Northeastern Sites Research Articles

Comparison of soil organic matter dynamics at five temperate deciduous forests with physical fractionation and radiocarbon measurements

Forest soils represent a significant pool for carbon sequestration and storage, but the factors con- trolling soil carbon cycling are not well constrained. We compared soil carbon dynamics at five broadleaf forests in the Eastern US that vary in climate, soil type, and soil ecology: two sites at the University of Michigan Biological Station (MI-Coarse, sandy; MI-Fine, loamy); Bartlett Experimental Forest (NH-BF); Harvard Forest (MA-HF); and Baskett Wildlife Recreation and Educa- tion Area (MO-OZ). We quantified soil carbon stocks and measured bulk soil radiocarbon to at least 60 cm depth. We determined surface (0-15 cm) soil carbon distribution and turnover times in free light (unpro- tected), occluded light (intra-aggregate), and dense (mineral-associated) soil fractions. Total soil carbon stocks ranged from 55 ± 4t o 229± 42 Mg C ha -1 and were lowest at MI-Coarse and MO-OZ and highest at MI-Fine and NH-BF. Differences in climate only partly explained differences in soil organic matter 14 C and mean turnover times, which were 75-260 year for free-light fractions, 70-625 year for occluded-light fractions, and 90-480 year for dense fractions. Turn- over times were shortest at the warmest site, but longest at the northeastern sites (NH-BF and MA-HF), rather than the coldest sites (MI-Coarse and MI-Fine). Soil texture, mineralogy, drainage, and macrofaunal activity may be at least as important as climate in determining soil carbon dynamics in temperate broadleaf forests.

Psychometric properties of the Kansas City Cardiomyopathy Questionnaire (KCCQ)

The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a well-established instrument used to evaluate the health status of heart failure (HF) patients. There has been a lack of clarity about the best way to conceptualize the KCCQ. The purpose of this investigation of the KCCQ was to: (1) explore the factor structure with an exploratory factor analyses; (2) perform reliability and validity testing to determine the best factor solution for item groupings; and (3) determine the most meaningful components of health status captured by the KCCQ. A secondary analysis of data from 280 adults with stage-C HF enrolled from three US northeastern sites was conducted to test the KCCQ subscale structure. Criterion-related validity for the Self-efficacy subscale was tested with the Dutch Heart Failure Knowledge Scale and the Self-care of Heart Failure Index Self-care Confidence Scale. Overall, internal consistency reliability (Cronbach's alpha) for the KCCQ and subscales was 0.92, social interference (seven items, 0.90), physical limitation (four items, 0.84), symptoms (eight items, 0.86), independent care (two items, 0.80), and self-efficacy (two items, 0.63). Two items failed to correspond to a previously identified factor so the independent care subscale was added. Items intending to measure quality of life were loaded in the social interference subscale. We recommend eliminating the quality of life subscale and including those items in the social interference subscale, and eliminating the self-efficacy items and re-evaluating the items related to independent care.

Generalized regional spatial patterns of larval recruitment of invasive ascidians, mussels, and other organisms along the coast of Maine

Along the coast of Maine, recruitment of most invasive marine ascidians follows a generalized regional pattern, with higher recruitment rates at western sites. Using artificial collectors we found that Botryllus schlosseri, Botrylloides violaceus, Ciona intestinalis, Ascidiella aspersa and Styela clava were more abundant in the western (southwestern) sites than in the eastern (northeastern) sites. This general pattern also applies to a number of other recruiting species including native mussels, Mytilus spp., and the invasive crab, Carcinus maenas. While recruitment of many marine organisms can appear stochastic in space, there can be some consistent regional patterns. Higher recruitment in the western sites of Maine may be the result of greater oceanographic dispersal due to the westward flow of the Maine coastal current, higher seawater temperatures in the west, and more anthropogenic

Abstract 17808: Perceived Health Predicts Risk of Hospitalizations and Death in Adults with Heart Failure

