Historical Urban Tree Canopy Cover Change in Two Post-Industrial Cities.

Present-day spatial patterns of urban tree canopy (UTC) are created by complex interactions between various human and biophysical drivers; thus, urban forests represent legacies of past processes. Understanding these legacies can inform municipal tree planting and canopy cover goals while also addressing urban sustainability and inequity. We examined historical UTC cover patterns and the processes that formed them in the cities of Chelsea and Holyoke, Massachusetts using a mixed methods approach. Combining assessments of delineated UTC from aerial photos with historical archival data, we show how biophysical factors and cycles of governance and urban development and decay have influenced the spatiotemporal dynamics of UTC. The spatially explicit UTC layers generated from this research track historical geographic tree distribution and dynamic change over a 62-year period (1952-2014). An inverse relationship was found between UTC and economic prosperity: while canopy gains occurred in depressed economic periods, canopy losses occurred in strong economic periods. A sustainable increase of UTC is needed to offset ongoing losses and overcome historical legacies that have suppressed UTC across decades. These findings will inform future research on residential canopy formation and stability, but most importantly, they reveal how historical drivers can be used to inform multi-decadal UTC assessments and the creation of targeted, feasible UTC goals at neighborhood and city scales. Such analyses can help urban natural resource managers to better understand how to protect and expand their cities' UTC over time for the benefit of all who live in and among the shade of urban forests.

Resource extraction and infrastructure threaten forest cover and community rights.

Mineral and hydrocarbon extraction and infrastructure are increasingly significant drivers of forest loss, greenhouse gas emissions, and threats to the rights of forest communities in forested areas of Amazonia, Indonesia, and Mesoamerica. Projected investments in these sectors suggest that future threats to forests and rights are substantial, particularly because resource extraction and infrastructure reinforce each other and enable population movements and agricultural expansion further into the forest. In each region, governments have made framework policy commitments to national and cross-border infrastructure integration, increased energy production, and growth strategies based on further exploitation of natural resources. This reflects political settlements among national elites that endorse resource extraction as a pathway toward development. Regulations that protect forests, indigenous and rural peoples' lands, and conservation areas are being rolled back or are under threat. Small-scale gold mining has intensified in specific locations and also has become a driver of deforestation and degradation. Forest dwellers' perceptions of insecurity have increased, as have documented homicides of environmental activists. To explain the relationships among extraction, infrastructure, and forests, this paper combines a geospatial analysis of forest loss overlapped with areas of potential resource extraction, interviews with key informants, and feedback from stakeholder workshops. The increasing significance of resource extraction and associated infrastructure as drivers of forest loss and rights violations merits greater attention in the empirical analyses and conceptual frameworks of Sustainability Science.

Tasks completed by nursing members of a teaching hospital Medical Emergency Team.

OBJECTIVES: To assess tasks completed by intensive care medical emergency team nurses. RESEARCH DESIGN: Prospective observational study. SETTING: Australian teaching hospital. MAIN OUTCOME MEASURES: Nursing-related technical and non-technical tasks and level of self-reported confidence and competence. RESULTS: Amongst 400 calls, triggers and nursing tasks were captured in 93.5% and 77.3% of cases, respectively. The median patient age was 73 years. The four most common triggers were hypotension (22.0%), tachycardia (21.1%), low SpO2 (17.4%), and altered conscious state (10.1%). Non-technical skills included investigation review (33.7%), history acquisition (18.4%), contribution to the management plan (40.5%) and explanation to bedside nurses (78.3%), doctors (13.6%), allied health (3.9%) or patient/relative (39.5%). Technical tasks included examining the circulation (32%), conscious state (29.4%), and chest (26.5%). Additional tasks included adjusting oxygen (23.9%), humidification (8.4%), non-invasive ventilation (6.5%), performing an ECG (22%), and administrating fluid as a bolus (17.5%) or maintenance (16, 5.2%), or medication as a statim dose (16.8%) or infusion (5.2%). Self-reported competence and confidence appeared to be high overall amongst our MET nurses. CONCLUSION: Our findings provide important information on the tasks completed by Medical Emergency Team nurses and will guide future training.

Features of an Intensive Care based Medical Emergency Team nurse training program in a University Teaching Hospital.

