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Background and Objectives Telehealth holds potential for inclusive and cost-saving health care; however, a better understanding of the use and acceptance of telehealth for health promotion among rural older adults is needed. This systematic review aimed to synthesize evidence for telehealth use among rural-living older adults and to explore cost-effectiveness for health systems and patients. Research Design and Methods This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study designs reporting health promotion telehealth interventions with rural-living adults aged 55 and older were eligible for review. Following screening and inclusion, articles were quality-rated and ranked by level of evidence. Data extraction was guided by the Technology Acceptance Model and organized into outcomes related to ease of use, usefulness, intention to use, and usage behavior along with cost-effectiveness. Results Of 2,247 articles screened, 42 were included. Positive findings for the usefulness of telehealth for promoting rural older adults’ health were reported in 37 studies. Evidence for ease of use and usage behavior was mixed. Five studies examined intention to continue to use telehealth and in 4 of these, patients preferred telehealth. Telehealth was cost-effective for health care delivery (as a process) compared to face to face. However, findings were mixed for cost-effectiveness with both reports of savings (e.g., reduced travel) and increased costs (e.g., insurance). Discussion and Implications Telehealth was useful for promoting health among rural-living older adults. Technological supports are needed to improve telehealth ease of use and adherence. Cost-effectiveness of telehealth needs more study, particularly targeting older adults.

Globally, Indigenous Peoples suffer disproportionately higher rates and complications of diabetes and obesity than non-Indigenous people. Western health interventions combined with culturally appropriate Traditional approaches can reduce incidence, prevalence, and related co-morbidities. This literature review reports effective culturally relevant Traditional and Western diabetes and obesity prevention and management intervention programs for Indigenous populations in Australia, Canada, New Zealand, and the United States. Experiential, immediate, interactive, and low-cost programs, co-developed and delivered by local Indigenous people within the communities they live, are most effective in improving health and wellbeing. Key themes of success of Togetherness, Empowerment, and Local Familiarity inform action for policy and practice changes adaptable for chronic disease prevention, treatment, and self-management programs for Indigenous Peoples globally.

Objectives: The onset of the 2020 coronavirus pandemic resulted in rapid implementation of virtual care solutions at an unprecedented pace. The news media, as a trusted source for many Canadians, p...

The conceptualization of assisted death as an act performed by physicians has resulted in a lack of attention to nurses' roles and experiences with the processes that surround an assisted death. In this article, we synthesize evidence from 6 articles focusing on the experiences of 55 nurses from Canada, Belgium, and the Netherlands, with relevant ethical and policy implications derived from the literature. Nurses have a central role in negotiating inquiries about assisted death and in providing wraparound care for patients, families, and other health care providers. This role is impactful for nurses and requires significant personal and professional moral work.

The aim was to identify the best practices of formal new graduate nurse transition programs. This information would be useful for organizations in their support and development of formal transition programs for newly hired nurses.An integrative review of the nursing research literature (2000-2018).The literature search included PubMed (MEDLINE), CINAHL (Cumulative Index to Nursing and Allied Health Literature), and EMBASE (Excerpt Medica dataBASE). Studies that dealt with programs geared towards pre-registration nursing students were removed. At least two researchers evaluated the literature to determine if the article met the inclusion and exclusion criteria. The final number of articles included in this review is 76.Cooper's (1989) five-stage approach to integrative review guided the process: problem formulation, data collection, evaluation of data points, data analysis and interpretation, presentation of results. This approach was supplemented by the PRISMA guidelines for reporting systematic searches.Selected studies (n=76) included a range of new graduate nurse program types. The literature was examined according to four major themes: education (pre-registration and practice), support/satisfaction, competency and critical thinking, and workplace environment. Common elements of programs were a specified resource person(s) for new graduates, mentorship, and peer support opportunities. Gaps were observed between pre-registration and new graduate nurse practice realities. A range of educational strategies were used but few were evaluated. Most programs staggered education over time but the limited evidence showed no difference in new graduate nurse transition or satisfaction. New graduate nurse support was an important emphasis of all programs with preceptors the most common form of support and with beginning evidence showing quality vs quantity in preceptor support. Strengthening the quality of preceptor support was evident across studies with the bundling of concurrent strategies found to be helpful. Competency and confidence were found to increase over time for new graduate nurses in transition programs. Workplace environments influenced new graduate nurse transition and organizational commitment.The variable quality of evidence limits the conclusions that can be drawn. The strongest evidence consistently showed new graduate nurse programs enhanced critical thinking, competency and retention and there were advantages with use of bundled preceptor strategies to support new graduates.

