Balancing multiple stakeholder objectives for floodplain reconnection and wetland restoration.

Floodplain reconnection and wetland restoration projects are increasingly implemented to enhance flood resiliency, and these nature-based solutions can also achieve co-benefits of nutrient storage and improved habitats. Considering the multiple and sometimes incompatible objectives of stakeholders for uses of riverside lands, a decision-support tool linked to a hydraulic model would enable planners to simulate floodplain restoration scenarios while also quantifying and assessing the trade-offs between the stakeholder objectives to arrive at optimal restoration designs. We illustrate a simple ranking approach using an n-dimensional objective function to represent key stakeholders engaged in restoration. We applied our approach in a watershed in central Vermont (USA) that has been identified by regional and state-level stakeholders as an important location to mitigate flooding damages but also to improve water quality - all within a context of increasing development pressures on riparian lands and limited financial resources to accomplish restoration. Eleven different floodplain reconnection and wetland restoration modifications were combined in six scenarios and simulated with 2D Hydrologic Engineering Center's River Analysis System (2D HEC-RAS), along with a baseline (no-action) scenario. Only modest attenuation of peak flows for 2-, 25-, 50- and 100-year design storms was achieved by the floodplain restoration scenarios due to the steep setting, and flashy nature of the watershed. Yet, several scenarios of floodplain reconnection projects more than met the necessary annual phosphorus load reductions targeted under a Total Maximum Daily Load implementation plan. Our approach provided planners with a ranking of restoration scenarios that best met multiple stakeholder objectives and allowed effectiveness of alternate design scenarios to be quantified, justified, and visualized to promote consensus decision-making.

Septic bursitis of the foot: diagnosis, management and end-result.

Septic bursitis of the foot is a disorder infrequently reported in the medical literature. This infrequent reporting may represent a true low incidence of occurrence or may be a reflection of failure to recognize and diagnose this condition. This paper retrospectively reviews the presentation, clinical course, and outcome of patients presenting with septic bursitis of the foot. The authors have reviewed those features of this disorder that may aid the clinician in diagnosis and management of this infrequent, but disabling entity. They describe a brief case history of 10 patients with septic bursitis of the foot, provide radiographic and microbacterial evaluation, and give an outcome determination. They make recommendations for diagnosis and treatment based upon this review of patients and review of the literature.