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Background Controversy exists regarding the optimal negative margin width for ductal carcinoma in situ (DCIS) treated with breast-conserving surgery and whole-breast irradiation (WBRT). Methods A multidisciplinary consensus panel used a meta-analysis of margin width and ipsilateral breast tumor recurrence (IBTR) from a systematic review of 20 studies including 7883 patients and other published literature as the evidence base for consensus. Results Negative margins halve the risk of IBTR compared with positive margins defined as ink on DCIS. A 2 mm margin minimizes the risk of IBTR compared with smaller negative margins. More widely clear margins do not significantly decrease IBTR compared with 2 mm margins. Negative margins less than 2 mm alone are not an indication for mastectomy, and factors known to impact rates of IBTR should be considered in determining the need for re-excision. Conclusion The use of a 2 mm margin as the standard for an adequate margin in DCIS treated with WBRT is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcome, and decrease health care costs. Clinical judgment should be used in determining the need for further surgery in patients with negative margins < 2 mm.

This article contains specific planning, partnering, and performing techniques for fully integrating dancers with special needs into a dance pedagogy program. Each aspect is discussed within the context of the domains of learning. Fundamental partnering strategies are related to each domain as part of the integration process. The authors recommend performing in multiple venues as a way of fully integrating dancers with disabilities into the dance culture and meeting individualized education goals and objectives related to normalization and socialization, intellectual and emotional growth, and skill development. The article also includes a detailed lesson plan and a rubric that serves as a guide for dancers as they learn to dance with partners who have disabilities. (Contains 2 tables.)

Purpose: This study investigates how linkages between a central office and its schools served as administrative controls while fostering professional accountability and organizational learning. Method: Using qualitative data sources (interviews, focus groups, observations, field notes, and document reviews), the study examines how resource, structural, communication, relational, and ideological linkages interacted in response to three reform efforts as perceived by 45 school leadership team members, 5 principals, and 10 central office leaders. Findings: Attending to relational linkages was central to initiating reform. Introducing external resources served to link central office leaders and schools enhancing relational and communication linkages but also increased controls. Initially, teachers viewed many of the structural linkages as constraining their ability to provide good instruction, and there was a lack of ideological agreement on instructional approaches. Central office leaders, principals, and school leadership teams recognized the important role that teams, with professional development, could play in supporting the district's efforts to improve teaching and learning. Conclusions: A major contribution of this research is that it begins to clarify how linkages need to be coordinated and which ones may need to be in place for reform success. Relational and ideological linkages are essential for enhancing commitment and professional accountability and for ensuring a coherent instructional focus and organizational learning. In contrast, the structural linkage was the primary vehicle used by the district to exert control, complete organizational tasks, and enforce desired changes. The communication and resource linkages can be seen as boundary spanners between these two theories of organizational change. (Contains 1 figure, 4 tables and 2 notes.)

School and district effectiveness studies show that high levels of student achievement are possible when schools and the district act as coordinated units of change. There is also a growing recognition that principals cannot lead alone and that school leadership teams (SLTs) are essential to the improvement process. Limited studies have explored the mental models of central office, principals, and teachers who are members of SLTs. We hypothesize that when SLTs and the central office engage collaboratively in professional development about the tasks of leadership, shared mental models are more likely to develop. A case study methodology is used and multiple sources of data are analyzed through two theoretical lenses: tasks of leadership and mental models. Findings indicate a growing congruence between the district and SLTs' mental models regarding the tasks of leadership. This study is significant in showing that with professional development, SLTs could serve as an important bridge between the central office and the schools in ways that can enhance coordination, depth, spread, and commitment to district reforms. (Contains 1 table.)

Describes various organizational structures and models, presents matrix management as an alternative to traditional hierarchical structures, and suggests matrix management as an appropriate organizational alternative for academic libraries. Benefits that are discussed include increased flexibility, a higher level of professional independence, and more balanced decision-making processes. (66 references) (LRW)

