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Infant Home Apnea Monitoring: A Quality Improvement Project for Provider Training of Practice RecommendationsThe use of home apnea monitoring for infants is a technology that has been utilized for over 40 years. Home apnea monitoring is currently prescribed for infants considered high risk following discharge from the hospital. Management of these monitors is within the scope of practice for pediatric providers in the primary care setting. Confusion has existed among pediatric outpatient providers about medical management of the monitors and when they should be discontinued. This project reviewed the evidence related to home apnea monitoring and sought to share current evidence with local pediatric primary care providers. Prior to presenting current evidence to a wider audience, a summary of the content was reviewed by local clinical experts. This content summary was placed into a digital (PowerPoint) recorded presentation. It was then distributed to the five local clinical experts for their review. These clinical experts were selected because they had extensive experience and knowledge in neonatology as well as a pediatric cardiology, and serve as resources for primary care providers These experts completed a survey before the educational brief, as well as after, measuring the usefulness of the information. Three of the five experts viewed the curriculum and responded. In the post-survey, all three responses indicated that this educational curriculum improved their knowledge of home apnea monitoring, indicating further education would be helpful. After the content was requested, a follow-up presentation with a more in-depth review of the literature was created and given to an audience of pediatric primary care providers at the American Academy of Pediatrics, Alaska Chapter, Grand Rounds. The same surveys were also given to the pediatricians to complete, with data obtained from the providers lending more support to the benefit of this education.
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SBIRT Screening in Primary Care of Women of Reproductive Age to Aid in the Identification of Alcohol Use Patterns Focusing On Prevention of Fetal Alcohol ExposureThe over consumption of alcohol can directly correlate with negative effects on health and quality of life. When vulnerable subjects such as pregnant women and subsequently the fetus is alcohol exposed lifelong detrimental consequences can ensue such as Fetal Alcohol Spectrum Disorder (Jones, Smith, Ulleland, & Streissguth, 1973). Although most women reduce their alcohol intake during pregnancy, 45% of pregnancies in the United States are unplanned (Finer & Zolna, 2016). The combination of social patterns of alcohol use in women of childbearing age and the prevalence of unintended pregnancy set the stage for an alcohol exposed fetus. Late recognition of an unintended pregnancy exposed a fetus to levels of alcohol capable of teratogenic effects (Balachova et al., 2015). Research asserts that prevention of alcohol-exposed pregnancies should begin before conception by identifying unhealthy drinking patterns among women of reproductive age. Alcohol screening and brief interventions in medical settings can significantly reduce alcohol use and potentially decrease the prevalence of a 100 % preventable condition such as FASD.
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An Integrative Review: Assessing Family Practice Providers Level of Confidence in Assessing, Managing, and Treating Suicidal AdultsSuicide is the fifth leading cause of death in Alaska and continues to be a public health crisis that is disproportionate to the population. Primary care providers (PCP) are at the front line of suicide prevention, which includes assessment, management, and treatment of severely depressed patients. The literature supports that PCPs as having the most frequent contact with those at risk for suicide in comparison to other types of health care providers. This reinforces the necessity of PCPs to be confident in their suicide assessment, management, and treatment skills. An appraisal of current evidence revealed that when suicide intervention education is inadequate or absent providers demonstrate a decreased level of confidence in their ability. The purpose of this integrative review was to assess PCPs confidence levels associated with suicide prevention. An extensive literature review concluded that there is a direct link between suicide education and training, and PCP confidence level. The results of the review also identified that with increased education and training, PCP can confidently assess, manage, and treat suicide. This integrative review highlighted the need for practice change by providing PCPs the necessary skills to treat and prevent suicide
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Primary Care Provider Time Limited Interventions for Obesity an Integrative ReviewObesity and excess weight are significant health problems in the United States, affecting the majority of United States citizens. The prevalence of obesity is already a large burden on individuals and society, but the steady growth is an ominous warning of what’s to come. If not addressed, the various complications of obesity are multiple and significant with often both immediate and lifelong sequelae. With an already taxed healthcare system the additional costs of obesity related healthcare are further depleting resources. Primary care providers have the best opportunity to influence this population and are thus on the front lines of this grave problem. Studies have shown that when providers counsel patients in weight and lifestyle, it can make a positive difference. The aim of this study is to identify the most effective methods and brief interventions that can be implemented in the primary care setting to achieve weight loss success. A literature search was performed in order to create an integrative review, and the results showed several consistencies. Importantly these recommendations can help achieve clinically significant weight loss from accessing primary care, if these services are reimbursed.
