Tiered Approach to Resilience Assessment.

Regulatory agencies have long adopted a three-tier framework for risk assessment. We build on this structure to propose a tiered approach for resilience assessment that can be integrated into the existing regulatory processes. Comprehensive approaches to assessing resilience at appropriate and operational scales, reconciling analytical complexity as needed with stakeholder needs and resources available, and ultimately creating actionable recommendations to enhance resilience are still lacking. Our proposed framework consists of tiers by which analysts can select resilience assessment and decision support tools to inform associated management actions relative to the scope and urgency of the risk and the capacity of resource managers to improve system resilience. The resilience management framework proposed is not intended to supplant either risk management or the many existing efforts of resilience quantification method development, but instead provide a guide to selecting tools that are appropriate for the given analytic need. The goal of this tiered approach is to intentionally parallel the tiered approach used in regulatory contexts so that resilience assessment might be more easily and quickly integrated into existing structures and with existing policies.

Flow-specific trends in river-water quality resulting from the effects of the Clean Air Act in three mesoscale, forested river basins in the northeastern United States through 2002.

Two new methods for assessing temporal trends in stream-solute concentrations at specific streamflow ranges were applied to long (40 to 50-year) but sparse (bi-weekly to quarterly sampling) stream-water quality data collected at three forested mesoscale basins along an atmospheric deposition gradient in the northeastern United States (one in north-central Pennsylvania, one in southeastern New York, and one in eastern Maine). The three data sets span the period since the implementation of the Clean Air Act in 1970 and its subsequent amendments. Declining sulfate (O4(2-)) trends since the mid 1960s were identified for all 3 rivers by one or more of the 4 methods of trend detection used. Flow-specific trends were assessed by segmenting the data sets into 3-year and 6-year blocks, then determining concentration-discharge relationships for each block. Declining sulfate (O4(2-)) trends at median flow were similar to trends determined using a Seasonal Kendall Tau test and Sen slope estimator. The trend of declining O4(2-) concentrations differed at high, median and low flow since the mid 1980s at YWC and NR, and at high and low flow at WR, but the trends leveled or reversed at high flow from 1999 through 2002. Trends for the period of record at high flows were similar to medium- and low-flow trends for Ca2++ Mg2+ concentrations at WR, non-significant at YWC, and were more negative at low flow than at high flow at NR; trends in nitrate (NO3-), and alkalinity (ALK) concentrations were different at different flow conditions, and in ways that are consistent with the hydrology and deposition history at each watershed. Quarterly sampling is adequate for assessing average-flow trends in the chemical parameters assessed over long time periods (approximately decades). However, with even a modest effort at sampling a range of flow conditions within each year, trends at specified flows for constituents with strong concentration-discharge relationships can be evaluated and may allow early detection of ecosystem response to climate change and pollution management strategies.

A randomised controlled trial of senior Lay Health Mentoring in older people with ischaemic heart disease: The Braveheart Project.

OBJECTIVE: to examine the effects and feasibility of educating and empowering older people with ischaemic heart disease using trained senior lay health mentors. DESIGN: randomised controlled trial with blinded evaluation. SETTING: Falkirk and District Royal Infirmary. PARTICIPANTS: inpatients and outpatients aged 60 or over attending secondary care with a diagnosis of angina or acute myocardial infarction. Three-hundred and nineteen entered and 289 completed exit assessments. The intervention group took part in mentoring groups for 1 year, meeting monthly for 2 hours, each led by two trained lay health mentors in addition to standard care. MAIN OUTCOME MEASURES: primary outcome measures were changes in coronary risk factors, medication usage and actual use of secondary care health services. Secondary outcomes were total and cardiovascular events; changes in medication compliance, non-medical support requirement, health status and psychological functioning, and social inclusion. RESULTS: there were significant improvements in a reported current exercise score (mean +0.33, +0.02 to +0.52), in the average time spent walking per week by 72 minutes (+1 to +137 minutes), and in the SF36 Physical Functioning Score (+6.1, +2.4 to +9.5). There was a 1.0% reduction in total fat (95% CI -3.0% to -0.6%) and a 0.6% reduction in saturated fat (95% CI -1.5% to -0.03%). The intervention group showed reduced outpatient attendance for coronary heart disease (-0.25 appointments, -0.61 to -0.08). Attendance rates were high. Socio-economic grouping did not affect participation. CONCLUSIONS: Lay Health Mentoring is feasible, practical and inclusive, positively influencing diet, physical activity, and health resource utilisation in older subjects with ischaemic heart disease without causing harm.