In the United States, stream restoration is currently a billion-dollar industry. Though it is commonly used as a method for stream impact mitigation, Total Maximum Daily Load (TMDL) crediting, and stormwater management, there is little scientific knowledge defending stream restoration as an effective tool for addressing these issues. In particular, few studies have been conducted with the goal of providing recommendations for future design improvements. To improve stream restoration success rates by advising practitioners and stakeholders in site selection and project assessment, a selection of completed Maryland stream restoration projects were assessed at the watershed and project level. Watershed, site, and design characteristics were quantified using ArcGIS, restoration design plans and monitoring reports. Using current literature and expert advice, stream restoration assessment methodologies were developed to assess geomorphic function and design success both in the field and through monitoring reports. Multiple linear regression analysis and related methods were then used to identify correlations and relationships between watershed- and project-level characteristics and stream restoration success. At the watershed scale, land use was most strongly related to functional success, with projects in more natural watersheds exhibiting higher geomorphic function. Design scores correlated negatively with watershed area. At the project level, projects with higher width to depth ratios scored higher on the functional assessment, while particle size was negatively correlated with geomorphic function. Study results suggest stream restoration designs are improving over time, but the ability to determine project success from monitoring remains limited. / Master of Science / In the United States, stream restoration is currently a multi-billion-dollar industry. Though it is commonly used as a method for water quality improvement, stormwater management, and habitat restoration after human disturbance, there is little scientific knowledge defending stream restoration as an effective tool for addressing these issues. In particular, few studies have been conducted with the goal of providing recommendations for future design improvements. To improve stream restoration success rates by advising practitioners and stakeholders in site selection and project assessment, a selection of completed Maryland stream restoration projects were assessed at the watershed and project level. Watershed, site, and design characteristics were quantified using spatial data analysis software along with restoration design plans and monitoring reports. Using current literature and expert advice, stream restoration assessment methodologies were developed to assess stream ability to transport water and sediment, as well as design resilience using monitoring reports, and during field visits. Data analysis showed projects built in more rural, natural watersheds were more similar to undisturbed streams. Projects constructed in large watersheds were less likely to remain stable after repeated storm events. At the project level, projects that were wider rather than deep were more functional, while those with significant amounts of large rock were less successful. Stream restoration designs seem to be improving with time, but the ability to determine project success from monitoring remains limited.

No description available.

Pain is an inherently subjective experience and should be assessed and treated as such; however, it is well documented that pediatric pain remains under assessed and under treated by nurses and healthcare professionals. To treat pain adequately, ongoing assessment of its presence and severity is critical to improving outcomes for pediatric patients. Although reliable, valid, and clinically sensitive assessment tools are available to healthcare providers, self-report is considered the "gold standard" to assess pain given its subjective nature. Children, particularly those between 1 and 7 years of age, are one of the most vulnerable populations with respect to poor pain management. Due to progression of cognitive development, they often lack the verbal fluency or vocabulary needed to describe the location, radiation, quality, and intensity of the pain they experience. As a result, pain often goes under treated; and, studies reveal that inadequately treated pain can have a detrimental impact on the course of childhood development. In order to prevent mismanagement of pain, parental pain reports are often used when self-report is inadequate or unable to be provided. This thesis provides a comprehensive review of research literature regarding the role of the parent in pediatric pain assessment and the ability of parents to serve as a proxy in reporting pain for their child. Studies included methods and behaviors parents use to assess their children's pain; parental assessment with use of clinically reliable pain measurement tools; and, comparisons of parental pain assessments to those made by nurses and healthcare professionals. The findings of the review of literature were used to make recommendations for nursing research, education and clinical practice.

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No / Student self-assessment is widely reported to offer numerous advantages to the learner. It is a popular practice for empowering students and the advantages are claimed to incorporate increased dialogue between students and teachers and the development of skills that encompass critical awareness and reflectivity. It is, potentially, a process that may enable health care practitioners to be lifelong learners, equipped with the skills for autonomy in learning and professional practice. As such it might be viewed as an essential element of the curriculum. This paper reports on a study designed to evaluate the implementation of self-assessment among student health care practitioners. The pilot study examined the impact of self-assessment on learning and how the process was perceived by students and staff. Findings indicated that a varied approach had been taken to its implementation, which had significant repercussions in the way in which it was perceived by students. Similarly, there was a varied approach taken by students to the process of self-assessment and this had significant repercussions for its overall value as a learning tool. The outcomes of this study provide a sound rational for maintaining and expanding the practice of student self-assessment and important lessons for the process of doing so.

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No / Effective record keeping underpins service delivery and provides a record of the quality of care delivered. Pressure ulcer risk assessment, prevention strategy and pressure ulcer care provision are a key element in the nursing process and are correctly a focus area within the safety agenda. This article reviews issues related to the documentation of pressure ulcer risk assessment and prevention and asks whether the time is right to move towards a universal system of pressure ulcer care documentation, linked to reporting within the NHS.