Background The use of electronic cigarettes (e-cigarettes), also known as vaping, has risen exponentially among North American youth in recent years and has become a critical public health concern. The marketing strategies used by e-cigarette companies have been associated with the uptick in use among youth, with video advertisements on television and other electronic platforms being the most pervasive strategy. It is unknown how these advertisements may be tapping into youth needs and preferences. Objective The aim of this 2-phase study was to examine the marketing strategies that underpin e-cigarette advertisements, specifically in the context of television. Methods In phase 1, a scoping review was conducted to identify various influences on e-cigarette uptake among youth. Results of this scoping review informed the development of a coding framework. In phase 2, this framework was used to analyze the content of e-cigarette advertisements as seen on 2 popular television channels (Discovery and AMC). Results In phase 1, a total of 20 articles met the inclusion criteria. The resultant framework consisted of 16 key influences on e-cigarette uptake among youth, which were categorized under 4 headings: personal, relational, environmental, and product-related. In phase 2, 38 e-cigarette advertisements were collected from iSpot.tv and represented 11 popular e-cigarette brands. All of the advertisements tapped into the cited influences of youth e-cigarette uptake, with the most commonly cited influences (product and relational) tapping into the most, at 97% (37/38) and 53% (20/38), respectively. Conclusions The findings highlight the multidimensional influences on youth uptake of e-cigarettes, which has important implications for developing effective antivaping messages, and assist public health professionals in providing more comprehensive prevention and cessation support as it relates to e-cigarette use. The findings also bring forward tangible strategies employed by e-cigarette companies to recruit youth into vaping. Understanding this is vital to the development of cohesive strategies that combat these provaping messages.

BACKGROUND The use of electronic cigarettes (e-cigarettes), also known as vaping, has risen exponentially among North American youth in recent years and has become a critical public health concern. The marketing strategies used by e-cigarette companies have been associated with the uptick in use among youth, with video advertisements on television and other electronic platforms being the most pervasive strategy. It is unknown how these advertisements may be tapping into youth needs and preferences. OBJECTIVE The aim of this 2-phase study was to examine the marketing strategies that underpin e-cigarette advertisements, specifically in the context of television. METHODS In phase 1, a scoping review was conducted to identify various influences on e-cigarette uptake among youth. Results of this scoping review informed the development of a coding framework. In phase 2, this framework was used to analyze the content of e-cigarette advertisements as seen on 2 popular television channels (Discovery and AMC). RESULTS In phase 1, a total of 20 articles met the inclusion criteria. The resultant framework consisted of 16 key influences on e-cigarette uptake among youth, which were categorized under 4 headings: personal, relational, environmental, and product-related. In phase 2, 38 e-cigarette advertisements were collected from iSpot.tv and represented 11 popular e-cigarette brands. All of the advertisements tapped into the cited influences of youth e-cigarette uptake, with the most commonly cited influences (product and relational) tapping into the most, at 97% (37/38) and 53% (20/38), respectively. CONCLUSIONS The findings highlight the multidimensional influences on youth uptake of e-cigarettes, which has important implications for developing effective antivaping messages, and assist public health professionals in providing more comprehensive prevention and cessation support as it relates to e-cigarette use. The findings also bring forward tangible strategies employed by e-cigarette companies to recruit youth into vaping. Understanding this is vital to the development of cohesive strategies that combat these provaping messages.