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An Integrative Review: Routine Screening for Adverse Childhood Experiences of Adults in Primary Care SettingsAdverse childhood experiences (ACEs) are traumatic events occurring in children prior to the age of 18 years. They include physical abuse, emotional abuse, neglect, and household dysfunction. ACEs have been associated with an increased risk of health-risk behaviors, leading to increased risk of chronic diseases and disability in adulthood. ACEs screening is not currently part of routine health assessment of adults in primary care settings. An integrative review of the current evidence supports that primary care providers believe their role is to screen adults for childhood traumas. Unfortunately, primary care providers lack confidence, education, time, and knowledge of the ACE survey tool in practice. Dissemination of evidence-based ACE education and screening tools to future health care providers and practicing providers is essential to prevent the devastating effects of adverse childhood experiences and promote healthy persons, families, and communities
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Improving Outcomes: Diabetes Management in Alaskan Primary Care, An Integrative ReviewDiabetes is a chronic, debilitating disease with a rising incidence in the United States. It is a major cause of complications such as renal failure, heart disease, stroke, lower extremity amputations, as well as blindness. The purpose of this integrative review was to discover what strategies are evidence-based and practical for effective diabetes self-management in the primary care setting. There is a plethora of published evidence that proves Diabetes Self-Management Education (DSME) is effective for the management of diabetes and prevention of complications. A review of the most current evidence revealed there is no standardized system that allows delivery of DSME from a primary care standpoint. The dissemination of a delivery system that is both feasible and cost-effective within primary care could be revolutionary to the prevention of diabetes in Alaska. Development of a DSME program for primary care could promote improvement in patient self-management of this complex chronic disease. Improving DSME would also help ameliorate serious complications with resultant decrease in costs associated with uncontrolled diabetes on Alaska’s health care system. The possibility of creating healthier lives, healthier communities, and a healthier planet is in the grasp of today’s clinicians.
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Screening and Referral in Those With Severe Mental Illness; The Role of the Psychiatric Mental Health Nurse PractitionerPersons suffering from severe mental illness (SMI) have a life expectancy that is 28 years less than the general population (Suetani, Whiteford, & McGrath, 2015). The high mortality rates seen in those with SMI are caused by preventable diseases. Cardiovascular disease (CVD), Chronic Obstructive Pulmonary Disorder (COPD), and cancers are the three most prevalent causes of death in this vulnerable population (Suetani et al., 2015). The purpose of this quality improvement project was to develop an evidence based clinical tool that would provide Psychiatric Mental Health Nurse Practitioners (PMHNP) with a somatic screening tool that could be used in behavioral health. The most recent guidelines established by the U.S. Preventive Services Task Force (USPSTF) (2014), provided the foundation for the somatic screening tool. The tool addressed cardiovascular disease, COPD, diabetes, and oral hygiene. The somatic screening tool was distributed to 51 PMHNPs’ practicing in the state of Alaska. Survey Monkey was used to deliver a post-implementation survey that evaluated the usefulness of the screening tool. Fifteen PMHNPs’ responded and evaluated the tool. Of the respondents, 86% (13 of 15) indicated that the screening tool would be useful in their practice when assessing the physical health of those with SMI; particularly when screening for CVD, COPD, and diabetes.