Yes / At present there is no established national minimum data set (MDS) for generic wound assessment in England, which has led to a lack of standardisation and variable assessment criteria being used across the country. This hampers the quality and monitoring of wound healing progress and treatment. The article aims to establish a generic wound assessment MDS to underpin clinical practice. The project comprised 1) a literature review to provide an overview of wound assessment best practice and identify potential assessment criteria for inclusion in the MDS and 2) a structured consensus study using an adapted Research and Development/University of California at Los Angeles Appropriateness method. This incorporated experts in the wound care field considering the evidence of a literature review and their experience to agree the assessment criteria to be included in the MDS. The literature review identified 24 papers that contained criteria which might be considered as part of generic wound assessment. From these papers 68 potential assessment items were identified and the expert group agreed that 37 (relating to general health information, baseline wound information, wound assessment parameters, wound symptoms and specialists) should be included in the MDS. Using a structured approach we have developed a generic wound assessment MDS to underpin wound assessment documentation and practice. It is anticipated that the MDS will facilitate a more consistent approach to generic wound assessment practice and support providers and commissioners of care to develop and re-focus services that promote improvements in wound care. / NHS England

2025 / Ambient air pollution poses significant health risks, with extensive research linking pollutants like PM2.5, NO2, and O3 to increased mortality and morbidity. The complex interplay between these pollutants, their sources, and atmospheric dynamics creates challenges for effective air quality management. Moreover, sociodemographic inequities in exposure to air pollution persist across multiple geographic scales, with marginalized communities facing disproportionate burdens due to historical and present-day inequities. Recent technological advancements in remote sensing, chemical transport modeling, and data integration have dramatically improved our ability to characterize air pollution exposure at fine spatial scales, even in areas lacking traditional monitoring networks. This enhanced understanding is crucial as the world grapples with climate change, presenting a unique opportunity to build solutions that simultaneously improve air quality, reduce existing inequities, and mitigate the worst impacts of our shifting climate.This dissertation explores the complex interplay between air pollution, climate change mitigation strategies, and the magnitude and distribution of health equity outcomes through three interconnected studies, each addressing fundamental aspects of air pollution exposure and health risk modeling at different geographic scales. The research examines the health benefits and equity implications of transportation emissions reduction scenarios and vehicle electrification strategies in the United States, while also providing insight regarding the health impacts of NO2 exposure in Mexico. This work collectively provides insight on alternative approaches for air pollution exposure modeling and for characterization of equity, helping to illuminate pathways for designing more impactful, equitable, and health-enhancing policies. In Chapter Two, we explore the equity implications of various transportation emissions reduction scenarios in the northeastern United States, focusing on four distinct equity constructs: racial/ethnic exposure inequities, benefits to environmental justice communities, distribution of benefits among participating states, and rural-urban share of benefits. Using advanced chemical transport modeling, we analyze scenarios for reducing directly emitted fine particulate matter across 12 Northeast states and the District of Columbia, revealing tradeoffs among different equity constructs. Our findings highlight that scenarios resulting in greater reductions in population-weighted primary PM2.5 exposure were generally those centered in states with large urban areas, leading to greater reductions in racial/ethnic exposure inequities but higher between state or rural/urban inequality. Conversely, scenarios targeting uniform percentage emission reductions from trucks better address rural/urban inequalities but lead to smaller reductions in racial/ethnic inequity. In Chapter Three, we evaluate the impacts of vehicle electrification strategies in the Boston metropolitan area of the Northeast United States, focusing on their potential to reduce emissions, improve health outcomes, and address existing exposure and health inequities among racial and ethnic groups. Using high-resolution chemical transport modeling, we examine a set of scenarios targeting different vehicle types within unique regions of the metropolitan area. Our findings highlight that while targeting larger vehicle fleets in suburban areas yielded greater overall health improvements, concentrating efforts on heavy-duty trucks and high-emitting vehicles in urban core areas proved most effective in reducing inequities on a per-vehicle basis. Our findings underline the importance of considering multiple pollutants and utilizing detailed health data in policy decision-making. The final study in Chapter Four assesses the public health burden of NO2 exposure in Mexico, highlighting uncertainties in health impact assessment modeling. This work utilizes two globally modeled ground-level NO2 datasets alongside TROPOMI satellite-derived tropospheric NO2 data to analyze spatial patterns in the pollutant across Mexico and their effects on population exposure estimates and health impact calculations, with different concentration-response functions also evaluated. The analysis reveals tens of thousands of premature deaths annually attributable to ambient NO2 exposure across Mexico annually. The study finds that health estimates vary more with the choice of concentration-response function at the national scale than the exposure dataset, though it is important to note only two exposure datasets were compared. Notable differences emerge between these exposure datasets, however, at the state level, particularly near Mexico City. While demographic patterns are consistent, differences are observed for smaller subpopulations like Indigenous language speakers. This work describes the notable health impacts of NO2 across Mexico, which were previously challenging to define due to limited air monitoring networks. It also highlights the complexities involved in selecting the most appropriate inputs for air pollution health impact assessments at different geographic scales. In conclusion, this dissertation underscores the importance of applying air pollution modeling techniques that fit both the pollutants of interest and the policy context, with heightened importance when considering local or regional contexts. Although the three chapters encompass diverse geographic scales and methodological frameworks, a recurring theme relates to the potential tradeoffs between overall public health improvements and targeted equity gains. Analyses that elucidate these tradeoffs and describe the attributes of policies that perform best across multiple endpoints will be maximally informative. These insights lay a groundwork for future research and policy development that simultaneously address air quality, climate change, and health equity.