Missouri National Recreational River, Natural Resource Condition Assessment

Executive Summary As a unit in the National Park Service (NPS), Missouri National Recreational River (MNRR) is responsible for the management and conservation of natural resources within its boundaries. This mandate is supported by the National Park Service Organic Act of 1916, which directs the NPS to: conserve the scenery and natural and historic objects and the wildlife therein and to provide for the enjoyment of the same in such a manner and by such means as will leave them unimpaired for the enjoyment of future generations. In 2003, NPS Water Resources Division received funding through the Natural Resource Challenge Program to systematically assess watershed resource conditions in NPS units, establishing the Watershed Condition Assessment Program. This program, now titled the Natural Resource Condition Assessment (NRCA) Program, aims to provide documentation about the current conditions of important park resources through a spatially explicit, multi-disciplinary synthesis of existing scientific data and knowledge. Findings from the NRCA, including the report and accompanying map products, will help MNRR managers to: develop near-term management priorities, engage in watershed or landscape scale partnership and education efforts, conduct park planning (e.g. Resource Stewardship Strategy), report program performance (e.g. Department of the Interior’s Strategic Plan ―land health goals, Government Performance and Results Act). Specific project expectations and outcomes for the MNRR NRCA are listed in Chapter 3. For the purpose of this NRCA, NPS staff identified key resources that are referred to as ―components‖ in the project framework and throughout the assessment. The components selected include natural resources and processes that are currently of the greatest concern to park management at MNRR. The final project framework contains nine resource components, along with measures, stressors, and reference conditions for each. This study involved reviewing existing literature and data for each of the components in the framework and, where appropriate, analyzing the data in order to provide summaries or to create new spatial or statistical representations. After gathering data regarding current condition of component measures, those data were compared to reference conditions (when possible) and a qualitative statement of condition was developed. The discussions in Chapter 4 represent a comprehensive summary of available information regarding the current condition of these resources. These discussions represent not only the most current published literature, but also unpublished park information and, most importantly, the perspectives of park experts. Nearly every component in MNRR is affected by the altered flow regime from the post-dam Missouri River and, with that, the conditions of most park resources (as indicated by the measures defined in the project framework) are of moderate or significant concern. These condition designations are largely a product of the ―pre-dam‖ reference condition assigned to nearly every MNRR component. When comparing the current condition of a resource that has been drastically altered by damming to its pre-dam condition, it is almost always worse off today. However, while the Missouri River ecosystem has endured large changes since dam construction, there are several individual components that are recovering and doing well with the given circumstances. Differing uses and interests of the Missouri River (e.g. preservation, recreation, electricity generation, navigation, etc.) further complicate MNRR’s ability to restore the Missouri River to its pre-dam condition. However, several components ( e.g. flow regime, aquatic and terrestrial habitats, erosional and depositional processes) are drivers of the entire ecosystem, and restoration of these components would have a cascading effect on the entire ecosystem. Overall, the Missouri River ecosystem is complex and while several components are considered to be of moderate or significant concern, their actual condition (when considering the the condition of the Missouri River ecosystem) is often times of lower concern

Road Trauma in Teenage Male Youth with Childhood Disruptive Behavior Disorders: A Population Based Analysis

Donald Redelmeier and colleagues conducted a population-based case-control study of 16-19-year-old males hospitalized for road trauma or appendicitis and showed that disruptive behavior disorders explained a significant amount of road trauma in this group

Nonconvulsive status epilepticus secondary to acute porphyria crisis

Both variegate and acute intermittent porphyria can manifest with various neurological symptoms. Although acute symptomatic seizures have been previously described, they are typically tonic–clonic and focal impaired awareness seizures. Convulsive status epilepticus and epilepsia partialis continua are rare and have been described on a case report basis. To our knowledge, there are no previously reported cases describing non-convulsive status epilepticus (NCSE) with electroencephalogram (EEG) documentation in the setting of acute porphyria crisis. We report a unique presentation of NCSE, which resolved after administering levetiracetam in a patient with variegate porphyria, without a known seizure disorder. Keywords: Variegate porphyria, Non-convulsive status epilepticus, Electroencephalogram, Anticonvulsant medication, Acute porphyria crisi

Development and pilot testing of a decision aid for drivers with dementia

Background An increasing number of older adults drive automobiles. Given that the prevalence of dementia is rising, it is necessary to address the issue of driving retirement. The purpose of this study is to evaluate how a self-administered decision aid contributed to decision making about driving retirement by individuals living with dementia. The primary outcome measure in this study was decisional conflict. Knowledge, decision, satisfaction with decision, booklet use and booklet acceptability were the secondary outcome measures. Methods A mixed methods approach was adopted. Drivers with dementia were recruited from an Aged Care clinic and a Primary Care center in NSW, Australia. Telephone surveys were conducted before and after participants read the decision aid. Results Twelve participants were recruited (mean age 75, SD 6.7). The primary outcome measure, decisional conflict, improved following use of the decision aid. Most participants felt that the decision aid: (i) was balanced; (ii) presented information well; and (iii) helped them decide about driving. In addition, mean knowledge scores improved after booklet use. Conclusions This decision aid shows promise as an acceptable, useful and low-cost tool for drivers with dementia. A self-administered decision aid can be used to assist individuals with dementia decide about driving retirement. A randomized controlled trial is underway to evaluate the effectiveness of the tool