Background: Medical Assistance in Dying, also known as euthanasia or assisted suicide, is expanding internationally. Canada is the first country to permit Nurse Practitioners to provide euthanasia. These developments highlight the need for nurses to reflect upon the moral and ethical issues that euthanasia presents for nursing practice. Purpose: The purpose of this article is to provide a narrative review of the ethical arguments surrounding euthanasia in relationship to nursing practice. Methods: Systematic search and narrative review. Nine electronic databases were searched using vocabulary developed from a stage 1 search of Medline and CINAHL. Articles that analysed a focused ethical question related to euthanasia in the context of nursing practice were included. Articles were synthesized to provide an overview of the literature of nursing ethics and euthanasia. Ethical Considerations: This review was conducted as per established scientific guidelines. We have tried to be fair and respectful to the authors discussed. Findings: Forty-three articles were identified and arranged inductively into four themes: arguments from the nature of nursing; arguments from ethical principles, concepts and theories; arguments for moral consistency; and arguments from the nature of the social good. Key considerations included nursing’s moral ontology, the nurse–patient relationship, potential impact on the profession, ethical principles and theories, moral culpability for acts versus omissions, the role of intention and the nature of the society in which euthanasia would be enacted. In many cases, the same assumptions, values, principles and theories were used to argue both for and against euthanasia. Discussion: The review identified a relative paucity of literature in light of the expansion of euthanasia internationally. However, the literature provided a fulsome range of positions for nurses to consider as they reflect on their own participation in euthanasia. Many of the arguments reviewed were not nursing-specific, but rather are relevant across healthcare disciplines. Arguments explicitly grounded within the nature of nursing and nurse–patient relationships warrant further exploration.

Objectives To review the research literature on cultural safety education within post-secondary health science programs. Methods We conducted health and social science database searches from 1996-2016, using combined keywords: cultural competence or safety; teaching or curriculum; universities, polytechnics or professional programs; and Aboriginal or Indigenous. In dyads, authors selected, and reviewed studies independently followed by discussion and consensus to identify thematic linkages of major findings. Results A total of 1583 abstracts and 122 full-text articles were reviewed with 40 selected for final inclusion. Publications from Australia, Canada, New Zealand and the United States described curriculum development and delivery. A variety of evaluation approaches were used including anecdotal reports, focus groups, interviews, course evaluations, reflective journals, pre-post surveys, critical reflective papers, and exam questions. Duration and depth of curricular exposure ranged from one day to integration across a six-year program. Changes in student knowledge, attitude, self-confidence, and behaviour when working with Indigenous populations were reported. Cultural safety education and application to practice were shown to be linked to improved relationships, healthier outcomes, and increased number of Indigenous people entering health education programs and graduates interested in working in diverse communities. Conclusions This review provides a summary of multidisciplinary didactic and experiential instructional approaches to cultural safety education and the impact on students, educators and Indigenous people. Institutional support, strategic planning and cultural safety curriculum policy within post-secondary settings and community engagement are imperative for positive student experiences, advocacy, and actions toward health equity and improved health for Indigenous people and communities.

Conservative chemicals (such as sodium chloride) have been utilized to perform tracer studies within drinking water distribution systems. The resulting signals from a tracer study can provi...

Objective The virtual delivery of patient education and other forms of telehealth have been proposed as alternatives to providing needed care for patients with chronic diseases. The purpose of this systematic review was to compare the efficacy of virtual education delivery on patient outcomes compared with usual care. Methods The review examined citations from 3 databases, MEDLINE, CINAHL, and EMBASE using the search words telehealth, chronic disease, patient education, and related concepts. From 2447 records published between 2006 and 2017, 16 high to moderate quality studies were selected for review. Eligible papers compared virtual education to usual care using designs allowing for assessment of causality. Results Telehealth modalities included the web, telephone, videoconference, and television delivered to patients with diabetes, chronic obstructive pulmonary disease, irritable bowel syndrome and heart failure. In 11 of 16 studies, virtually delivered interventions significantly improved outcomes compared to control conditions. In the remaining 5 studies, virtual education showed comparable outcomes to the control conditions. Conclusions Findings demonstrated that virtual education delivered to patients with chronic diseases was comparable, or more effective, than usual care. Research implications Despite its benefits, there is potential for further research into the individual components which improve effectiveness of virtually delivered interventions

