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Item Open Access The Natural History and Ecological Assessment of Joe's Pond-Morrisville, Vermont(2026-05-07)Joe’s Pond-Morrisville is a 26-acre parcel composed of mixed uplands and wetlands, located in Morrisville in Lamoille County, Vermont. This property was donated to the University of Vermont Natural Areas Program in January 2025 by its previous owners, Ronald and Judith Stancliff, making it the eleventh UVM Natural Area. This Master's Project is an ecological assessment of this new property, with a focus on its natural history, peatland ecology, wetland functions and values, educational opportunities, and management recommendations. The project included a general inventory of plant and animal species, a classification of natural communities, an investigation into the site’s natural history, and the development of baseline management recommendations. In total, I identified eight natural communities, including two aquatic communities that have not been previously described. The uplands are primarily Hemlock–Northern Hardwood Forest, while the wetlands are dominated by rare fen peatland systems. I also documented six rare or uncommon plant species, all within the wetlands, contributing to the broader understanding of their distribution in Vermont. The wetlands, composed almost entirely of rare (S2) fen peatland natural community types in Vermont, were the main focus of my investigation into the natural history of the site. Based on historic aerial imagery, I hypothesized that the current conditions of the peatland natural communities are quite different than they had been even eighty years ago, mainly due to influence by beavers. This hypothesis prompted me to dive deeper into the current ecology and paleoecology of the peatlands, including a transect along the three natural communities to measure environmental variables and vegetation throughout the field season, and taking a peat depth measurements and a peat core within the fen, which was used for macrofossil analysis. Multivariate analyses revealed strong relationships between vegetation patterns and gradients in pH and water table dynamics across peatland communities. The paleoecological methods indicate that the site’s wetlands developed through a combination of infilling and paludification since the last glaciation, with multiple hydrologic shifts over time, from open water to marshy fen, to forested swamp, and to the present-day open Sphagnum and sedge-dominated fen. Beaver activity has been a major driver of recent site conditions, especially following the construction of a large dam in the 1950s that raised water levels and shifted the system toward more open peatland communities. Wetland evaluation using the Vermont Rapid Assessment Method for Wetlands classified the site as a high-quality reference wetland system. Management recommendations are minimal due to the site’s excellent ecological condition and low levels of disturbance. Overall, Joe’s Pond-Morrisville represents a valuable addition to the University of Vermont’s Natural Areas Program, offering significant ecological, educational, and research opportunities.Item Open Access Supporting Pregnant Immigrant Patients: Overcoming Barriers and Improving Health Literacy through Provider and Community Collaboration(2025)2025 Immigrant Health project Abstract Pregnant immigrant patients often face language and cultural barriers that make it difficult to navigate the U.S. healthcare system. These challenges highlight the importance of health literacy, which we define as familiarity with the U.S. healthcare system. This project looks at the specific obstacles these patients encounter and explores strategies to improve the quality of the care they receive. We contacted key community stakeholders to learn more information about pregnant immigrant patients. We conducted pre-survey informational interviews with two community health partners, a midwife and two family medicine physicians. A 14-question survey was developed and distributed to a sample of approximately 750 healthcare providers as well as community health partners in Burlington. Of the 61 survey responses we received, 38 respondents had experience working with pregnant immigrant patients, 84% clinical providers and 16% non-providers. Responses indicated that the most common strategy used to support patients’ health literacy is pausing to check for understanding or having patients repeat back information. This was followed by extending visit times and using medical interpreters. The strategies that were ranked as most important included use of interpreters, more time during visits, and collaboration with community health workers. The