BACKGROUND: Medical Emergency Teams (METs) involve specialist staff who respond to acutely deteriorating ward patients. There is little literature describing the scope of practice and training of MET responders. PURPOSE: To describe and discuss an education and training program for Intensive Care Unit (ICU) nurses who function in a high capability teaching hospital MET. FINDINGS: The program is overseen and coordinated by four senior nurses. Applicants require at least three years experience working as an ICU nurse in a level 3 tertiary ICU. Each program participant is allocated a mentor and must complete the program within six months. Induction involves attending lectures outlining expected roles, responsibilities and appropriate conduct during MET calls. A course handbook outlines a series of competencies including checking of the MET trolley, assisting endo-tracheal intubation, commencement of non-invasive ventilation and high flow oxygen. Each participant attends the first five MET calls under supervision. A series of case scenarios are discussed and reviewed and an oral examination on two such cases is undertaken prior to completion of the program. Throughout, candidates are trained in their expected roles and responsibilities during MET calls, follow-up of at-risk and deteriorating patients, emergency calls in the mental health precinct, and assisting with procedures outside of the ICU. Emphasis is placed on both technical and non-technical skills. CONCLUSIONS: We have provided a framework for the development of a MET nurse training program. The applicability of this program to other settings and effects of this program on patient outcomes remain unknown.

Large carbon release legacy from bark beetle outbreaks across Western United States.

Warmer conditions over the past two decades have contributed to rapid expansion of bark beetle outbreaks killing millions of trees over a large fraction of western United States (US) forests. These outbreaks reduce plant productivity by killing trees and transfer carbon from live to dead pools where carbon is slowly emitted to the atmosphere via heterotrophic respiration which subsequently feeds back to climate change. Recent studies have begun to examine the local impacts of bark beetle outbreaks in individual stands, but the full regional carbon consequences remain undocumented for the western US. In this study, we quantify the regional carbon impacts of the bark beetle outbreaks taking place in western US forests. The work relies on a combination of postdisturbance forest regrowth trajectories derived from forest inventory data and a process-based carbon cycle model tracking decomposition, as well as aerial detection survey (ADS) data documenting the regional extent and severity of recent outbreaks. We find that biomass killed by bark beetle attacks across beetle-affected areas in western US forests from 2000 to 2009 ranges from 5 to 15 Tg C yr(-1) and caused a reduction of net ecosystem productivity (NEP) of about 6.1-9.3 Tg C y(-1) by 2009. Uncertainties result largely from a lack of detailed surveys of the extent and severity of outbreaks, calling out a need for improved characterization across western US forests. The carbon flux legacy of 2000-2009 outbreaks will continue decades into the future (e.g., 2040-2060) as committed emissions from heterotrophic respiration of beetle-killed biomass are balanced by forest regrowth and accumulation.

Improving communication of the daily care plan in a teaching hospital intensive care unit.

BACKGROUND: Patients admitted to intensive care units have complex care needs. Accordingly, communication and handover of the medical care plan is very important. OBJECTIVE: To assess changes in ICU nurses' understanding of the medical daily care plan after development and implementation of a pro forma to improve documentation and communication of the plan. DESIGN, SETTING AND PARTICIPANTS: The study was conducted between February and November 2012 in a mixed medical-surgical, 18-bed, closed ICU in a teaching hospital. Baseline and post-intervention surveys assessed ICU bedside nurses' self-reported understanding of elements of the daily care plan. INTERVENTION: After receiving input from bedside nurses and medical staff, we developed the daily care plan as a single-page pro forma for handwritten documentation of a clinical problems list, plan and interventions list, daily chest x-ray results, a modified FAST-HUG checklist, and discharge planning during the evening consultant ward round. The finalised pro forma was introduced on 25 July 2012. RESULTS: Introduction of the pro forma daily care plan was associated with marked and statistically significant improvements in nurses' self-reported understanding of a list of the patient's clinical problems, the management plan after the ward round, issues for discharge for the following day (all P < 0.001) and, to a lesser extent, the physiological targets and aims (P = 0.003) and interpretation of the daily chest x-ray (P < 0.001). In the post-intervention survey, only 4/118 free-text comments (3.4%) suggested that documentation of the plan was doctor-dependent, compared with 28/198 (14.1%) at baseline (P = 0.002). CONCLUSIONS: Introduction of a single-page, handwritten, structured daily care plan produced marked improvements in ICU nurses' self-reported understanding of elements of the medical plan, and may have reduced practice variation in medical plan documentation. The effects of this intervention on patient outcomes remain untested.

Accelerating anthropogenic land surface change and the status of Pleistocene drumlins in New England.

