Programs and Communities

Restoration of riverine ecosystems is often stated as a management objective for regulated rivers, and floods are one of the most effective tools for accomplishing restoration. The National Re- search Council (NRC 1992) argued that ecological restoration means re- turning "an ecosystem to a close approximation of its condition prior to disturbance" and that "restoring altered, damaged, O f destroyed lakes, rivers, and wetlands is a high-priority task." Effective restoration must be based on a clear definition of the value of riverine resources to society; on scientific studies that document ecosystem status and provide an understanding of ecosystem processes and resource interactions; on scientific studies that predict, mea- sure, and monitor the effectiveness of restoration techniques; and on engineering and economic studies that evaluate societal costs and benefits of restoration.

In the case of some large rivers, restoration is not a self-evident goal. Indeed, restoration may be impossible; a more feasible goal may be rehabilitation of some ecosystem components and processes in parts of the river (Gore and Shields 1995, Kondolfand Wilcock 1996, Stanford et al. 1996). In other cases, the appropriate decision may be to do nothing. The decision to manipulate ecosystem processes and components involves not only a scientific judgment that a restored or rehabilitated condition is achievable, but also a value judgment that this condition is more desirable than the status quo. These judgments involve prioritizing different river resources, and they should be based on extensive and continuing public debate.

In this article, we examine the appropriate role of science in determining whether or not to restore or rehabilitate the Colorado River in the Grand Canyon by summarizing studies carried out by numerous agencies, universities, and consulting firms since 1983. This reach of the Colorado extends 425 km between Glen Canyon Dam and Lake Mead reservoir (Figure 1). Efforts to manipulate ecosystem processes and components in the Grand Canyon have received widespread public attention, such as the 1996 controlled flood released from Glen Canyon Dam and the proposal to drain Lake Powell reservoir.

Diabetes, a common chronic condition, effects many individuals causing poor quality of life, expensive medical bills, and devastating medical complications. While health care providers try to manage diabetes during short office visits, many patients still struggle to control their diabetes at home. Lack of diabetes self-management (DSM) is a potential barrier for people with diabetes having to maintain healthy hemoglobin A1cs (HgA1c).

In hopes of addressing this concern, an evidenced-based intervention; diabetic education and phone calls, using the chronic care model as its framework was implemented. The intervention targeted people with type II diabetes at a transitional care setting. Measured variables included HgA1c and DSM. Statistically significant improvements were seen in reported physical activity. Average improvements were seen in HgA1c and DSM after three months of diabetes self-management education (DSME). Attrition, cultural sensitivity, and increasing DSME hours should be further evaluated for future projects.

Background and Purpose: Over 30 million people in the United States (U.S.) have diabetes mellitus, which comprises about 9% of the population, and about 90% of individuals with diabetes have type 2 diabetes (Centers for Disease Control and Prevention [CDC], 2017). Adults with type 2 diabetes at a local internal medicine clinic were consistently having high glycated hemoglobin (HbA1C) levels, demonstrated by data collected from the electronic health record (EHR), and there was no ordering process for referring patients to diabetes management education and support (DSMES) services. The purpose of this project was to improve glycemic control, demonstrated by lower HbA1C levels, and reach a diabetes education attendance rate of 62.5% at an internal medicine clinic in Chandler, Arizona.

Methods: An electronic health record (EHR) template was created and brief staff training was completed to connect patients with diabetes in the community to a local formal diabetes education program. HbA1C levels were measured before and three months after adults with education program. HbA1C levels were measured before and three months after adults with type 2 diabetes mellitus (T2DM) received physicians’ orders for a DSMES program, and rates of attendance to the program were calculated. Data was collected through the EHR and through feedback from the DSMES program. Descriptive statistics were used in data analysis.

Outcomes: The participants’ results did not demonstrate significant differences in pre-referral and post-referral HbA1C results after they were ordered DSMES services (p = .506). The proportion of education attendance (30%) was lower than the project goal of 62.5%, but increased from the clinic baseline.

Conclusions: EHR template implementation for referral to DSMES may increase rates of formal diabetes education and improve glycemic control. Larger sample sizes, longer project periods, alternative methods of communication, and increased follow-up of participants may be required to produce significant results.

Background: The global prevalence of all types of diabetes increased from 108 million in 1980 to 422 million in 2014 (Nazir et al., 2018). The Centers for Disease Control and Prevention (2017) ranks diabetes as the 7th leading cause of death in the United States with an estimated annual expense of $327 billion. Within the rural setting, patients typically have less resources available for the treatment and self-management of their diseases. It is important to explore self-management techniques that can be utilized by patients with type 2 diabetes living in rural areas. Research demonstrating the importance of education, exercise, diet, glucose monitoring, medications, and supportive measures is prominent throughout the literature.

Objective: The purpose of this Doctor of Nursing Practice (DNP) applied project is to investigate the effects of delivering biweekly text messages containing diabetes self-management education (DSME) materials to patients in an effort to support successful self-care.

Methods: During an 8 week period, DSME was provided via text messaging, bi-weekly (Sunday and Wednesday), to 23 rural participants with type 2 diabetes, in a family clinic in Payson, Arizona. Participants were asked to complete the Skills, Confidence, and Preparedness Index both pre- and post-intervention to evaluate their knowledge of diabetes self-management.

Results: Twenty-three adults aged 52 to 78 years (M = 64.91) participated in the project. Of the participants, 57% (13/23) were female. The majority of participants had T2DM diagnosis less than 10 years (M=13.8 years). There was a statistical difference between the pre- and post-Skills, Confidence and Preparedness Index questionnaire (p < .001) indicating an improvement in self-efficacy scores post- intervention.