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1467-9566.2009.01216.x Byline: Alisa K. Lincoln (1), Andrew White (2), Casandra Aldsworth (3), Peggy Johnson (4), Lee Strunin (3) Keywords: psychiatric emergency room; observations; mental healthcare Abstract: Abstract Staff in the psychiatric emergency room (PER) have demanding jobs requiring a complex balance between the needs and safety of the individual and the community, systemic resources, and job responsibilities while providing timely, effective care. Little research exists concerning day-to-day work activities of PER staff, their interaction, and their perceptions of their work. This study explored the work of PER staff and the organisational context of the PER work setting. Observations of staff were conducted in the public spaces of a public urban PER using two observational techniques. The first was designed to measure the types of work activities staff engaged in and the time spent in these work activities (work task data). The second technique was the gathering of observational data by a peripheral-member-researcher (participant observation data). Analyses were conducted of both the work task and participant observation data. Results indicate that most PER staff time is spent in administrative and phone tasks, while less than a third is spent on direct clinical work. Four important issues for PER work were identified: a workload that is unmanageable, managing the unmanageable, bogus referrals and dumping and insurance problems. The PER remains the front-line of the medical and social service systems. Work done in these settings is of critical importance; however little attention is paid to the content and nature of the work. Our study demonstrates that staff of the PER face challenges on many levels as they struggle with the task of working with people presenting in psychiatric and social crisis. Author Affiliation: (1)Health Sciences and Sociology, Northeastern University, Boston, USA (2)Portland DBT, Portland, Oregon, USA (3)Social and Behavioral Sciences Department, Boston University, USA (4)Division of Psychiatry, Boston Medical Center, USA Article note: Address for correspondence: Alisa K. Lincoln, Health Sciences and Sociology, Northeastern University, 316 Robinson Hall, Boston, MA 02115, USA, e-mail: Al.Lincoln@neu.edu

Great thicknesses of eolian dune deposits of early Oligocene age crop out in the Chuska Mountains of northwestern New Mexico-Arizona (as much as 535 m thick) and in the Mogollon-Datil volcanic field of western New Mexico-Arizona (as much as 300 m thick). [sup.40]Ar/[sup.39]Ar ages of intercalated volcanic rocks indicate eolian deposition in these areas was approximately synchronous, with eolian accumulation beginning regionally at ca. 33.5 Ma and ending at ca. 27 Ma. Probable eolian sandstone of Oligocene age 483 m thick is also present in the subsurface of the Albuquerque Basin of the Rio Grande rift. The beginning of eolian deposition on the Colorado Plateau corresponds closely to the beginning of eolian (loessic) deposition in the White River Group of the Great Plains and major Oi-1 glaciation in Antarctica, suggesting possible global paleoclimatic control. Successions of Oligocene eolian sandstone on the Colorado Plateau are thicker than all of the better known Upper Paleozoic-Mesozoic eolianites in the region, except the Jurassic Navajo Sandstone. We suggest that the widely separated Oligocene eolianites in the Colorado Plateau region were probably originally continuous, and thus are erosional remnants of an extensive (~140,000 [km.sup.2]), regional sand sea (the Chuska erg). This interpretation is based on: (1) comparison with thickness trends of older eolianites in the Colorado Plateau region, (2) evaluation of regional topographic gradients of modern ergs, and (3) hydrologic modeling of a 300- to 400-m-thick zone of saturation that existed during eolian deposition in the Chuska Mountains. The Chuska erg represents the final episode of Paleogene aggradation on the central and southern Colorado Plateau. Aggradation was driven primarily by trapping of fluvial sediments on the plateau by development of major volcanic fields along the eastern plateau margin. These volcanic fields blocked earlier Laramide drainages that had previously transported sediments eastward off the plateau. Following a shift to widespread eolian deposition at ca. 33.5 Ma, constructional volcanic topography induced eolian accumulation upwind of developing volcanic fields. Stratal accumulation rates (not decompacted) of eolian deposits were ~28-82 m/m.y. The reconstructed top of the Chuska erg would lie at a present-day elevation of ~3000 m or more, and provides a datum for assessing subsequent erosion on the Colorado Plateau. Major exhumation ([greater than or equal to] 1230 m) occurred during the late Oligocene and early Miocene, following the end of Chuska deposition and prior to the onset of Bidahochi Formation deposition at ca. 16 Ma on the south-central part of the plateau. The Bidahochi Formation attained a thickness of ~250 m by ca. 6 Ma, followed by ~520 m of late Miocene and younger erosion in the valley of the Little Colorado River. The depth of late Oligocene-early Miocene (ca. 26-16 Ma) exhumation of the central and southern Colorado Plateau thus was more than twice that of the late Miocene-Holocene (ca. 6-0 Ma). The timing of initial deep erosion in the Colorado Plateau-Southern Rocky Mountains region suggests the beginning of major epeirogenic rock uplift occurred during post-Laramide magmatism. Keywords: eolian, erg, paleoclimate, Colorado Plateau, Oligocene, epeirogeny, exhumation.

A low-risk, stream restoration design includes methods that validate design assumptions, incorporate uncertainty in the decision-making process during the project design phase, and reduce uncertainty by checking the final design. A two-step method of incorporating uncertainty and risk in stream restoration design has been developed as a combination of design failure modes and effects analysis (DFMEA) and risk quantification. As a first step, DFMEA is applied to identify risk in terms of ratings with respect to consequence of failure, the likelihood of occurrence of a failure, and the ability to detect a failure. Due to its evolutionary nature, the DFMEA can be revised to account for design modifications and relative ratings are reevaluated to examine reductions in uncertainty, and thereby, risk. The second step of the method is quantifying risk using initial and expected failure costs. The two-step, risk-based method is illustrated through application to a stream relocation project in Pennsylvania. Both sediment transport capacity and supply analysis and alluvial channel modeling design methods were shown to reduce uncertainty and risk by detecting design deficiencies that the initial design using incipient motion tests overlooked. However, the alluvial channel model method was favored due to its ability to simulate the combined effects of flow hydraulics, sediment transport, and river channel adjustment. DOI: 10.1061/(ASCE)0733-9429(2007)133:5(468) CE Database subject headings: Risk management: Stream improvement; Sediment transport: Shear stress; Rock structures; Stabilization; Case reports; Stream channels.