Background: Hospitalization and death are common in adults with heart failure (HF). The purpose of this study is to determine whether overall perceived health can predict all-cause hospitalization or death in HF patients. Methods: A secondary analysis was conducted using data collected on 280 Stage C HF patients from three U.S. northeastern sites. Perceived health was measured at enrollment with the question, “In general would you say your health is, excellent, very good, good, fair, or poor?” Data on hospitalization and death were obtained from the medical record or US death records. We compared the rate of events among patients with poor or fair perceptions of health to those with good or excellent perceptions of health. A Cox proportional hazards model was used to examine the association between perceived health and event rates. Kaplan-Meier survival estimates were compared between groups. Results: The sample was older (mean=62 SD 12.5 years), 64.3% male, 76.4% NYHA class III/IV, 69% with systolic HF (ejection fraction 35.4% SD 17%), and 39% ischemic etiology. Few patients (13.2%) rated their health as being poor. During a 180-day follow-up period, 6 deaths and 91 hospitalizations occurred as first events. Among patients with events, 64.9% perceived their health as poor and 33.9% perceived their health as fair. Controlling for 8 confounders (site, age, race, gender, NYHA class, HF type, HF knowledge, Charlson Comorbidity Index), patients with poor perceived health had over double the rate of dying or being hospitalized (hazard ratio (HR): 2.5; 95% confidence interval (CI): 1.3 to 4.7; p=0.007). CONCLUSION: Perceived health is a powerful indicator of impending events. Asking HF patients how they perceive their health can be a simple and quick tool for prioritizing patients who are at highest risk of death and hospitalization.

Spatial and temporal patterns of occurrence of Lutzomyia sand fly species in an endemic area for cutaneous leishmaniasis in the Atlantic Forest region of northeast Brazil

Sand fly populations of different ecological niches in the Amaraji endemic American Cutaneous Leishmaniasis (ACL) focus of the Pernambuco Atlantic Forest region of northeastern Brazil were monitored spatiotemporally. Lutzomyia whitmani was dominant in all niches but occurred in smaller numbers in forested locations. L. whitmani was significantly less seasonal than the other species, being present throughout the year while other species were more abundant between February and April. These results suggest that L. whitmani may potentially be the principal vector of ACL in the region, even though the sand fly fauna was diverse: 88% were L.whitmani and 12% belonged to 11 other species. Two other species, L. complexa (1.3%) and L. migonei (0.8%), considered to be ACL vectors in other regions, were also present. This detailed picture of the sand fly population's abundance and spatiotemporal distribution provides a basis for future modeling studies of forecasting sand fly activity patterns and ACL occurrence.

Present-day testing of a paleoecological pattern: Is there really a latitudinal difference in leaf-feeding insect-damage diversity?

The fossil record suggests greater diversity of insect leaf feeding during warm climate intervals. Much published work in the paleobotanical literature has been based on the presumed validity of this pattern. However, the existence of this pattern in nature has never been tested from the present-day world. Here we ask, is it true that on average, in warmer climates, a leaf is being eaten in more ways? We compared forests at seven sites in northern Florida (30° N, MAT ca. 19.5 °C) to seven sites across the north-eastern USA (40–42° N, MAT 7–9 °C). Presence and absence of damage types were determined using a standard leaf damage guide; 93 damage types were found in the Florida samples and 80 in the north-eastern samples. In bulk floras, there was a consistent difference in damage diversity, on a per-leaf basis (as in the fossil studies), between Florida and north-eastern sites. Florida sites had a greater number of damage types. When northern and southern populations of individual tree species were compared, higher southern damage diversity was found in four species ( Acer rubrum, Acer saccharum, Fagus grandifolia, and Quercus coccinea), though with no difference with latitude in a fifth species ( Quercus alba). These results appear to validate that the trend seen in the fossil record is not a spurious effect of site differences. They also extend a pattern seen in deep time into the present day, adding greatly to its generality.

Spatial variability of climate and land‐use effects on lakes of the northern Great Plains

Evaluation of the effects of climate change and human activities on lakes requires improved understanding of how stressors interact and the degree to which individual sentinel lakes represent broad spatial patterns of ecosystem response to disturbance. We surveyed modern water chemistry (major ions, conductivity, salinity, lake volume) and sediments (algal pigments, stable isotopes) in 21 lakes that surround Humboldt Lake, Saskatchewan, site of a 2,000‐yr climate reconstruction, to quantify spatial synchrony (S, the mean among‐lake correlation coefficient) of prairie lake response to climate variability, land use, and their interactions. Whole‐lake mass balances of total dissolved substances constructed at each site revealed that evaporation of water controlled seasonal changes in salt content only in years with dry summers (2003), leading to widespread spatial coherence of ecosystems (S = 0.78). In contrast, variations in hydrologic inputs (precipitation, groundwater) and solute fluxes regulated salt balances of lakes during years with wet summers (2004, 2005) and substantially reduced lake synchrony (S = 0.13‐0.58). Furthermore, >25% of sites exhibited increased nitrogen influx (as d15N) and cyanobacterial production (as fossil pigments) between ca. 1920 and 2003, with particularly strong effects of land use recorded for northeastern sites, where evaporative forcing was greatest. Finally, principal component and canonical ordinations with redundancy analysis both explained ~50% of the variance in lake sensitivity to climate and land use and revealed that the effects of climate and land use interacted strongly, but that the unique effects of each factor remained identifiable in modern lake surveys.