The effect of limitations in the structural detail available in a network model on contamination warning system (CWS) design was examined in case studies using the original and skeletonized network models for two water distribution systems (WDSs). The skeletonized models were used as proxies for incomplete network models. CWS designs were developed by optimizing sensor placements for worst-case and mean-case contamination events. Designs developed using the skeletonized network models were transplanted into the original network model for evaluation. CWS performance was defined as the number of people who ingest more than some quantity of a contaminant in tap water before the CWS detects the presence of contamination. Lack of structural detail in a network model can result in CWS designs that (1) provide considerably less protection against worst-case contamination events than that obtained when a more complete network model is available and (2) yield substantial underestimates of the consequences associated with a contamination event. Nevertheless, CWSs developed using skeletonized network models can provide useful reductions in consequences for contaminants whose effects are not localized near the injection location. Mean-case designs can yield worst-case performances similar to those for worstcase designs when there is uncertainty in the network model. Improvements in network models for WDSs have the potential to yield significant improvements in CWS designs as well as more realistic evaluations of those designs. Although such improvements would be expected to yield improved CWS performance, the expected improvements in CWS performance have not been quantified previously. The results presented here should be useful to those responsible for the design or implementation of CWSs, particularly managers and engineers in water utilities, and encourage the development of improved network models.

Introduction Engaging in physical activity and recreation are important aspects of health for children living with Autism Spectrum Disorders (ASD). However, children with ASD experience higher levels of inactivity and obesity along with increased injury rates. Since parent support is key to children’s activity participation, their safety related perceptions are important to understand and address. This scoping review aimed to examine literature on parent-focussed interventions, supports and barriers for safe physical activity for children with ASD. Methods The methodology was guided by Arksey and O’Malley’s framework for scoping reviews. Search procedures were developed collaboratively with a university librarian and included searches of five electronic databases, as well as grey literature and hand searching. Included abstracts were those reporting parent level measures related to physical or recreational activity for children 0–19 years living with ASD. Abstracts and articles were further examined for inclusion of concepts related to safety or injury prevention. Two reviewers examined each abstract and full text article and a third reviewer resolved any disagreements. Results Library electronic database searches yielded 603 abstracts and grey literature and hand searching yielded 2049 titles. In total, 44 full text articles were reviewed, 21 met the inclusion criteria and eight addressed parental perspectives on safety for children with ASD. Study methods included quantitative (4), qualitative (2) and mixed methods (2). No intervention studies were found while descriptive studies reported parental safety concerns including: program staff ability to ensure safety; safety of outdoor environments, and children’s lack of safety awareness and skills. Conclusions Research on parent views and experiences regarding safety-related factors influencing activity participation for children with ASD is currently limited. Additional research on this topic is needed to inform program and policy development and promote opportunities for children with ASD to engage safely in physical activity while also addressing parental perspectives.

Despite efforts to increase cultural competence of services within juvenile justice systems, disproportional minority contact (DMC) persists throughout Canada and the United States. Commonly cited approaches to decreasing DMC include large-scale systemic changes as well as enhancement of the cultural relevance and responsiveness of services delivered. Cultural adaptations to service delivery focus on prevention, decision-making, and treatment services to reduce initial contact, minimize unnecessary restraint, and reduce recidivism. Though locating rigorous testing of these approaches compared to standard interventions is difficult, this paper identifies and reports on such research. The Cochrane guidelines for systematic literature reviews and meta-analyses served as a foundation for study methodology. Databases such as Legal Periodicals and Books were searched through June 2015. Three studies were sufficiently rigorous to identify the effect of the cultural adaptations, and three studies that are making potentially important contributions to the field were also reviewed.

