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This study presents an effective approach to tackle the challenge of long-term monitoring of contaminated groundwater sites where remediation leaves residual contamination in the subsurface. Traditional long-term monitoring of contaminated groundwater sites focuses on measuring contaminant concentrations and is applicable to sites where contaminant mass is removed or degraded to a level below the regulatory standard. The traditional approach is less effective at sites where risk from metals or radionuclides continues to exist in the subsurface after remedial goals are achieved. We propose a long-term monitoring strategy for this type of waste site that focuses on measuring the hydrological and geochemical parameters that control attenuation or remobilization of contaminants while de-emphasizing contaminant-concentration measurements. We demonstrate how this approach would be more effective than traditional long-term monitoring, using a site in South Carolina, USA, where groundwater is contaminated by several radionuclides. A comprehensive enhanced attenuation remedy has been implemented at the site to minimize discharge of contamination to surface water. The immobilization of contaminants occurs in three locations by manipulation of hydrological and geochemical parameters, as well as by natural attenuation processes. Deployment of our proposed long-term monitoring strategy will combine subsurface and surface measurements using spectroscopic tools, geophysical tools, and sensors to monitor the parameters controlling contaminant attenuation. The advantage of this approach is that it will detect the potential for contaminant remobilization from engineered and natural attenuation zones, allowing potential adverse changes to be mitigated before contaminant attenuation is reversed.

Objective: This article presents a pilot study that employed a user-centered methodology for evaluating and quantifying neonatal intensive care unit (NICU) designs based on the needs of the primary users., Background: The design of NICUs has begun to shift from open-bay to single-family rooms. Both designs present unique advantages and challenges that impact babies, families, and caregivers., Methods: One NICU design was analyzed using the functional scenario (FS) analysis method. For the FS, users' needs were determined through literature review, interviews with NICU providers and parents, and a review of published design guidelines. Quantitative metrics were developed for each FS, so that characteristics of the NICU design could be analyzed to determine how successful they were in meeting the users' needs. The results were graphically represented to visualize the success and considerations of the design., Results: A total of 23 FSs and 61 spatial metrics were developed. FSs for babies focused on infection prevention, minimizing exposure to environmental stimuli, and supporting enriching care activities. FSs for family members focused on direct access to the baby, and privacy and adequate space for daily activities. FSs for providers and caregivers focused on infection prevention, care activities, care zones, and visibility., Conclusion: Using an FS approach highlights design characteristics in the NICU that need to be addressed during the design process to more successfully meet the needs of the different users. Additionally, using this approach can inform design professionals' decision-making by presenting them with the design characteristics that impact the needs of the user groups.

Objective: This comparative study of two adult neuro critical care units examined the impact of patient- and family-centered design on nurse-family interactions in a unit designed to increase family involvement., Background: A growing evidence base suggests that the built environment can facilitate the delivery of patient- and family-centered care (PFCC). However, few studies examine how the PFCC model impacts the delivery of care, specifically the role of design in nurse-family interactions in the adult intensive care unit (ICU) from the perspective of the bedside nurse., Methods: Two neuro ICUs with the same patient population and staff, but with different layouts, were compared. Structured observations were conducted to assess changes in the frequency, location, and content of interactions between the two units. Discussions with staff provided additional insights into nurse attitudes, perceptions, and experiences caring for families., Results: Nurses reported challenges balancing the needs of many stakeholders in a complex clinical environment, regardless of unit layout. However, differences in communication patterns between the clinician- and family-centered units were observed. More interactions were observed in nurse workstations in the PFCC unit, with most initiated by family. While the new unit was seen as more conducive to the delivery of PFCC, some nurses reported a loss of workspace control., Conclusions: Patient- and family-centered design created new spatial and temporal opportunities for nurse-family interactions in the adult ICU, thus supporting PFCC goals. However, greater exposure to unplanned family encounters may increase nurse stress without adequate spatial and organizational support., (© The Author(s) 2015.)