Evaluation of the Moderate Resolution Imaging Spectroradiometer aerosol products at two Aerosol Robotic Network stations in China

Moderate Resolution Imaging Spectroradiometer (MODIS) aerosol products have been used to address aerosol climatic issues in many parts of the world, but their quality has yet to be determined over China. This paper presents a thorough evaluation of aerosol optical depth (AOD) data retrieved from MODIS collections 4 (C004) and 5 (C005) at two AERONET sites in northern and southeastern China. Established under the aegis of the East Asian Study of Tropospheric Aerosols: An International Regional Experiment (EAST‐AIRE) project, the two sites, Xianghe and Taihu, have distinct ecosystems and climate regimes, resulting in differences in retrieval performance. At the rural northeastern site (Xianghe), MODIS C004 retrievals generally overestimate AOD at 550 nm during clean days, with the largest errors occurring during winter. In the warm and humid regions of southeastern China (Taihu), MODIS C004 retrievals overestimate AOD throughout the year. The systematic error at Xianghe is primarily due to the fixed surface reflectance ratio, while as the error at Taihu is mainly caused by the choice of the single scattering albedo (SSA) for the fine model aerosols. Both problems are alleviated considerably in the C005. The comparisons between C005 retrievals and AERONET data show much higher correlation coefficient, lower offset and a slope closer to unity. Also, the variability of AOD retrieval among neighboring pixels is reduced by several factors. The strong overestimation problem at small AOD values was fixed by using dynamic reflectance ratios that vary with the vegetation index and scattering angle. However, significant uncertainties remain because of the use of highly simplified aerosol models.

Aerosol major ion record at Mount Washington

This study examined the seasonal cycles and regional‐scale meteorological controls on the chemical properties of bulk aerosols collected from 1999 to 2004 at Mount Washington, the highest peak in the northeastern United States. The concentrations of NH4+ and SO42− peaked during summer months. The pattern for aerosol NO3− was more complicated with relatively high median concentrations characterizing spring and summer months, but with major elevated events occurring during fall, winter, and spring. The seasonal relationship between NH4+ and SO42− indicated that during warmer months a mixture of (NH4)2SO4 and NH4HSO4 was present, while it was mainly the latter in winter. More acidity and higher concentrations of the major species were generally associated with winds from the southwest and west sectors. The highest (≥95th percentile) concentrations of SO42− and NH4+ were associated with air mass transport from major upwind source regions in the Midwest and along the eastern seaboard. The ionic composition and seasonal cycle observed at Mount Washington were similar to those measured at other northeastern sites, but the range and average concentrations were much lower. These differences were exaggerated during wintertime. Included in this paper are several Eulerian case studies of SO2 conversion to SO42− during transit from Whiteface Mountain, New York, to Mount Washington. The calculations suggest a gas‐phase SO2 oxidation rate of ∼1–2% per hour and demonstrate the possibility of using these two sites to investigate the chemical evolution of air masses as they move from Midwestern source regions to northern New England.

Unexpectedly low genetic divergences among populations of the threatened bog turtle (Glyptemys muhlenbergii)

We used mitochondrial DNA sequence comparisons to assess range-wide population structure and historical patterns of differentiation among populations of the bog turtle (Glyptemys muhlenbergii). This species is one of North America’s smallest and most endangered pond turtles, and is currently found in three largely disjunct groups of populations: in the southern U.S., in the northeast, and in the Finger Lakes and Lake Ontario Plains region of western and central New York State. All the New York sites and most of the northeastern sites were glaciated during the Pleistocene. We surveyed 2793 bases pairs of mitochondrial DNA spanning three genes (cytb, nd4, and d-loop) in 41 individuals from 21 populations throughout most of the bog turtle’s distribution. We found surprisingly low levels of divergence among populations, even in southern populations that have been hypothesized as refugia during times of climate change. Our data suggest populations of bog turtle’s suffered a bottleneck, followed by a rapid post-Pleistocene expansion into northern segments of the species’ range. We discuss historical changes in habitat availability and climate that may have influenced the historical deployment of lineages in this species, and possible life history traits and habitat dynamics that might also contribute to the overall low genetic diversity across its range.