The use of management control systems (MCS) is shaped by perceptions of the environment. Next to this traditional view, some studies suggest that MCS use simultaneously shapes environmental perceptions. In other words, there is a reciprocal relationship between MCS use and environmental perceptions. We investigate this relationship in the 2008–2010 economic crisis. This study examines whether the perception of negative external crisis effects affects the interactive use of MCS on the organizational level. It also explores whether an interactive use of MCS during an economic crisis influences the perception of negative external crisis effects. The direction of causality is difficult to assess from cross-sectional data. Thus, we apply a cross-lagged panel design using data from two (time-lagged) surveys. The results show that perception of negative external crisis effects leads to more interactive use of MCS. Moreover, our findings support a positive effect of the interactive use of MCS on senior managers’ perception of negative external crisis effects. Furthermore, we provide practitioner statements that illustrate the interactive use of MCS in times of economic crisis.

Background: Despite far reaching support for integrated care, conceptualizing and measuring integrated care remains challenging. This knowledge synthesis aimed to identify indicator domains and tools to measure progress towards integrated care. Methods: We used an established framework and a Delphi survey with integration experts to identify relevant measurement domains. For each domain, we searched and reviewed the literature for relevant tools. Findings: From 7,133 abstracts, we retrieved 114 unique tools. We found many quality tools to measure care coordination, patient engagement and team effectiveness/performance. In contrast, there were few tools in the domains of performance measurement and information systems, alignment of organizational goals and resource allocation. The search yielded 12 tools that measure overall integration or three or more indicator domains. Discussion: Our findings highlight a continued gap in tools to measure foundational components that support integrated care. In the absence of such targeted tools, “overall integration” tools may be useful for a broad assessment of the overall state of a system. Conclusions: Continued progress towards integrated care depends on our ability to evaluate the success of strategies across different levels and context. This study has identified 114 tools that measure integrated care across 16 domains, supporting efforts towards a unified measurement framework.

EPANET is widely employed to simulate water quality in water distribution systems. However, in general, the time-driven simulation approach used to determine concentrations of water-quality constituents provides accurate results only for short water-quality time steps. Overly long time steps can yield errors in concentration estimates and can result in situations in which constituent mass is not conserved. The use of a time step that is sufficiently short to avoid these problems may not always be feasible. The absence of EPANET errors or warnings does not ensure conservation of mass. This paper provides examples illustrating mass imbalances and explains how such imbalances can occur because of fundamental limitations in the water-quality routing algorithm used in EPANET. In general, these limitations cannot be overcome by the use of improved water-quality modeling practices. This paper also presents a preliminary event-driven approach that conserves mass with a water-quality time step that is as long as the hydraulic time step. Results obtained using the current approach converge, or tend to converge, toward those obtained using the preliminary event-driven approach as the water-quality time step decreases. Improving the water-quality routing algorithm used in EPANET could eliminate mass imbalances and related errors in estimated concentrations. The results presented in this paper should be of value to those who perform water-quality simulations using EPANET or use the results of such simulations, including utility managers and engineers.

Aims/Objectives To examine hospital nurses’ attitudes towards caring for older adults and delineate associated factors contributing to their attitudes. Background Population aging is of international significance. A nursing workforce able to care for the ageing population is critical for ensuring quality older adult care. A synthesis of research related to nurses’ attitudes towards older adult care is important for informing care quality and the nursing workforce issues. Methods A systematic integrative review process guided the review. Cumulative Index of Nursing and Allied Health Literature and Medline databases were searched for primary research published between 2005 and 2017. A total of 1690 papers were screened with 67 papers read in-depth and 8 selected for this review that met the inclusion/exclusion criteria. Results Nurses’ held co-existing positive and negative attitudes towards generic and specific aspects of older adult care. Negative attitudes, in particular, were directed at the characteristics of older adults, their care demands, or reflected in nurses’ approaches to care. Across jurisdictions work environment, education, experience, and demographics emerged as influences on nurses’ attitudes. Conclusion There is a paucity of research examining nurses’ attitudes towards older adult care. The limited evidence indicates that attitudes towards older people care are complex and contradictory. Influences on nurses’ attitudes need further study individually and collectively to build a strong evidence base. Interventional studies are needed as are the development of valid and reliable instruments for measuring nurses’ attitudes towards older adult care. Relevance to Clinical Practice Bolstering post-graduate gerontological preparation is critical for promoting nurses’ attitudes towards older adult care. Creating age-friendly work environments, including appropriate resource allocation, is important to support older people care and facilitate positive nursing attitudes. This article is protected by copyright. All rights reserved.

