In-Basket Teamwork: Divide the Work and Multiply the Success The Registered Nurse Role in Ambulatory Clinic EHR In-Basket Management

Electronic Health Record (EHR) in-basket results (e.g., lab results, pathology reports, etc.) must be reviewed and acted upon in a timely manner by clinical staff in order to provide safe and effective care to ambulatory patients. Delays in reading results are significant contributors to medical errors. A large backlog of in-basket results that have never been appropriately filed is both a safety concern and a symptom of other clinical workflow issues. EHRs have shifted a greater proportion of administrative and triage roles onto providers, contributing to provider burnout. This paper synthesizes some of the best evidenced-based practices available for the management of provider in-basket results to address the in-basket results backlog at a large, tertiary medical center. The framework outlined is intended to provide concrete recommendations. However, it is intentionally broad so that it can be applied to any of the 200+ diverse clinics of the Medical Center, regardless of specialty or clinic structure. The framework emphasizes collaboration and utilizes registered nurses as part of the clinical team to improve the safety and efficiency of the process. Nurses serve a unique function because their critical thinking skills and broad scope of practice bridge the gap between providers and medical assistants (MAs). By using the plan, do, study, act (PDSA) cycle and gradually expanding the nursing role, more effective clinical teams can be built to meet the needs of both clinicians and patients

On the Divisibility of 7-Elongated Plane Partition Diamonds by Powers of 8

In 2021 da Silva, Hirschhorn, and Sellers studied a wide variety of congruences for the $k$-elongated plane partition function $d_k(n)$ by various primes. They also conjectured the existence of an infinite congruence family modulo arbitrarily high powers of 2 for the function $d_7(n)$. We prove that such a congruence family exists -- indeed, for powers of 8. The proof utilizes only classical methods, i.e., integer polynomial manipulations in a single function, in contrast to all other known infinite congruence families for $d_k(n)$ which require more modern methods to prove

An Effort to Map and Monitor Baldcypress Forest Areas in Coastal Louisiana, Using Landsat, MODIS, and ASTER Satellite Data

This presentation discusses a collaborative project to develop, test, and demonstrate baldcypress forest mapping and monitoring products for aiding forest conservation and restoration in coastal Louisiana. Low lying coastal forests in the region are being negatively impacted by multiple factors, including subsidence, salt water intrusion, sea level rise, persistent flooding, hydrologic modification, annual insect-induced forest defoliation, timber harvesting, and conversion to urban land uses. Coastal baldcypress forests provide invaluable ecological services in terms of wildlife habitat, forest products, storm buffers, and water quality benefits. Before this project, current maps of baldcypress forest concentrations and change did not exist or were out of date. In response, this project was initiated to produce: 1) current maps showing the extent and location of baldcypress dominated forests; and 2) wetland forest change maps showing temporary and persistent disturbance and loss since the early 1970s. Project products are being developed collaboratively with multiple state and federal agencies. Products are being validated using available reference data from aerial, satellite, and field survey data. Results include Landsat TM- based classifications of baldcypress in terms of cover type and percent canopy cover. Landsat MSS data was employed to compute a circa 1972 classification of swamp and bottomland hardwood forest types. Landsat data for 1972-2010 was used to compute wetland forest change products. MODIS-based change products were applied to view and assess insect-induced swamp forest defoliation. MODIS, Landsat, and ASTER satellite data products were used to help assess hurricane and flood impacts to coastal wetland forests in the region

Developing New Coastal Forest Restoration Products Based on Landsat, ASTER, and MODIS Data

This paper discusses an ongoing effort to develop new geospatial information products for aiding coastal forest restoration and conservation efforts in coastal Louisiana and Mississippi. This project employs Landsat, Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER), and Moderate Resolution Imaging Spectroradiometer (MODIS) satellite data in conjunction with airborne elevation data to compute coastal forest cover type maps and change detection products. Improved forest mapping products are needed to aid coastal forest restoration and management efforts of State and Federal agencies in the Northern Gulf of Mexico (NGOM) region. In particular, such products may aid coastal forest land acquisition and conservation easement procurements. This region's forests are often disturbed and subjected to multiple biotic and abiotic threats, including subsidence, salt water intrusion, hurricanes, sea-level rise, insect-induced defoliation and mortality, altered hydrology, wildfire, and conversion to non-forest land use. In some cases, such forest disturbance has led to forest loss or loss of regeneration capacity. In response, a case study was conducted to assess and demonstrate the potential of satellite remote sensing products for improving forest type maps and for assessing forest change over the last 25 years. Change detection products are needed for assessing risks for specific priority coastal forest types, such as live oak and baldcypress-dominated forest. Preliminary results indicate Landsat time series data are capable of generating the needed forest type and change detection products. Useful classifications were obtained using 2 strategies: 1) general forest classification based on use of 3 seasons of Landsat data from the same year; and 2) classification of specific forest types of concern using a single date of Landsat data in which a given targeted type is spectrally distinct compared to adjacent forested cover. When available, ASTER data was useful as a complement to Landsat data. Elevation data helped to define areas in which targeted forest types occur, such as live oak forests on natural levees. MODIS Normalized Difference Vegetation Index time series data aided visual assessments of coastal forest damage and recovery from hurricanes. Landsat change detection products enabled change to be identified at the stand level and at 10- year intervals with the earliest date preceding available change detection products from the National Oceanic and Atmospheric Administration and from the U.S. Geological Survey. Additional work is being done in collaboration with State and Federal agency partners in a follow-on NASA ROSES project to refine and validate these new, promising products. The products from the ROSES project will be available for aiding NGOM coastal forest restoration and conservation