A physically based model of the effects of forest roads on slope stability

Road networks in mountainous forest landscapes have the potential to increase the susceptibility to shallow landsliding by altering subsurface flow paths. In this paper a road interception/rerouting grid‐based model is developed and coupled with a hydrogeomechanical, threshold‐based model for slope instability. Model results allow quantification of the influence of roads on shallow landsliding hazard across a landscape and generation of hypotheses about the broader geomorphic effect of roads. The model is applied to three sites in northeastern Italy to study the influence of three different procedures for upslope drainage area computation on model results. The three procedures are a single‐flow direction procedure (D8), a multiple‐flow direction procedure (MF), and an algorithm based on proportioning flow between two downslope pixels (DINF). Model results are highly sensitive to upslope drainage area algorithm choice. It is shown that D8 and MF are unsuitable for road impact evaluation due to grid bias (D8) and excessive dispersion (MF). Model implementation with the DINF procedure results in a reasonable compromise between the artifacts that characterize the other two algorithms. Observed landslide patterns are broadly consistent with model estimates, a finding that underscores the utility of this simple approach for predicting the geomorphic effects of forest roads constructed on steep slopes. The approach used in this study may be useful for defining criteria for road design that reduce the effects of roads on geomorphic processes.

The emotional effects of cancer care on family members: A multidimensional analysis

Utilizing data collected from in-person interviews with cancer caregivers at a non-urban, southern site and an urban, northeastern site, the present study attempted to identify factors that account for multiple dimensions of caregiver subjective stress (i.e., emotional reactions to cancer care demands, such as feelings of exhaustion and fatigue, feelings of entrapment in care responsibilities, and loss of intimacy with the loved one suffering from cancer). Family caregivers of cancer patients were recruited from the Radiation Oncology, Outpatient, and Chemotherapy treatment centers at each site. The following inclusion criteria were applied: the participant must have indicated that she/he provided help to a loved one because of cancer and the participant must have considered themselves the person who provides the most help to the loved one suffering from cancer (i.e., primary caregiver). Following the screening procedure, the interviewer provided an informed consent form as well as necessary HIPAA documentation assuring the primary caregiver and patient of their rights as research participants and asked if they would be willing to participate in a 60–90 minute interview at a time and place of their convenience. These recruitment and interview procedures resulted in a cross-sectional sample of 129 cancer caregivers from the rural and 104 caregivers from the urban site, respectively. The protocol included three sections: 1) sociodemographic characteristics of caregivers and cancer patients (i.e., context of care), 2) primary objective stressors (i.e., care demands and cancer severity), caregiving resources (e.g., social support for the caregiver); and 4) primary subjective stressors (emotional distress experienced by the caregiver). All scales were averaged for the purposes of the analysis. A series of multiple regression equations was conducted, where the various indices of context of care, primary objective stress, and resources were regressed onto each dimension of primary subjective stress (i.e., role overload, role captivity, loss of intimate exchange). The final regression models accounted for a considerable amount of variance in role overload (R2 = .40), role captivity (R2 = .33) and loss of intimate exchange (R2 = .31). The most potent predictors of emotional distress in cancer caregiving were care demands, or care recipient behavior problems and activities of daily living care needs. Resources such as feelings of mastery over care responsibilities and socioemotional support from others appeared to alleviate feelings of distress on the part of cancer caregivers. The results emphasize the importance of informal family care provision in cancer, and how negative emotional outcomes can result due to these responsibilities. As opposed to cancer site or other variables (e.g., context of care), the most potent predictors of caregiver emotional distress appeared to lie in the behavioral and mood disruptions experienced by cancer patients, as well as any functional dependencies that occurred as a result of cancer. However, caregiving resources also played an important role in allaying negative emotional stressors; both intrapsychic (e.g., mastery) and external support (e.g., socioemotional support) were strongly and negatively related to feelings of exhaustion, emotional entrapment, or loss of intimacy. Overall, these results suggest the multifaceted nature of cancer caregiving stress, those factors that exacerbate emotional upheaval of caregivers, and how certain aspects of the cancer caregiving context can be bolstered to alleviate the negative ramifications of family cancer care. Overall, the findings have strong theoretical, clinical, and practice implications for the psycho-oncological literature