greatest communication challenges faced by healthcare providers and community health workers were difficulty verifying patient understanding, inability for patients to access patient portal, and over-reliance on virtual interpreters. Survey respondents cited social workers as most helpful for improving health literacy followed by Women, Infants, & Children (WIC) and Bridges to Health community health workers. This study emphasizes the need for both provider and patient education that goes beyond language translation. Enhancing patients’ familiarity with the healthcare system and strengthening collaboration with community health workers and cultural liaisons may offer an effective path forward.Item Open Access Clinician EHR Work Burden Review Post Ambient AI Implementation(2025-08-15)Background: University of Vermont Health Network (UVMHN) participates in the AMA Joy in Medicine Health System Recognition Program. One category of metrics is “Efficiency of Practice.” UVMHN implemented Abridge Ambient AI scribing to reduce documentation burden in early 2025. Objective: To evaluate changes in physician EHR use and work burden following early ambient AI implementation by comparing Epic Signal metrics across Family Medicine (FM), General Internal Medicine (GIM), Primary Care Pediatrics, and Rheumatology. Methods: We conducted a quality improvement analysis of Epic Signal audit-log data comparing a pre-implementation baseline (January 2025) with an early post-implementation period (June 2025). Metrics included Total EHR time (EHR8), Outside Work time (WOW8), Inbox time (IB-Time8), and Note documentation time (Note-Time8), normalized to 8 hours of scheduled patient time. Specialty-level results were aggregated; no identifiable individual data were retained. Results: Effects varied by specialty. FM showed marked EHR8 reduction (−2.23 h; −38.9%) and IB-Time8 decrease (−6.9%), with increased Note-Time8 (+21.4%) and stable WOW8 (+3.1%). GIM remained stable for EHR8 (+0.1%), with slight IB-Time8 reduction (−4.4%) and increases in Note-Time8 (+15.2%) and WOW8 (+6.1%). Pediatrics showed notable WOW8 improvement (−0.31 h; −36.9%) but small increases in EHR8 (+3.4%) and IB-Time8 (+16.7%), with decreased Note-Time8 (−5.1%). Rheumatology was stable for EHR8 (−0.2%) and WOW8 (+1.2%), with reduced IB-Time8 (−12.1%) and slight Note-Time8 increase (+2.5%). Discussion: 16 statistical analyses were run using independent sample t-test (Welch’s) and effect size (Cohen’s d) and adjusted with Holm-Bonferroni to screen for false positives. Early trends suggest specialty-specific impacts, potentially reflecting adoption curves and workflow variation. Results are unadjusted for case mix or visit type and limited by small sample sizes (<100). More physicians were audited in June for FM and GIM. Differences may reflect who was measured and not behavior changes. Overall, FM reduction in EHR8 was statistically significant, while Pediatrics WOW8 was not significant post-adjustment. Conclusions/Future Directions: Expansion of Abridge Ambient AI could benefit from targeted optimization (e.g., inbox triage, training) and continued monitoring of Signal data to ensure tools are aligned to specific departmental needs. References: - 2025 Project Guidelines. Sept. 2024, www.ama-assn.org/system/files/joy-in-medicine-guidelines.pdf. - Sinsky CA, Rule A, Cohen G, et al. Metrics for assessing physician activity using electronic health record log data. Journal of the American Medical Informatics Association. 2020.Item Open Access Moving From Chlorine to Monochloramine: What Rutland Residents Need to Know(2025-06)In June of 2025, the City of Rutland’s Department of Public Works announced that the secondary disinfectant used to treat the city’s drinking water supply will switch from chlorine to monochloramine. This change reflects an effort to reduce drinking water concentrations of Haloacetic Acids (HAAs), a disinfection byproduct that may increase the risk of certain cancers. Secondary disinfectants, including chlorine and monochloramine, are added to drinking water as it leaves the treatment plant to maintain microbial protection as water flows through distribution pipes. Both agents are widely used as secondary disinfectants, but there are important differences between the two. Of particular importance, the use of chlorine results in higher concentrations of HAAs due to higher reactivity with organic matter in surface water. Federal regulatory limits of HAA levels exist to keep drinking water safe. The Rutland treatment plant, a surface water system, has historically used chlorine as its secondary disinfectant. Since February 2015, a total of 10 of 42 quarterly Rutland City water samples have exceeded federal