Climate Variability and Impact at NASA's Marshal Space Flight Center

Climate analysis for the Southeast U. S. has indicated that inland regions have experienced an average temperature increase of 2F since 1970. This trend is generally characterized by warmer winters with an indication of increased precipitation in the Fall season. Extended periods of limited rainfall in the Spring and Summer periods have had greater areal coverage and, at other times the number of precipitation events has been increasing. Climate model projections for the next 10-70 years indicate warmer temperatures for the Southeast U.S., particularly in the Spring and Summer, with some indication of more extremes in temperature and precipitation as shown in the table below. The realization of these types of regional climate changes in the form of extended heat waves and droughts and their subsequent stress on facilities, infrastructure, and workforce could have substantial impact on the activities and functions of NASA's Marshall Space Flight Center (MSFC) in Huntsville, Alabama. This presentation will present the results of an examination of the 100 year temperature and precipitation record for MSFC. Local warming has cause an increase in daily maximum and minimum temperatures by nearly 3F, with a substantial increase in the number of maximum temperatures exceeding 90F and a decrease in the number of days with minimum temperatures below freezing. These trends have substantial impact of the number of heating / cooling degree days for the area. Yearly precipitation totals are inversely correlated with the change in mean temperature and the frequency of heavy rain events has remain consistent with the changes in yearly totals. An extended heat wave index was developed which shows an increase in frequency of heat waves over the last 35 years and a subsequent reduction in precipitation during the heat waves. This trend will contribute to more intense drought conditions over the northern Alabama region, increasing the potential of destructive wildfires in and around the Center. MSFC has begun using this climate change information to adapt short-term and long-term plans for Center operations

Spruce Creek Watershed Non-point Source Loading Model

The pollutant transport from watershed to receiving waters is modeled for Spruce Creek basin. The data requirements for such a model are: daily rainfall; monthly lake evaporation; soil and land use breakdown; water quality history for the main indicators, total nitrogen, total phosphorus, suspended solids, and total organic carbon; surface flow and interflow delay coefficients; channel flow time; daily flow gage records; and channel flow characteristics. The model uses the SCS runoff curve number method to generate rainfall excess where the antecedent conditions are varied daily by a water budget analysis. The direct runoff is delayed and routed by the CDET and Muskingum method respectively. Daily pollutant loading are generated by the use of pollutant loading functions which relate pollutant mass loading to average daily flow for the pollutants desired. These are totaled for each year of simulation to predict average pollutants loading from the water shed in pounds per acre per year for use in water quality planning

Land-use and Land-cover Change from 1974 to 2008 around Mobile Bay

This project is a Gulf of Mexico Application Pilot in which NASA Stennis Space Center (SSC) is working within a regional collaboration network of the Gulf of Mexico Alliance. NASA researchers, with support from the NASA SSC Applied Science Program Steering Committee, employed multi-temporal Landsat data to assess land-use and land-cover (LULC) changes in the coastal counties of Mobile and Baldwin, AL, between 1974 and 2008. A multi-decadal time-series, coastal LULC product unique to NASA SSC was produced. The geographic extent and nature of change was quantified for the open water, barren, upland herbaceous, non-woody wetland, upland forest, woody wetland, and urban landscapes. The National Oceanic and Atmospheric Administration (NOAA) National Coastal Development Data Center (NCDDC) will assist with the transition of the final product to the operational end user, which primarily is the Mobile Bay National Estuary Program (MBNEP). We found substantial LULC change over the 34-year study period, much more than is evident when the change occurring in the last years. Between 1974 and 2008, the upland forest landscape lost almost 6% of the total acreage, while urban land cover increased by slightly more than 3%. With exception to open water, upland forest is the dominant landscape, accounting for about 25-30% of the total area

