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Human alteration of land cover (e.g., urban and agricultural land use) and shoreline hardening (e.g., bulkheading and rip rap revetment) are intensifying due to increasing human populations and sea level rise. Fishes and crustaceans that are ecologically and economically valuable to coastal systems may be affected by these changes, but direct links between these stressors and faunal populations have been elusive at large spatial scales. We examined nearshore abundance patterns of 15 common taxa across gradients of urban and agricultural land cover as well as wetland and hardened shoreline in tributary subestuaries of the Chesapeake Bay and Delaware Coastal Bays. We used a comprehensive landscape-scale study design that included 587 sites in 39 subestuaries. Our analyses indicate shoreline hardening has predominantly negative effects on estuarine fauna in water directly adjacent to the hardened shoreline and at the larger system-scale as cumulative hardened shoreline increased in the subestuary. In contrast, abundances of 12 of 15 species increased with the proportion of shoreline comprised of wetlands. Abundances of several species were also significantly related to watershed cropland cover, submerged aquatic vegetation, and total nitrogen, suggesting land-use-mediated effects on prey and refuge habitat. Specifically, abundances of four bottom-oriented species were negatively related to cropland cover, which is correlated with elevated nitrogen and reduced submerged and wetland vegetation in the receiving subestuary. These empirical relationships raise important considerations for conservation and management strategies in coastal environments.

Coastal shoreline hardening is intensifying due to human population growth and sea level rise. Prior studies have emphasized shoreline-hardening effects on faunal abundance and diversity; few have examined effects on faunal biomass and size structure or described effects specific to different functional groups. We evaluated the biomass and size structure of mobile fish and crustacean assemblages within two nearshore zones (waters extending 3 and 16 m from shore) adjacent to natural (native wetland; beach) and hardened (bulkhead; riprap) shorelines. Within 3 m from shore, the total fish/crustacean biomass was greatest at hardened shorelines, driven by greater water depth that facilitated access to planktivore (e.g., bay anchovy) and benthivore-piscivore (e.g., white perch) species. Small-bodied littoral-demersal species (e.g., Fundulus spp.) had greatest biomass at wetlands. By contrast, total biomass was comparable among shoreline types within 16 m from shore, suggesting the effect of shoreline hardening on fish biomass is largely within extreme nearshore areas immediately at the land/water interface. Shoreline type utilization was mediated by body size across all functional groups: small individuals (≤60 mm) were most abundant at wetlands and beaches, while large individuals (>100 mm) were most abundant at hardened shorelines. Taxonomic diversity analysis indicated natural shoreline types had more diverse assemblages, especially within 3 m from shore, although relationships with shoreline type were weak and sensitive to the inclusion/exclusion of crustaceans. Our study illustrates how shoreline hardening effects on fish/crustacean assemblages are mediated by functional group, body size, and distance from shore, with important applications for management.

CitationThis initiative required all facilitiesʼ EDs to achieve door to doctor time <30 minutes, ancillary turnaround time (TAT) <60 minutes, total length of stay (LOS) <150 minutes, left without being seen (LWBS) <1%, and Emergency Department Patient Experience of Care (ED-PEC) Top Box >70%. AHMC utilized prospective improvement process tools such as LEAN, monthly site visits, best practice and quality meetings, and social media reviews. AHMC implemented an internal centralized online data collection tool through all facilities and AHMC corporate with the ability to track Centers for Medicare and Medicaid Services (CMS) mandated metrics.Results: By the end of FY 2016, AHMC hospitals reduced their LOS from over 200 minutes to 180 minutes, LWBS rates decreased from 3-5% to less than 1%, door to doctor times decreased to an average of 31 minutes, and EDPEC satisfaction scores increased from 44% to 50%. Conclusion: AHMC's EDsʼ significant improvement demonstrated the strong potential of replicating their efforts on improving patient experience and quality measures to other departments and community hospitals.

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