Spatial and Temporal Variations in Fluxes of Energy, Water Vapour and Carbon Dioxide During OASIS 1994 and 1995

This paper introduces the micrometeorological field campaigns known asOASIS (Observations At Several Interacting Scales) and then summarizesseveral companion studies that have used the OASIS dataset. Instrumentedtowers, aircraft and atmospheric sondes were used for measurements overthree paired sites (crops and pastures), approximately equi-spaced along an88-km transect in south-eastern New South Wales, Australia, during the australsprings of 1994 and 1995. Measurements included standard meteorologicaldata and the fluxes of solar and net radiation, sensible heat, water vapour andthe greenhouse gases CO2, N2O, CH4. Descriptions of the site, andthe spatial and temporal variations of climate fields and fluxes, are presented.There were strong contrasts in fluxes and surface conductances, evaporationratios and water use efficiencies between the 1994 drought year and the normalrainfall year of 1995. Despite greater incoming solar radiation in 1994 associatedwith less cloud cover, net radiation was lower than in 1995 because of greateroutgoing thermal radiation caused by higher surface temperatures. In 1994 dailysensible heat fluxes were about 50% higher and evaporation rates about half thosefor 1995. Rainfall in the three-month growing season prior to the field campaignswas the key determinant of leaf area index, surface conductances and the fluxes ofsensible and latent heat and CO2. Antecedent rainfall distribution also controlled variation in fluxes and surface properties along the transect within each year. There was a net loss of CO2 to the atmosphere at the drier central sites in 1994, and a net uptake at the wetter north-eastern sites. Both sites recorded uptake of CO2 in 1995, but values were lower at the central site than at the north–east site due to the strong rainfall gradient along the transect in the three months prior to each fieldcampaign. Differences in fluxes between crops and pastures at each site were smallerthan between sites.

Erratiques de dolomie au Cap Colombier, sur la haute Côte-Nord du Saint-Laurent estuarien

À environ 150 km au NE de Tadoussac, le cap Colombier apparaît comme le site le plus oriental connu de la dispersion des erratiques de dolomie sur la rive nord de l'estuaire maritime du Saint-Laurent. Une cinquantaine de cailloux de dolomie de diverses catégories ont, en effet, été observés sur le bas estran argileux du havre du Colombier. La taille des cailloux va de 7 à 320 cm (axe-a). Si le plus gros bloc pèse environ 20 tonnes, les autres sont beaucoup plus petits : les dix plus gros pesant entre 33 et 345 kg. Il y a environ 12 % de cailloux de dolomie cristalline de couleur rose et 20 % des cailloux sont striés. Un bloc de dolomie partiellement bréchique contenait des structures stromatolitiques. La source la plus vraisemblable demeure le bassin sédimentaire de Mistassini situé à environ 500 km au NO, ce qui implique, dans un premier temps, un transport glaciaire par un courant de glace à partir d'un dôme localisé au NO du lac Mistassini, puis, dans un deuxième temps, une mise en place par des icebergs dans la Mer de Goldthwait probablement issus de la langue glaciaire canalisée dans le Saguenay.

A dendroecological method to evaluate past caribou (Rangifer tarandus L.) activity

Records of population changes of caribou come from various sources (historical accounts, hunting and trading statistics, herd surveys) that are typically incomplete and discontinuous in time and space. Here we propose a new method for the evaluation of past caribou activity using tree-ring records from boreal and subarctic conifer stands. The age-frequency distributions of trampling scars produced by caribou hooves on surficial roots and low branches of erect and stunted conifers are used as an index of the passage of caribou through stands during the snow-free period. To verify if changes in the age structure of trampling scars correspond to changes in abundance of caribou movement, we analyzed factors influencing production and loss of scars at two lichen-woodland sites in northeastern Québec-Labrador (Canada). The detailed analysis of trampling scars in the first site indicates that the capacity of conifers to produce scars is maintained under a regime of repeated caribou traffic; scars were formed at new positions along the exposed roots and scars continued to be produced at a same position in a minimum time of one growing season, even after 15 years of caribou traffic. The influence of repeated caribou trampling on loss of scars was measured by comparing the age structure of scars of three vegetation groups (based on caribou trail network) with different intensities of use. The similarity of the age structures of the three groups showed that scar loss due to trampling was hardly detectable, which indicated that scar loss was low in comparison to the number of scars produced, even in the most used trails. Sampling of trampling scars during two successive years at the second site showed that the stability of the age structure of scars was not affected by moderate caribou traffic. Our results, therefore, indicate that most of the information deduced from the age structures of trampling scars comes from changes in caribou activity. The method opens the possibility of assessing caribou activity in time (several decades) and space over large areas of the boreal forest and the forest-tundra biomes.

