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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.
Method: A single group pre-test post-test design was utilized to evaluate nursing staff knowledge before and after an education program on pressure injury prevention. Staff knowledge was evaluated using a modified version of the Pressure Ulcer Knowledge Assessment Tool 2.0. Participants completed pre- and post-education surveys. Rates of hospital acquired pressure injuries were obtained via chart review.
Results: Pre- and post-education scores were analyzed in participants who completed both surveys using a paired t-test. Post-education scores (M = 0.73, SD = 0.07) were significantly higher than pre-education scores (M = 0.59, SD = 0.09); t(7) = -5.39, p = .001. Pre- and post-education median scores of all participants were analyzed using two-tailed Mann-Whitney U test. Post-education scores (Mdn = 0.71) were significantly higher compared to pre-education scores (Mdn = 0.56); U = 102.5, z = -4.05, p = .001. Monthly incidence of pressure injuries on the unit increased following education.
Discussion: Increase in scores from pre- to post-education surveys indicate staff knowledge improved. The increased incidence of pressure injuries is thought to be secondary to staff’s increased ability to detect pressure injuries. Staff education is recommended, but more research is needed regarding the impact on pressure injury rates.
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.
Informed by the CompuGirls program, the CompuPower: Technology and Leadership program curriculum uses culturally responsive education practices to foster student leadership and civic engagement through the exploration of technology. This program is a year-long, in-school, high school elective course that schools can offer to male and female students for Career and Technical Education (CTE) course credit.