Bridge engineers are often faced with the task of selecting and designing effective bridge scour countermeasures. The selection of an appropriate countermeasure is dependent on whether the problem is local scour at the pier or abutment, contraction scour across the bed at the bridge opening, reach-wide channel degradation, or lateral channel movement. Confidence in a given countermeasure depends on prior experience in using the measure, cost, maintenance, and the ability to detect failure. The use of countermeasures often introduces uncertainty due to a lack of systematic testing and unknown potential for failure. In this paper, a risk-based method for ranking, comparing, and choosing the most appropriate scour countermeasures is presented using failure modes and effects analysis and risk priority numbers (RPN). Failure modes and effects analysis incorporates uncertainty in the selection process by considering risk in terms of the likelihood of a component failure, the consequence of failure, and the level of difficulty required to detect failure. Risk priority numbers can provide justification for selecting a specific countermeasure and the appropriate compensating actions to be taken to prevent failure of the countermeasure. CE Database subject headings: Risks; Scour; Bridges.

Although culverts have traditionally been an economical means of conveying stream flow at a road crossing, they can hinder fish and wildlife passage in the channel and on the floodplain and can create or augment localized channel instabilities. A possible solution to these problems is to use a multiple-cell arrangement, in which one or more culverts placed in the channel convey all flows up to the dominant discharge and one or more culverts positioned in the floodplain convey overbank flows up to the design discharge. This arrangement results in a reduction of flow concentration through the culvert and a properly functioning floodplain, thereby improving fish and wildlife passage and reducing erosional problems. For this system to function properly, a well-established and active floodplain is required; the multicell system will not perform adequately in an incised channel. In this paper, a method to determine appropriate physical environments for multicell culvert systems, based on stream-channel stability and stage-of-channel evolution, is presented.

The ability to assess channel stability of gravel bed rivers in the vicinity of structures such as bridges, culverts, and roadways is necessary for bridge inspection, design, and the mitigation and prediction of erosion at those structures. Given the time constraints for bridge inspections and the expense of conducting lengthy geomorphic studies, it is desirable to have a technique for rapid assessment. Although several methods are currently available for the rapid and qualitative assessment of stability, these methods are often vague or apply only to a specific region. In this paper, we review existing methods and parameters for assessing channel stability and develop a systematic rapid channel stability assessment method based on various aspects of the existing methods. The rapid assessment method provided here is based on 13 qualitative and quantitative indicators of morphologic processes. The indicators are rated, weighted, and summed to produce a stability rating for gravel bed channels. The method is demonstrated through application to several streams in Pennsylvania and Maryland.

Hydraulic Engineering, a junior/senior-level course, is typically taught in a lecture-based format. Lecturing as a singular teaching technique has repeatedly been shown to be ineffective. Lecturing does not advance problem-solving skills, does not require creative or critical thinking, and does not prepare students for the types of problems they will face as professional engineers. In this study, two teaching techniques, problem-based learning (PBL) and cooperative learning (CL), were used to enhance learning in the hydraulic engineering course. The goals of PBL are to provide the student with an active role in learning and to allow the student to take responsibility for learning. The goals of CL are to have students work in teams, thereby learning from both each other and the instructor, and to teach students to work together cooperatively in small groups. Methods of developing teams, projects, and other assignments were explored. The course was assessed midterm and at the end of the semester. As a result, some changes were made midsemester and other recommendations are made for the future.

Scour at bridges is generally estimated as a deterministic value. Other loads at bridges, such as vessel impact and wind loads, are determined as probabilistic values. In an effort to use probabilistic estimates as a tool in decision making, a probabilistic framework was developed for estimating scour using deterministic methods given in the Hydraulic Engineering Circular (HEC-18). Uncertainties in the HEC-18 model, in determination of the parameters and in estimating the hydraulic variables for a large event storm, were included in the analysis. The probabilistic framework can then be used as the basis for determining the likelihood of achieving various scour depths, probabilities of failure for various foundation designs, pile depths necessary to achieve a specified probability of failure for a design bridge life span, and for comparing designs based on various storm events. The Bonner Bridge in North Carolina is used as an example. Pile depths appropriate for various design life spans are calculated based on both 100- and 500-year storm events.