Conclusion: DSME delivered via text message is a cost-effective way to increase patients' self-efficacy and potentially improve their ability to successfully self-manage their disease.

Warming associated with urban development will be exacerbated in future years by temperature increases due to climate change. The strategic implementation of urban green infrastructure (UGI) e.g. street trees, parks, green roofs and facades can help achieve temperature reductions in urban areas while delivering diverse additional benefits such as pollution reduction and biodiversity habitat. Although the greatest thermal benefits of UGI are achieved in climates with hot, dry summers, there is comparatively little information available for land managers to determine an appropriate strategy for UGI implementation under these climatic conditions. We present a framework for prioritisation and selection of UGI for cooling. The framework is supported by a review of the scientific literature examining the relationships between urban geometry, UGI and temperature mitigation which we used to develop guidelines for UGI implementation that maximises urban surface temperature cooling. We focus particularly on quantifying the cooling benefits of four types of UGI: green open spaces (primarily public parks), shade trees, green roofs, and vertical greening systems (green walls and facades) and demonstrate how the framework can be applied using a case study from Melbourne, Australia.

Urban Heat Island (UHI) has significant impacts on the buildings energy consumption and outdoor air quality (OAQ). Various approaches, including observation and simulation techniques, have been proposed to understand the causes of UHI formation and to find the corresponding mitigation strategies. However, the causes of UHI are not the same in different climates or city features. Thus, general conclusion cannot be made based on limited monitoring data.

With recent progress in computational tools, simulation methods have been used to study UHI. These approaches, however, are also not able to cover all the phenomena that simultaneously contribute to the formation of UHI. The shortcomings are mostly attributed to the weakness of the theories and computational cost.

This paper presents a review of the techniques used to study UHI. The abilities and limitations of each approach for the investigation of UHI mitigation and prediction are discussed. Treatment of important parameters including latent, sensible, storage, and anthropogenic heat in addition to treatment of radiation, effect of trees and pond, and boundary condition to simulate UHI is also presented. Finally, this paper discusses the application of integration approach as a future opportunity.

This study investigates the impact of urban form and landscaping type on the mid-afternoon microclimate in semi-arid Phoenix, Arizona. The goal is to find effective urban form and design strategies to ameliorate temperatures during the summer months. We simulated near-ground air temperatures for typical residential neighborhoods in Phoenix using the three-dimensional microclimate model ENVI-met. The model was validated using weather observations from the North Desert Village (NDV) landscape experiment, located on the Arizona State University's Polytechnic campus. The NDV is an ideal site to determine the model's input parameters, since it is a controlled environment recreating three prevailing residential landscape types in the Phoenix metropolitan area (mesic, oasis, and xeric).

After validation, we designed five neighborhoods with different urban forms that represent a realistic cross-section of typical residential neighborhoods in Phoenix. The scenarios follow the Local Climate Zone (LCZ) classification scheme after Stewart and Oke. We then combined the neighborhoods with three landscape designs and, using ENVI-met, simulated microclimate conditions for these neighborhoods for a typical summer day. Results were analyzed in terms of mid-afternoon air temperature distribution and variation, ventilation, surface temperatures, and shading. Findings show that advection is important for the distribution of within-design temperatures and that spatial differences in cooling are strongly related to solar radiation and local shading patterns. In mid-afternoon, dense urban forms can create local cool islands. Our approach suggests that the LCZ concept is useful for planning and design purposes.

Objectives: We estimated neighborhood effects of population characteristics and built and natural environments on deaths due to heat exposure in Maricopa County, Arizona (2000–2008).

Methods: We used 2000 U.S. Census data and remotely sensed vegetation and land surface temperature to construct indicators of neighborhood vulnerability and a geographic information system to map vulnerability and residential addresses of persons who died from heat exposure in 2,081 census block groups. Binary logistic regression and spatial analysis were used to associate deaths with neighborhoods.

Results: Neighborhood scores on three factors—socioeconomic vulnerability, elderly/isolation, and unvegetated area—varied widely throughout the study area. The preferred model (based on fit and parsimony) for predicting the odds of one or more deaths from heat exposure within a census block group included the first two factors and surface temperature in residential neighborhoods, holding population size constant. Spatial analysis identified clusters of neighborhoods with the highest heat vulnerability scores. A large proportion of deaths occurred among people, including homeless persons, who lived in the inner cores of the largest cities and along an industrial corridor.

Conclusions: Place-based indicators of vulnerability complement analyses of person-level heat risk factors. Surface temperature might be used in Maricopa County to identify the most heat-vulnerable neighborhoods, but more attention to the socioecological complexities of climate adaptation is needed.

While previous studies have shown that urban heat islands (UHI) tend to increase residential water use, they have not yet analyzed the feedbacks among vegetation intensity, diurnal temperature variation, water use, and characteristics of the built environment. This study examines these feedback relationships with the help of a path model applied to spatially disaggregated data from Phoenix, Arizona. The empirical evidence from the observations in Phoenix suggests the following: (1) impervious surfaces contribute to increased residential water use by exacerbating UHI; (2) larger lots containing pools and mesic vegetation increase water demand by reducing diurnal temperature difference; and (3) smart design of urban environments needs to go beyond simplistic water body- and vegetation-based solutions for mitigating uncomfortably high temperatures and consider interactions between surface materials, land use, UHI, and water use.