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Screening for Traumatic Brain Injury During Mental Health EvaluationsTraumatic brain injuries (TBIs) are a major cause of mortality and long-term functional impairment (Gould, Ponsford, Johnston, & Schonberger, 2011; Whelan-Goodinson, Ponsford, Johnston, & Grant, 2009) and are associated with new-onset or worsening of many psychiatric disorders (Gould et al., 2011; Juengst, Whyte, & Skidmore, 2014; Masel & DeWitt, 2010; Whelan-Goodinson et al., 2009) including depression, anxiety, and post-traumatic stress (PTSD). Affected patients may also experience personality changes and problems with aggressive behavior, which can negatively influence personal relationships, ability to work and overall quality of life. This screening can help identify a past TBI, which may influence current mental health status and level of psychosocial function as well as leading to more patient referrals for further evaluation such as neuropsychological testing. Current psychiatric mental health nurse practitioner (PMHNP) and other mental health provider TBI screening practices during mental health evaluations are widely varied with many screening questions being limited only to asking about history of concussions, loss of consciousness or motor vehicle accidents resulting in head injury. This information though important may be insufficient in determining TBI history and symptoms. This project used a pretest posttest design and an educational webinar to provide an overview of TBI and to introduce a brief brain injury screening tool which could be used by providers during mental health evaluations. Overall the educational offering was positively received with the all participants (n = 11, 100%) reporting improved knowledge of TBI and intent to use the screening tool in clinical practice.
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Barriers to Screening Adverse Childhood Experience and Suicide Risk in Adults: An Integrative ReviewAdverse childhood experiences (ACE) can have significant emotional and behavioral consequences long after the events occurred. This integrative review answered the clinical question: What are the barriers to routinely screening adults for ACEs to identify those at higher risk of suicide?” Search criteria were applied using several databases to find a body of relevant sources, that were critically appraised. Data were analyzed by ordering, categorizing, and summarizing. Levels of evidence ranged from I through V. Primary care providers reported several barriers to screening for ACEs, to include lack of time, competing primary practice recommendations, lack of confidence in ACE screening skills, lack of education, provider’s discomfort with asking patients about ACE, lack of knowledge of male and of female ACE prevalence, and providers’ negative attitude towards screening ACEs.
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The Effect of Restricted Parental Movement During the COVID-19 Pandemic on the Utilization of Pasteurized Donor Breastmilk in the NICU: A Quality Improvement ProjectThe COVID-19 pandemic presented as a major health crisis that caused shutdowns and restricted access to healthcare facilities globally. Not only did this have an immeasurable impact on adult critical care units, but also on neonatal intensive care units (NICUs). One impact of COVID-19 was restricted access and movement to Providence Alaska Medical Center’s (PAMC’s) NICU, affecting both families and designated caregivers. This movement restriction caused families to choose whether to stay at the bedside or leave the NICU without the ability to re-enter for an undefined or restricted period of time. The purpose of this retrospective chart review was to evaluate how restricted access affected donor breast milk (DBM) usage in the NICU for infants <35 weeks according to their respective feeding protocols. DBM was used as a surrogate marker for mothers own milk (MOM) as this is routinely supplemented when MOM is unavailable. Yearly averages of DBM (in mLs) per infant in their respective feeding protocol from 2019-2020 were collected and sorted according to episode (monthly for 2019 data versus monthly or restricted access period for 2020). A survey was provided to NICU staff to obtain qualitative data on barriers and facilitators to MOM during COVID-19. An ANOVA test was planned to interpret results for average DBM usage per infant in their respective feeding protocol and descriptive statistics and trends in the qualitative data were reported from the NICU staff survey. Incomplete data collection occurred due to unforeseeable issues with the electronic healthcare record (EHR) report. The staff survey provided a small sample size of data (n = 10) for perceived barriers to utilizing MOM (restricted access, stress, and childcare concerns) and facilitators (more time in the NICU and more access to lactation) during COVID-19. Considering the inability to interpret average DBM mLs per infant accurately, this study demonstrates a need for a more consistent and accurate EHR report to carry out the methods for this study. Overall, this study provides strong methodology to conduct and analyze DBM as a surrogate marker for MOM during the COVID-19 pandemic for future studies at PAMC or other NICUs.