Determining Trends in Impervious Cover for the Mobile Bay, AL Region for 1974-2008, Based on a Landsat Time Series

This presentation will discuss the development and use of Landsat-based impervious cover products in conjunction with land use land cover change products to assess multi-decadal urbanization across the Mobile Bay region at regional and watershed scales. This nationally important coastal region has undergone a variety of ephemeral and permanent land use land cover change since the mid-1970s, including gradual but consequential increases in urban surface cover. This urban sprawl corresponds with increased regional percent impervious cover. The region s coastal zone managers are concerned about the increasing percent impervious cover, since it can negatively influence water quality and is an important consideration for coastal conservation and restoration work. In response, we processed multi-temporal Landsat data to compute maps of percent impervious cover for multiple dates from 1974 through 2008, roughly at 5-year intervals. Each year of product was classified using one single date of leaf-on and leaf-off Landsat data in conjunction with Cubist software. We are assessing Landsat impervious cover product accuracy through comparisons to available reference data, including available NLCD impervious cover products from the USGS, raw Landsat data, plus higher spatial resolution aerial and satellite data. In particular, we are quantitatively comparing the 2008 Landsat impervious cover products to those from QuickBird 2.4-meter multispectral data. Initial visual comparisons with the QuickBird impervious cover product suggest that the 2008 Landsat product tends to underestimate impervious cover for high density urban areas and to overestimate impervious cover in established residential subdivisions mixed with forested cover. Landsat TM and ETM data appears to produce more accurate impervious cover products compared to those using lower resolution Landsat MSS data. Although imperfect, these Landsat impervious cover products have helped the Mobile Bay National Estuary Program visualize basic urbanization trends for multiple HUC-12 watersheds of concern to them and their constituent

A Landsat-Based Assessment of Mobile Bay Land Use and Land Cover Change from 1974 to 2008

The Mobile Bay region has experienced noteworthy land use and land cover (LULC) change in the latter half of the 20th century. Accompanying this change has been urban expansion and a reduction of rural land uses. Much of this LULC change has reportedly occurred since the landfall of Hurricane Frederic in 1979. The Mobile Bay region provides great economic and ecologic benefits to the Nation, including important coastal habitat for a broad diversity of fisheries and wildlife. Regional urbanization threatens the estuary s water quality and aquatic-habitat dependent biota, including commercial fisheries and avian wildlife. Coastal conservation and urban land use planners require additional information on historical LULC change to support coastal habitat restoration and resiliency management efforts. This presentation discusses results of a Gulf of Mexico Application Pilot project that was conducted in 2008 to quantify and assess LULC change from 1974 to 2008. This project was led by NASA Stennis Space Center and involved multiple Gulf of Mexico Alliance (GOMA) partners, including the Mobile Bay National Estuary Program (NEP), the U.S. Army Corps of Engineers, the National Oceanic and Atmospheric Administration s (NOAA s) National Coastal Data Development Center (NCDDC), and the NOAA Coastal Services Center. Nine Landsat images were employed to compute LULC products because of their availability and suitability for the application. The project also used Landsat-based national LULC products, including coastal LULC products from NOAA s Coastal Change & Analysis Program (C-CAP), available at 5-year intervals since 1995. Our study was initiated in part because C-CAP LULC products were not available to assess the region s urbanization prior to 1995 and subsequent to post Hurricane Katrina in 2006. This project assessed LULC change across the 34-year time frame and at decadal and middecadal scales. The study area included the majority of Mobile and Baldwin counties that encompass Mobile Bay. In doing so, each date of Landsat data was classified using an end-user defined modified Anderson level 1 classification scheme. LULC classifications were refined using a decision rule approach in conjunction with available C-CAP products. Individual dates of LULC classifications were validated by image interpretation of stratified random locations on raw Landsat color composite imagery in combination with higher resolution remote sensing and in-situ reference data. The results indicate that during the 34-year study period, urban areas increased from 96,688 to 150,227 acres, representing a 55.37% increase, or 1.63% per annum. Most of the identified urban expansion results from conversion of rural forest and agriculture to urban cover types. Final LULC mapping and metadata products were produced for the entire study area as well as watersheds of concern within the study area. Final project products, including LULC trend information, were incorporated into the Mobile Bay NEP State of the Bay report. Products and metadata were transferred to NOAA NCDDC to allow free online accessibility and use by GOMA partners and by the public