The operation of Glen Canyon Dam on the Colorado River affects several downstream resources and water uses including water supply for consumptive uses in Arizona, California, and Nevada, hydroelectric power production, endangered species of native fish, recreational angling for non-native fish, and recreational boating in the Grand Canyon. Decisions about the magnitude and timing of water releases through the dam involve trade-offs between these resources and uses. The numerous laws affecting dam operations create a hierarchy of legal priorities that should govern these decisions. At the top of the hierarchy are mandatory requirements for water storage and delivery and for conservation of endangered species. Other resources and water uses have lower legal priorities. The Glen Canyon Dam Adaptive Management Program ("AMP") has substituted collaborative decision making among stakeholders for the hierarchy of priorities created by law. The AMP has thereby facilitated non-compliance with the Endangered Species Act by the Bureau of Reclamation, which operates the dam, and has effectively given hydroelectric power production and non-native fisheries higher priorities than they are legally entitled to. Adaptive management is consistent with the laws governing operation of Glen Canyon Dam, but collaborative decision making is not. Nor is collaborative decision making an essential, or even logical, component of adaptive management. As implemented in the case of Glen Canyon Dam, collaborative decision making has actually stifled adaptive management by making agreement among stakeholders a prerequisite to changes in the operation of the dam. This Article proposes a program for adaptive, but not collaborative, management of Glen Canyon Dam that would better conform to the law and would be more amenable to adaptation and experimentation than would the current, stakeholder-centered program.

Background: Healthcare providers are encouraged to prepare their practice to effectively manage the care of mild to moderate adolescent depression. Cost-effective screening, diagnostic, and newly developed pediatric primary care depression management guidelines have been established. To integrate guidelines into practice, primary care providers (PCPs) must document effectively to ensure a complete treatment plan is in place in the patient’s electronic health record (EHR).

Intervention: Elements from a flowsheet were implemented into the EHR to promote thorough assessment and documentation of care delivered to adolescents with depression.

Methods: An initial chart review was completed on patients diagnosed with depression. An updated depression template was implemented within the EHR for six weeks. A follow-up chart review was completed post-intervention to determine if documentation of elements from the adolescent depression guidelines improved after the EHR update. Pre-intervention and post- intervention surveys were delivered to PCP’s to understand their perspective on adolescent depression management.

Outcomes: The chart review revealed that baseline PHQ-9 screenings were documented in 91% (n=43) of the charts reviewed in the pre-intervention timeframe. Only 78% (n=7) of the charts reviewed during post-intervention included PHQ-9 screenings. Early intervention treatment options documented in the pre-intervention timeframe included education 100% (n=47), medication prescriptions 53% (n=25), and psychotherapy referrals 18% (n=18). During post- intervention, education 100% (n=9), medication prescriptions 78% (7), and psychotherapy referrals 22% (n=7) were documented by the PCPs.

Recommendation: The quality improvement project focused heavily on documentation completed over a one year pre-intervention timeframe compared to a six-week post-intervention timeframe. Further evaluation and chart review over the next year will provide a more adequate comparison of documentation within primary care practice.

Disease burden is higher in the United States than in comparable countries. The Patient Self Determination Act of 1990 requires healthcare facilities to provide Advance Care Planning (ACP) information to all Medicare patients. The healthcare staffs’ (n=7) commitment to 3-days of ACP training increase ACP rates in the primary care setting. The Medicare Incentive Program is the platform for this initiative. This quantitative project used a valid and reliable pre and posttest design that consisted of 27 items on a Likert-scale. A 3.5-month chart audit (n=91) was conducted to assess the completion rate. Descriptive statistics was used to describe the demographic data.

The results of the two-tailed Wilcoxon signed rank test were significant based on an alpha value of 0.05, V = 0.00, z = -2.37, p = .018. There was a significant increase in the post-readiness to change average scores. A Mann Whitney test was used to analyze the statistically significant difference between the averages in two ACP types and electronic health record documentation (EHR). Staff did not always code (Mdn = 0.00) but they documented in the EHR (Mdn =1.00; 512.00, p = 0.003). ACP discussion was performed 63% of the time during Annual Wellness Visits (AWV), and there was a 49% increase in the EHR documentation. Trained staff are key stakeholders in guiding ACP conversations. They understand the barriers, impact, and consequences related to the lack of advance directives.

Maria is a United States citizen whose parents just recently obtained legal status in the US due to Maria having turned 21. Maria has been around the undocumented population her entire life due to a large part of her family being undocumented. She became very involved with the undocumented movement back in 2010 with the passing of SB1070 in Arizona. She states that the reason she became so involved at this time was because she realized how these anti-immigrant laws were affecting her family and her community. She has worked on many campaigns at the local level such as the recall of Russell Pierce, the Adios Arpaio Campaign among other things. She is set to graduate from ASU this May 2015 with a degree in Political Science and Transborder Studies, and hopes to study law one day. She currently works with Unite Here a labor union and continues to be involved with varies campaigns some being DACA/DAPA information sessions among other things

In her interview, Monica discusses her association with the Grassroots Leadership Organization and her involvement with DreamZone. She talks about why DreamZone is important and why she is politically inclined. She talks about DreamZone’s Clinton Global Initiative campaign and her involvement at the White House breakout sessions after DACA was signed. She has been involved in sit-ins and letter writing campaigns

Jonathan was born in a small farming town in Maryland. He talks about racism, segregation and the homophobic climate that prevailed in his hometown, and how that informed his activism and that of his parents. During middle school, he got involved in activism around queer youth of color. In the beginning, he was mostly involved in LGBT issues. Later, he also organized around economic injustice in peasant and working class communities.