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Application of Marginal Analysis Using a Decision Tree to Produce an Architectural MagazineDecision tree analysis is typically used to provide quantitative cost benefit analysis of uncertainty associated with options to achieve project objectives. A project to apply marginal analysis using a decision tree to produce an architectural magazine was undertaken to test the value of using this approach for what-if analysis applied to critical risk, quality, schedule, and cost management decisions in that application. Project research included survey to understand stakeholder preferences for content, quality, and distribution of an architectural magazine. Additionally, literature reviews, project observations and interviews with subject matter experts provided insights into the use of decision tree analysis for this application. Marginal analysis using a decision tree was used for key decisions in the planning, printing, and content preparation phases of the magazine project to determine the cost benefit of different options. Key deliverables produced by the project were a decision tree template, risk register for marginal analysis and well documented lessons learned for the planning and content preparation phases of the magazine production. Outcomes can be applied to follow on phases of the magazine production including marketing, publishing, and distribution optimizing decisions.
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Contract Administration Process Improvements Developed and Applied to a USDA Forest Service, Chugach National Forest, Cordova Ranger District Hazmat Storage Facility ReplacementContract administration is a critical work component for United States federal government agencies. It ensures that contractors perform according to the contract requirements and deliver the scope of work as defined. Successful administration of a contract between the federal agency (project owner) and the contractor conducting the work is essential to deliver positive outcomes, reduce risk, and maintain a productive and collaborative workflow involving multiple people with different roles. Both new and experienced staff may have limited or inconsistent understanding of contract administration and how to initiate and manage this important process. Detailed and holistic representation of process workflows provides clarity, captures valuable information, supports effective decision making, and identifies continuous improvement opportunities. A companion guide adds supporting detail to ensure consistent understanding. Existing contract administration documents, literature review, and stakeholders’ experiences for the Engineering Department of the United States Department of Agriculture Forest Service-Chugach National Forest-Cordova Ranger District were evaluated. Research identified opportunities to refine clarity, comprehensiveness, accuracy, and consistent use of the contract administration process for this agency. Based on research conducted, this project developed an instructional guide and process workflow chart to improve the contract administration process for new and experienced project staff using a hazardous materials storage facility replacement project in Cordova, Alaska as a reference example.
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Opening a Wedding Planning Company in AlaskaWedding planning is often stressful and costly. This project created a business plan for a company that emphasizes tailored, cost-effective wedding planning services based on analyzing local wedding planning needs, possible services to offer, and existing competition. Three online research methods and tools were used to collect and analyze data. Literature research findings analyzed local competitors' primary focus, products, services offered, and costs. Likewise, literature research facilitated the development of a business plan and studied the overall wedding industry trends throughout the United States in general and Alaska in particular. An online survey was conducted to understand potential clients' needs and expectations. Social media research tools are used to create a wedding-related photo and video source pool for wedding planners. Based on the research findings, the business will set three pricing levels for customers to choose from depending on their wants and budgets. Making a contract to the vendors to seal a deal will be a substantial competitive advantage in a market where vendors work with other competitors simultaneously. The product of this project, the business plan, was prepared to get an additional investment. Even though the number of wedding planning businesses has declined over the years, a new, specialized wedding planning business could grow and thrive in Alaska.
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SARS-CoV-2 - Related Nonpharmaceutical Interventions in Atlantic Canada, Japan, Slovakia, and SweedenAt the end of 2019 a new pandemic of respiratory infection started and affected every continent (Centers for Disease Control and Prevention [CDC], 2021). Since the Chinese Ministry of Health announced a new pneumonia outbreak in Wuhan province caused by SARS- CoV-2 virus, countries around the world started preparations for their own epidemic response. Actions of Japan, Slovakia, Sweden, and four provinces of Atlantic Canada were analyzed for association of their adopted measures with morbidity and mortality of their population. While both nonpharmaceutical and pharmaceutical interventions were necessary for the best outcomes, nonpharmaceutical interventions aiming on decrease of population mobility and interpersonal contact, such as limitations of international and domestic travel, lockdowns or curfews, teleworking and telemedicine, banned visits to vulnerable populations, caps on gatherings, physical distancing, isolation of confirmed cases and their contacts, and covering nose and mouth, had significant effect on size of waves of infection and on mortality of infected.