Drumlins are glacially derived landforms that are prominent in the landscape over much of southern New England. We carried out a comprehensive ground-based survey in a three-town study area in eastern Massachusetts with the goals of establishing the extent to drumlins have been altered and assessing the associated environmental consequences and probable driving factors. Results show that many drumlins have been significantly altered through levelling and truncation (creation of steep cut and fill slopes), with projects involving movement of 1-1.5×10(6) m(3) of earth materials not now uncommon. Stormwater and wetlands infractions were documented at all the larger excavation sites and resulted in enforcement actions and fines in many cases; the broader environmental consequences of the loss/alteration of these forested uplands are harder to establish. The excavations are significant in terms of materials cycling: the movement of earth materials, when considered regionally, greatly exceeds natural denudation processes and is also greater than during other periods of high anthropogenic denudation. Our findings suggest that the region's glacial landscapes are at risk given current development patterns. The accelerating rate of land-surface change is undoubtedly also generalizable to other fast-developing regions of the United States. The landform alterations documented are part of a changing pattern of land use and vegetation cover since the Colonial era and are linked to shortages of land for development, current development and building practices, and lack of explicit rationales for preservation of the region's geoheritage.

Bridging the educational research-teaching practice gap: curriculum development, part 2: becoming an agent of change.

Many faculty members in science departments are experiencing pressure to improve their courses, particularly with respect to the ways in which students are taught and assessed. The purpose of this article is to provide some insights and practical ideas on how curriculum change can be brought about-how motivated individuals can become agents of change. Change almost always elicits opposing and supporting forces, examples of which are given. Finally, we discuss examples of strategies to deal with these forces and highlight various factors that need to be considered when implementing such strategies, including the concepts of a zone of feasible innovation, the zone of tolerance, and the development of communities of practice.

Bridging the educational research-teaching practice gap. Curriculum development, Part 1: Components of the curriculum and influences on the process of curriculum design.

This article summarizes the major components of curriculum design: vision, operationalization of the vision, design, and evaluation. It stresses that the relationship between these components is dynamic, and that the process of curriculum design does not proceed via a linear application of these components. The article then summarizes some of the major influences on curriculum design: policy, local context, societal expectations, research trends, and technology. Then, it provides examples of how these influences affect the design of a curriculum and ends with a comprehensive set of questions that instructors could use to guide their curriculum development process.

Evaluation of a radial artery cannulation training program for intensive care nurses: a descriptive, explorative study.

BACKGROUND: Radial arterial line is required for critically ill patients to provide continuous blood pressure monitoring and arterial blood sampling. A program training experienced ICU nurses to perform radial artery cannulation was introduced in a Melbourne metropolitan ICU to allow early treatment and intervention to be delivered to patients while medical staff attend to more urgent diagnostic care. The aim of this research was to evaluate the effectiveness of the training program for radial artery cannulation in the ICU. METHOD: This descriptive explorative study involving a convenience sample of two groups of ICU nurses (11 and 10 participants) was conducted in a 20-bed multi-discipline adult ICU within this metropolitan hospital. Stage I involved data collection of all radial artery cannulation attempts made by participants for a period of 6 months from the training date. Stage II involved completion of questionnaires by participants to reflect on their experience 6 months post-training. The effectiveness of the training program was evaluated based on the success rates of cannulations, any reports of adverse events and participants' responses to questionnaires. RESULTS: 107 patients underwent a cannulation attempt of which 67 (63%) were successful with no reports of adverse events. Eleven nurses managed to achieve competency with a minimum of two successful cannulations. Sixty-seven percent (14 out of 21) responded to the questionnaire and 93% expressed that they would recommend this course to other colleagues. About half of the respondents stated that the ICU nurses' ability to perform radial artery cannulations may prevent patients from having to wait for long periods when doctors are held up. CONCLUSION: The findings showed that ICU nurses can safely insert radial arterial lines with improvements recommended.

Bridging the educational research-teaching practice gap: Tools for evaluating the quality of assessment instruments.

Student assessment is central to the educational process and can be used for multiple purposes including, to promote student learning, to grade student performance and to evaluate the educational quality of qualifications. It is, therefore, of utmost importance that assessment instruments are of a high quality. In this article, we present various tools that instructors could use, both to improve instrument design and validity before presentation to students and, to evaluate the reliability and quality of the assessment after students have answered the questions. In keeping with our goals of the Bridging-the-Gap series, we also present various ideas from the educational literature regarding the evaluation of assessment quality and end with a list of criteria that instructors could use to guide their evaluation process.