We carried out a scoping review to identify key priorities and challenges relevant to rural Indigenous palliative care stated in existing literature. Our scoping review activities followed Arskey and O'Malley's principles for conducting a scoping review. We included peer-reviewed literature from MEDLINE, CINAHL and EMBASE that included a discussion of Indigenous populations, palliative care, and rural settings, and did not use date limits. The literature search was conducted in April 2016, and the retrieved literature was screened for relevance and appropriateness April 2016-March of 2017. In addition to the academic literature, a scan of the grey literature was conducted in March 2017. The retrieved grey literature was screened for relevance and reviewed by a team from a provincial health authority serving Indigenous peoples to ensure relevance in a rural BC setting. Once reviewed for relevance and appropriateness, we added four reports to supplement our analysis. Ultimately, 44 peer-reviewed articles and 4 pieces of grey literature met our inclusion criteria and were included in the review. Our analysis revealed several challenges and priorities relevant to rural Indigenous palliative care. Key challenges included: (i) environmental and contextual issues; (ii) institutional barriers; and (iii) interpersonal dynamics challenging client/clinician interactions. Priorities included: (i) family connections throughout the dying process; (ii) building local capacity for palliative care to provide more relevant and culturally appropriate care; and (iii) flexibility and multi-sectoral partnerships to address the complexity of day-to-day needs for patients/families. These findings point to several areas for change and action that can improve the relevance, access and comprehensiveness of palliative care programming for rural Indigenous communities in Canada and elsewhere. Taking into account of the diversity and unique strengths of each Indigenous community will be vital in developing sustainable and meaningful change.

Background Membership in diverse racial, ethnic, and cultural groups is often associated with inequitable health and mental health outcomes for diverse populations. Yet, little is known about how cultural adaptations of standard services affect health and mental health outcomes for service recipients. This systematic review identified extant themes in the research regarding cultural adaptations across a broad range of health and mental health services and synthesized the most rigorous experimental research available to isolate and evaluate potential efficacy gains of cultural adaptations to service delivery. Methods MEDLINE, PsycINFO, CINAHL, EMBASE, and grey literature sources were searched for English-language studies published between January 1955 and January 2015. Cultural adaptations to any aspect of a service delivery were considered. Outcomes of interest included changes in service provider behavior or changes in the behavioral, medical, or self-reported experience of recipients. Results Thirty-one studies met the inclusion criteria. The most frequently tested adaptation occurred in preventive services and consisted of modifying the content of materials or services delivered. None of the included studies focused on making changes in the provider’s behavior. Many different populations were studied but most research was concerned with the experiences and outcomes of African Americans. Seventeen of the 31 retained studies observed at least one significant effect in favor of a culturally adapted service. However there were also findings that favored the control group or showed no difference. Researchers did not find consistent evidence supporting implementation of any specific type of adaptation nor increased efficacy with any particular cultural group. Conclusions Conceptual frameworks to classify cultural adaptations and their resultant health/mental health outcomes were developed and applied in a variety of ways. This review synthesizes the most rigorous research in the field and identifies implications for policy, practice, and research, including individualization, cost considerations, and patient or client satisfaction, among others. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1953-x) contains supplementary material, which is available to authorized users.