Maximum Contaminant Levels of Haloacetic Acids (60 ppb). The decision to use monochloramine in place of chlorine is expected to significantly reduce HAA concentrations and thus avoid potential health risks. The primary aim of this project is to create a public-facing community resource that provides information about the upcoming changes to Rutland’s drinking water. A single-page, accessible infographic explaining the utility of a secondary disinfectant and the reason for Rutland’s switch to monochloramine was designed. Information was compiled from sources including the EPA and VT Department of Health. A secondary aim is to review and modify existing public outreach notices regarding at-home water sampling. Strategic edits were made to improve readability, encourage participation in local sampling efforts, and promote community engagement with national heavy metal testing initiatives and the local water system.Item Open Access Exploring Secure Chat Usage and Etiquette Perceptions in Clinical Settings(2025)Background: Secure chat platforms transformed communication within healthcare systems, including the University of Vermont Health Network (UVMHN). While most research focused on inpatient settings, outpatient usage dynamics remain underexplored [1], and its impact on workflow, user experience, and communication etiquette remains unclear. Issues like message overload, interruptions, and unclear guidelines on appropriate usage are emerging concerns [2,3], particularly as these challenges differ by clinical role and setting, influencing how secure messaging is perceived and utilized. Objective: To assess how clinical staff use Secure Chat, its impact on work and personal time, and perceptions of message appropriateness, with the goal of guiding improvements in training and etiquette standards. Study Design: A survey was distributed to clinicians and support staff within inpatient Internal Medicine departments and outpatient Family Medicine offices across UVMHN. The questionnaire comprised 15 items covering demographics, usage patterns, impact on workflow, and perceptions of message appropriateness and etiquette. Results: A total of 126 responses were collected, with nearly equal representation from outpatient ( 46.8%) and inpatient ( 46. 0%) settings. Some message types were consistently viewed as appropriate across settings, while others varied in both perceived appropriateness and frequency of receipt. Urgent clinical concerns (66.7% appropriate) and clinical updates visits (90 .5 % ) were broadly seen as appropriate, with no significant differences by setting. In contrast, clinical updates outside of visits, polite acknowledgments, and administrative messages received mixed ratings ( ~55% appropriate); only polite acknowledgments showed higher frequency of receipt in inpatient settings (93.0% vs. 62.0%; p < .001 ). Greater variation was observed for non-urgent clinical questions, viewed as appropriate by 75.4% (p < .001) and more frequently received by inpatient respondents (91.4% vs. 61.0%; p < .01 ); worldlow-related messages, with higher inpatient endorsement (80.7% vs. 61.0%; p < .05); and message reactions, which were highly favored overall (89. 7%; p < .001) and more strongly endorsed (96.5% vs. 72.4%; p < .001) and frequently received (98.2% vs. 72.4%; p < .001) in inpatient settings. Most respondents showed strong communication awareness, but gaps in effectively managing availability settings and notifications, especially among outpatient providers. A significant portion of providers reported missing important messages ( 43. 7%) due to high message volume and notification fatigue. These findings underscore the need for enhanced guidelines and training support to better align communication behaviors and etiquette standards across clinical settings. Expected Outcomes: Further analysis will be conducted. Future studies should explore specialty-specific differences and examine underlying reasons for varying attitudes toward communication etiquette. Citations: Baratta LR, HarfordD, Sinsky CA, Kannampallil T, Lou SS. Characterizing the Patterns of Electronic HealthRecord-Integra1ed Secure Messaging Use: Cross Sectional Study. J Med Internet Res. 2023 Oct 6;25 :e48583. doi: I 0.2196/48583. PMID: 37801359; PM CID: PMCI 0589827. Lew D, Baratta LR, Xia L, Eiden E, Sinsky CA, Kannampallil T, Lou SS. AssociationofEHR-Jntegrated Secure Messaging Use with Clinician Workload and Attention Switching. J Gen Intern Med. 2025 Mar 14. doi: 10.1007 /s l 1606-025-09466-x. Lou SS, Lew D, Xia L, Baratta L, Eiden E, Kannampallil T. Secure Messaging Use and Wrong-Patient Ordering Errors Among Inpatient Clinicians. JAMA
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