Catches of <i>Ips duplicatus</i> and other non-target Coleoptera by <i>Ips typographus</i> pheromone trapping

Catches of non-target Coleoptera in Ips typographus pheromone traps baited with Ipslure® were analysed along a geographic gradient running from southwestem Finland to eastern Finland and Russian Karelia. Besides I. typographus, two other bark beetles, Pityogenes chalcographus and Ips duplicatus were caught in high numbers. I. duplicatus occuned on northeastern sites only, suggesting a more restricted distribution than previously known. High numbers of Thanasimus spp. beetles indicate that I. typographus pheromone is also an effective attractant for bark beetle predators. In addition, the originally North American ambrosia beetle Gnathotrichus materiarius, now widely spread in Europe was found for the first time in nature in Finland.

Isolation and distribution ofStreptomyces populations with heat-resistant collagenolytic activity from two protein-rich areas in Bulgarian soils

Two sites in Northeastern of Bulgaria were investigated as a source ofStreptomyces populations to screen for production of heat-resistant collagenase. The distribution and diversity of collagenolytic activity inStreptomyces populations from protein-rich residue were studied. Collagenolytic activity was found in 14% of the 350 tested strains. Poor collagenase producers generally dominated (70%). Highly active collagenase producers were rarely found (12%) and they were mainly fromAlbus andRoseus groups. The isolatedStreptomyces cultures developed a constitutive collagenase activity. Two promising, highly active, producers of heat-resistant collagenase were selected and identified asStreptomyces candidus 91 andS. cremeus 3. The investigatedStreptomyces collagenases were active over a broad range of temperature (40–80°C) and a narrow range of pH values (6.5–8.5), with optima at 40°C and pH 7.5.

Emergence of Pear Thrips (Thysanoptera: Thripidae) and its Relation to Foliar Damage

Adult emergence of pear thrips, Taeniothrips inconsequens (Uzel), from soil in forests predominating in sugar maple, Acer saccharum Marshall, was monitored, using 7.6- cm-diameter traps, at sites in north central, northeastern, central and southwestern Vermont from 1989 to 1991. The onset of emergence ranged from 2 April to 15 May, but generally occurred in mid-April in all regions. We measured the number of thrips in soil in September and how many emerged in the spring, and monitored the timing and rate of emergence to determine if damage could be predicted from these factors. Thrips density in the soil was not consistently correlated with damage, making it an unreliable predictive measure. A correlation between thrips damage and the timing or duration of emergence was also not detected. The number of thrips per emergence trap was positively correlated with damage in all study years, and from this correlation the predicted number of thrips per trap for moderate damage to occur was 18 in 1989, 13 in 1990 and 8 in 1991. Annual fluctuations in the threshold number of thrips required for damage could limit the use of thrips emergence data for predictive purposes.

A multisite study of client outcomes in assertive community treatment

This study examined outcomes of clients admitted to assertive community treatment programs simultaneously implemented at six sites in northeastern Indiana. A total of 212 clients at risk for psychiatric rehospitalization were assessed at baseline and at six-month intervals for 18 months after admission to assertive community treatment programs. Data on rehospitalization, quality of life, and level of functioning were compared using t tests. Progressive improvement was also examined by linear trend analysis. Frequency of psychiatric hospitalization was reduced by one-third and the number of inpatient days by 50 percent after admission to the program. Improvements were progressive, with continued reductions over the 18-month period. Progressive improvements also occurred in quality of life as measured by both client and staff ratings. Case managers rated clients as having improved family and social support, increased self-reliance and independence, and improved daily living skills. Clients reported significantly more legal problems, which may have been an artifact of increased monitoring during treatment. A key element of the programs' success was the position of clinical coordinator, important functions of which are described. Results of this study provide support for wide-scale dissemination of assertive community treatment as an effective form of community care for persons with serious mental illness.

Cottonwood Site-Index Growth Curves

Cottonwood Site-Index Growth Curves