration (VA) developed Re-Engage, an effective population-based outreach program to identify veterans with SMI lost to care and to reconnect them with VA services. However, such programs often encounter barriers getting implemented into routine care. Adaptive designs are needed when the implementation intervention requires augmentation within sites that do not initially respond to an initial implementation intervention. This protocol describes the methods used in an adaptive implementation design study that aims to compare the effectiveness of a standard implementation strategy (Replicating Effective Programs, or REP) with REP enhanced with External Facilitation (enhanced REP) to promote the uptake of Re-Engage. Methods/Design This study employs a four-phase, two-arm, longitudinal, clustered randomized trial design. VA sites (n = 158) across the United States with a designated Re-Engage provider, at least one Veteran with SMI lost to care, and who received standard REP during a six-month run-in phase. Subsequently, 88 sites with inadequate uptake were stratified at the cluster level by geographic region (n = 4) and VA regional service network (n = 20) and randomized to REP (n = 49) vs. enhanced REP (n = 39) in phase two. The primary outcome was the percentage of veterans on each facility outreach list documented on an electronic web registry. The intervention was at the site and network level and consisted of standard REP versus REP enhanced by external phone facilitation consults. At 12 months, enhanced REP sites returned to standard REP and 36 sites with inadequate participation received enhanced REP for six months in phase three. Secondary implementation outcomes included the percentage of veterans contacted directly by site providers and the percentage re-engaged in VA health services. Discussion Adaptive implementation designs consisting of a sequence of decision rules that are tailored based on a site’s uptake of an effective program may produce more relevant, rapid, and generalizable results by more quickly validating or rejecting new implementation strategies, thus enhancing the efficiency and sustainability of implementation research and potentially leading to the rollout of more cost-efficient implementation strategies. Trial registration Current Controlled Trials ISRCTN21059161 .http://deepblue.lib.umich.edu/bitstream/2027.42/112609/1/13012_2013_Article_711.pd

Pinning Susceptibility: The Effect Of Dilute, Quenched Disorder On Jamming

We study the effect of dilute pinning on the jamming transition. Pinning reduces the average contact number needed to jam unpinned particles and shifts the jamming threshold to lower densities, leading to a pinning susceptibility, χp. Our main results are that this susceptibility obeys scaling form and diverges in the thermodynamic limit as χp∝|ϕ−ϕ∞c|−γp where ϕ∞c is the jamming threshold in the absence of pins. Finite-size scaling arguments yield these values with associated statistical (systematic) errors γp=1.018±0.026(0.291) in d=2 and γp=1.534±0.120(0.822) in d=3. Logarithmic corrections raise the exponent in d=2 to close to the d=3 value, although the systematic errors are very large

Cluster randomized trial comparing standard versus enhanced implementation strategies for improving outreach to persons with SMI: 12-month results

http://deepblue.lib.umich.edu/bitstream/2027.42/134545/1/13012_2015_Article_940.pd

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