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The Effects of a Nutrition Education Intervention on Supervised Practice Students' Meal Preparation Attitudes and BehaviorsBackground Registered dietitian nutritionists (RDNs) are food and nutrition experts who can help individuals make positive lifestyle changes, including the adoption of healthy culinary habits like meal preparation. However, many dietetic students and entry level RDNs themselves may be lacking the culinary and meal preparation knowledge, attitudes and behaviors necessary to prepare them for this role. Goal To evaluate the effect of a nutrition education intervention on the meal preparation attitudes and behaviors of supervised practice students. Methods Accreditation Council for Education in Nutrition and Dietetics (ACEND) supervised program practice directors received an original email invitation for students to participate and two followup emails. The invitation included a link to the study information, details on how to qualify for a chance to win one of two incentives, informed consent, and the baseline survey. A link for the virtual interventions, with instruction on meal preparation, was provided upon completion of the baseline survey. A follow-up survey was made available after viewing the final virtual intervention. The pre and post survey included 20 Likert scale questions designed to evaluate the attitudes and behaviors regarding nutrition education and meal preparation. The survey also examined potential barriers and facilitators associated with meal preparation. Participants Students currently enrolled in a ACEND accredited supervised practice program (n = 103) participated in the baseline survey via Qualtrics. The students were invited to participate in virtual interventions identifying the What, Why, and How of meal preparation before completing the post intervention survey (n = 20). Analysis The results were imported into SPSS and a repeated-measures paired t-test was used to determine if there was a statistical difference in meal preparation attitude and behaviors following the virtual intervention. Results The majority of DocuSign Envelope ID: 191D1537-DD0E-4F94-88B7-2109894965C1 iv participants (87.4%, n = 90) reported they received education in menu development and food science (76.7%, n = 79). Top barriers to meal preparation selected included lack of time to cook (75.7%, n = 78) and hours worked (66.0%, n = 68).The minority of the participants (10.7%, n = 11) reported that farmers markets not accepting electronic benefit transfer cards was a barrier. The top facilitator to preparing meals at home was recipes that take 30 minutes or less to prepare (84.5%, n = 87). Few participants believed tools such as a rice cooker (27.2%, n = 28) or BBQ grill (25.2%, n = 26) were facilitators to home meal preparation. Three participant attitudes about the relationship between meal planning and beneficial outcomes reflected a statistically significant change: higher fruit and vegetable intake (p <0.00), reduced nutrition-related disease (p <0.02), and confidence in the ability to provide meal preparation education (p<0.02). Two behaviors about the relationship between meal planning and benefits of incorporating meal preparation education into their personal life and professional practice reflected a statistically significant change: personally prepare two or meals in advance at home (p < 0.01) and will provide meal preparation education in professional settings (p < 0.00). Conclusions Meal preparation education has the ability to positively influence the attitudes and behaviors of supervised practice students and the possibility of providing meal preparation education to their clients. Recommendations/DN Practice Implications More culinary nutrition education in the ACEND required didactic education, and supervised practice competencies is needed.
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Modernize Home for Competitive MarketingThis Capstone Project creates a Project Management Plan (PMP) for Do-It Yourself (DIY) home remodels to increase the resale value of a house. This product either does not exist, is too complex, or is difficult to find for homeowners to use. By working with the homeowner, their realtor, the general contractor and additional project management professionals, this project will create a digital packet for the realtors’ clients to use as a tool to assist them in completing home remodels before selling. This project management plan will be used in a home to finish open remodels that need to be accomplished in 2022, which is when the homeowner plans on listing. These renovations will be demonstrated as the completed example for others to relate to, alter, and use as a path forward on their own DIY Projects. Additionally, the DIY packet includes tips and tricks when remodeling, tips to achieve a positive return on investment and/or raise the selling price of the home. Furthermore, the DIY Packet includes the interviews that took place, research techniques, results, and checklist that was gathered throughout the project.