New graduate nurses are often targets of bullying and horizontal violence. The support offered by new graduate nurse transition programs may moderate the effects of bullying and limit its negative impact on new graduate nurse transition. This study examined the relationships between access to support, workplace bullying and new graduate nurse transition within the context of new graduate transition programs. As part of a mixed methods study, an online survey was administered to new graduates (N = 245) approximately a year from starting employment. Bullied new graduate nurses were less able to access support when needed and had poorer transition experiences than their non-bullied peers. Participation in a formal transition program improved access to support and transition for bullied new graduate nurses. People supports within transition programs positively influenced the new graduate nurse transition experience. Formal transition programs provide support that attenuates the impact of bullying on new graduate nurses and improves transition.

Objective The objective of this study was to explore the role librarians play on research teams. The experiences of a librarian and a faculty member are situated within the wider literature addressing collaborations between health science librarians and research faculty. Methods A case study approach is used to outline the involvement of a librarian on a team created to investigate the best practices for integrating nurses into the workplace during their first year of practice. Results Librarians contribute to research teams including expertise in the entire process of knowledge development and dissemination including the ability to navigate issues related to copyright and open access policies of funding agencies. Discussion The librarian reviews the various tasks performed as part of the research team ranging from the grant application, to working on the initial literature review as well as the subsequent manuscripts that emerged from the primary research. The motivations for joining the research team, including authorship and relationship building, are also discussed. Recommendations are also made in terms of how librarians could increase their participation on research teams. Conclusion The study shows that librarians can play a key role on interprofessional primary research teams.

In this paper, an overview of a strategy for automatic meter reading (AMR) data interpretation and aggregation is presented along with the proposed stochastic models adequate for representing the intrinsic characteristics of the data. Water demand measurements from single user accounts are obtained from an AMR system that continuously monitors consumption in different zones of Cincinnati, Ohio. The data represent volumetric measurements characterized by fixed increments, which depend on the sensitivity of the instruments used and occur at irregular times due to the polling method of the AMR system. Given the nature of the data, a nonhomogeneous Poisson process is proposed to model the arrivals of the increments within a selected time interval of 350 days. An exponential-polynomial-trigonometric rate function with multiple periodicities (EPTMP) is assumed to describe both trends and periodicities in the observed data. A specific methodology for estimating the parameters of the EPTMP rate function i...

Water distribution network models for large municipalities have tens of thousands of interconnecting pipes and junctions with complex hydraulic controls. Many water security applications, including sensor placement optimization, require detailed simulation of potential contamination incidents. The postsimulation optimization problem can easily exceed memory on standard desktop computers. Large networks can be skeletonized to reduce computation; however, this alters network hydraulics, and therefore sensor placement. The objective of this paper is to evaluate a two-tiered sensor placement approach that combines hydraulic and water quality simulations using all-pipes, or original, network models with subsequent geographic aggregation of time and impact values to reduce memory requirements. The two-tiered approach first places sensors on aggregated regions, then refines the solution to actual nodes in the original model. The two-tiered sensor placement approach is compared to results using the origin...

Intentional or accidental releases of contaminants into a water distribution system (WDS) have the potential to cause significant adverse health effects among individuals consuming water from the system. A flexible analysis framework is presented here for estimating the magnitude of such potential effects and is applied using network models for 12 actual WDSs of varying sizes. Upper bounds are developed for the magnitude of adverse effects of contamination events in WDSs and evaluated using results from the 12 systems. These bounds can be applied in cases in which little system-specific information is available. The combination of a detailed, network-specific approach and a bounding approach allows consequence assessments to be performed for systems for which varying amounts of information are available and addresses important needs of individual utilities as well as regional or national assessments. The approach used in the analysis framework allows contaminant injections at any or all network nodes and uses models that (1) account for contaminant transport in the systems, including contaminant decay, and (2) provide estimates of ingested contaminant doses for the exposed population. The approach can be easily modified as better transport or exposure models become available. The methods presented here provide the ability to quantify or bound potential adverse effects of contamination events for a wide variety of possible contaminants and WDSs, including systems without a network model.