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Application of Project Management Tools and Techniques to Develop a Business Plan for Elysian Word Editing, A Content Creation Business Designed to be Fully RemoteThis project produced a Business Plan for starting a small, woman-owned business – Elysian Word Editing (EWE) LLC – designed to streamline content creation services primarily to online clients via a virtual storefront at ElysianWE.com. Business would consist of one self-employed individual, the business owner, experienced and professionally trained in technical writing and editing, online marketing, and graphic design, with ability to contract resources for website development tasks and building brand identities. Maturing a small business into full-time occupations requires years of prolonged dedication. The project research question, “Would application of project management tools and techniques to the development of a technical writing and editing consulting business, designed to be fully remote, enhance concept suitability in Alaska?” evaluated suitability and acceptability – cost, timeline, and economic factors – of the EWE business concept. Focused effort on project risk management, resource-loaded schedule management, stakeholder management, analysis-driven project control, and quality management were core competencies demonstrated during project planning and execution. EWE intends to target local Alaska businesses and cultivate existing partnerships to leverage quality and grow nationwide clientele demand. Project research revealed reduced per capita demand for these services in Alaska versus other US domestic locations. Through market risk analysis, the project manager determined expediting EWE’s expansion outside of Alaska is preferred.
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Project Management Institute (PMI®) Alaska Chapter Attrition Reduction Implementation PlanThe Project Management Institute (PMI Global) is a world’s leading authority in project management. This organization constitutes of individuals that are empowered to make ideas a reality around the world. PMI Alaska chapter is an entity of PMI Global, that ensures the representation of this global body in the state of Alaska. Recently there has been a growing concern of attrition of PMI Alaska chapter members. The stakeholders conducted research through selected methods and developed an attrition reduction implementation plan for the chapter that will help identify the reason for the exits, what can retain / capture interests of young, new, and old members and how this can be done. The project gathered information and data from the PMI-AK board members on the demographics of members, obtained a sample number of members for the research purpose and got the data on PMI-AK membership trend over the past years, it also gathered information from PMI Global Chapter Services on PMI Chapter membership trend globally and programs to engage members. Questionnaires, interviews, meetings were tools that was used to gather data. An analysis of this data was done using the approved analysis approach and recommendations were made.
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State of Alaska Department of Health and Social Services (DHSS) Project Management Process ImprovementState of Alaska DHSS provides support to Alaska’s healthcare industry and a wide variety of services to the residents of Alaska. Much of this support is borne out of Information Technology (IT) initiatives that would turn into projects. At the time this research was conducted, there was no consistent project management methodology applied across the department. The role of a project manager would be typically assigned to a department employee with no formal project management education and experience, who still had their regular role to fill. According to the leadership, projects were rarely completed on time and often shelved indefinitely. This project was initiated to add value to the DHSS Project Management Office (PMO) through analysis and improvement recommendations for its project management process. The intended outcomes were to 1) deliver a process that would aid in completing projects in a timelier manner with the current resources and 2) provide the necessary project status clarity to the department leadership. The original project scope could not be completed due to lack of support at the governance level and employees’ unwillingness to participate in the research. Instead, a report was produced on the observed challenges of project management in the public sector.
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Arctic Valley Trails Feasibility Assessment and Master Planning SupportThis project conducted a feasibility assessment to determine whether it is feasible to implement new trails at Arctic Valley. This assessment was executed by reviewing literature, collecting primary and secondary data, organizing data into tables, maps, interview logs, and documents. The data was analyzed and presented in summary reports elaborating on data collected, analysis performed, and findings. Findings were organized into six product packages for knowledge transfer to Anchorage Ski Club (ASC). These included a Stakeholder Feedback Report, Historical Infrastructure Analysis Report, Literature Review, Chugach State Park Regulation Change Process Model, Trail Mapping and Models Analysis, and Feasibility Assessment Report. Upon conclusion of the research and reports, the feasibility of trails implementation was affirmed. It is tenable to build trails within ASC’s Concession Contract area in accordance with regulatory guidelines, modern trail construction best practices, and ASC’s financial capabilities. The data collected, analysis performed, and products created were transferred to the project sponsor and advisory committee. ASC was recommended to utilize the results conveyed and perform alternatives analysis of their proposed projects and investment opportunities.