When a water distribution system (WDS) is contaminated, short-term inhalation exposures to airborne contaminants could occur as the result of domestic water use. The most important domestic sources of such exposures are likely to be showering and the use of aerosol-producing humidifiers, i.e., ultrasonic and impeller (cool-mist) units. A framework is presented for assessing the potential effects of short-term, system-wide inhalation exposures that could result from such activities during a contamination event. This framework utilizes available statistical models for showering frequency and duration, available exposure models for showering and humidifier use, and experimental results on both aerosol generation and the volatilization of chemicals during showering. New models for the times when showering occurs are developed using time-use data for the United States. Given a lack of similar models for how humidifiers are used, or the information needed to develop them, an analysis of the sensitivity of results to assumptions concerning humidifier use is presented. The framework is applied using network models for three actual WDSs. Simple models are developed for estimating upper bounds on the potential effects of system-wide inhalation exposures associated with showering and humidifier use. From a system-wide, population perspective, showering could result in significant inhalation doses of volatile chemical contaminants, and humidifier use could result in significant inhalation doses of microbial contaminants during a contamination event. From a system-wide perspective, showering is unlikely to be associated with significant doses of microbial contaminants. Given the potential importance of humidifiers as a source of airborne contaminants during a contamination event, an improved understanding of the nature of humidifier use is warranted.

Information literacy is an important foundation for evidence-based nursing practice. Librarians, the experts in information literacy, are important collaborators in the process of teaching nursing students information literacy skills. In this article we describe a service learning project, offered in a third year nursing research course, designed to teach information literacy and to enhance students' appreciation of the role of evidence in nursing practice. Students worked in groups, and under the guidance of a nursing instructor and librarian, to answer a question posed by practice-based partners. Through the project students learned essential skills of refining a question, identifying systematic search strategies, gleaning essential information from a study and using a bibliographic management tool. Evaluation of the project indicated that although the project was challenging and labour intensive students felt they learned important skills for their future practice. Several recommendations for further enhancing the collaboration are made.

Properly designing contamination warning systems requires an understanding of potential public health impacts for a range of contaminated water systems and a wide range of contaminants. To address this need, we determined potential impacts for 12 actual systems serving populations ranging from ∼ 104 to over 106 persons by simulating contamination events for the systems. We found several consistent patterns in the estimated impacts (defined as the size of the population receiving an ingestion dose above a given level). Significant impacts, those similar to worst-case impacts, result from injections of contaminants at only a minority of nodes. For contaminants with high thresholds for adverse effects, significant exposures are concentrated near the injection location, and impacts are not sensitive to population served. However, for contaminants with low thresholds, significant exposures are present over a significant fraction of the system, and impacts are sensitive to population. When exposures are concent...

A contamination event in a water distribution system can result in adverse health impacts to individuals consuming contaminated water from the system. Assessing impacts to such consumers requires accounting for the timing of exposures of individuals to tap-water contaminants that have time-varying concentrations. Here we present a probabilistic model for the timing of ingestion of tap water that we developed for use in the U.S. Environmental Protection Agency’s Threat Ensemble Vulnerability Assessment and Sensor Placement Tool, which is designed to perform consequence assessments for contamination events in water distribution systems. We also present a statistical analysis of the timing of ingestion activity using data collected by the American Time Use Survey. The results of the analysis provide the basis for our model, which accounts for individual variability in ingestion timing and provides a series of potential ingestion times for tap water. It can be combined with a model for ingestion volume to per...

Drinking water systems are vulnerable to contamination by toxic substances, whether the contaminants are introduced intentionally during a terrorist attack, or unintentionally through accidental cross-connections or backflow incidents. In this paper, we discuss the particular characteristics of distribution systems that make a “systems modeling” approach useful and effective in assessing, preventing, and mitigating water security threats, and we outline the research needed to develop robust models for water security.