Are mangroves in the tropical Atlantic ripe for invasion? Exotic mangrove trees in the forests of South Florida

Abstract Two species of mangrove trees of Indo- Pacific origin have naturalized in tropical Atlantic mangrove forests in South Florida after they were planted and nurtured in botanic gardens. Two Bruguiera gymnorrhiza trees that were planted in the intertidal zone in 1940 have given rise to a population of at least 86 trees growing interspersed with native mangrove species Rhizophora mangle, Avicennia germinans and Laguncularia racemosa along 100 m of shoreline; the population is expanding at a rate of 5.6% year-1. Molecular genetic analyses confirm very low genetic diversity, as expected from a population founded by two individuals. The maximumnumber of alleles at any locus was three, and we measured reduced heterozygosity compared to native-range populations. Lumnitzera racemosa was introduced multiple times during the 1960s and 1970s, it has spread rapidly into a forest composed of native R. mangle, A. germinans, Laguncularia racemosa and Conocarpus erectus and now occupies 60,500 m2 of mangrove forest with stem densities of 24,735 ha-1. We estimate the population growth rate of Lumnitzera racemosa to be between 17 and 23% year-1. Populations of both species of naturalized mangroves are dominated by young individuals. Given the long life and water-dispersed nature of propagules of the two exotic species, it is likely that they have spread beyond our survey area. We argue that the species-depauperate nature of tropical Atlantic mangrove forests and close taxonomic relatives in the more species-rich Indo-Pacific region result in the susceptibility of tropical Atlantic mangrove forests to invasion by Indo-Pacific mangrove species.

Are mangroves in the tropical Atlantic ripe for invasion? Exotic mangrove trees in the forests of South Florida

Two species of mangrove trees of Indo- Pacific origin have naturalized in tropical Atlantic mangrove forests in South Florida after they were planted and nurtured in botanic gardens. Two Bruguiera gymnorrhiza trees that were planted in the intertidal zone in 1940 have given rise to a population of at least 86 trees growing interspersed with native mangrove species Rhizophora mangle, Avicennia germinans and Laguncularia racemosa along 100 m of shoreline; the population is expanding at a rate of 5.6% year-1. Molecular genetic analyses confirm very low genetic diversity, as expected from a population founded by two individuals. The maximumnumber of alleles at any locus was three, and we measured reduced heterozygosity compared to native-range populations. Lumnitzera racemosa was introduced multiple times during the 1960s and 1970s, it has spread rapidly into a forest composed of native R. mangle, A. germinans, Laguncularia racemosa and Conocarpus erectus and now occupies 60,500 m2 of mangrove forest with stem densities of 24,735 ha-1. We estimate the population growth rate of Lumnitzera racemosa to be between 17 and 23% year-1. Populations of both species of naturalized mangroves are dominated by young individuals. Given the long life and water-dispersed nature of propagules of the two exotic species, it is likely that they have spread beyond our survey area. We argue that the species-depauperate nature of tropical Atlantic mangrove forests and close taxonomic relatives in the more species-rich Indo-Pacific region result in the susceptibility of tropical Atlantic mangrove forests to invasion by Indo-Pacific mangrove species.

Tubular and sector heat pipes with interconnected branches for gas turbine and/or compressor cooling

Designing turbines for either aerospace or power production is a daunting task for any heat transfer scientist or engineer. Turbine designers are continuously pursuing better ways to convert the stored chemical energy in the fuel into useful work with maximum efficiency. Based on thermodynamic principles, one way to improve thermal efficiency is to increase the turbine inlet pressure and temperature. Generally, the inlet temperature may exceed the capabilities of standard materials for safe and long-life operation of the turbine. Next generation propulsion systems, whether for new supersonic transport or for improving existing aviation transport, will require more aggressive cooling system for many hot-gas-path components of the turbine. Heat pipe technology offers a possible cooling technique for the structures exposed to the high heat fluxes. Hence, the objective of this dissertation is to develop new radially rotating heat pipe systems that integrate multiple rotating miniature heat pipes with a common reservoir for a more effective and practical solution to turbine or compressor cooling. In this dissertation, two radially rotating miniature heat pipes and two sector heat pipes are analyzed and studied by utilizing suitable fluid flow and heat transfer modeling along with experimental tests. Analytical solutions for the film thickness and the lengthwise vapor temperature distribution for a single heat pipe are derived. Experimental tests on single radially rotating miniature heat pipes and sector heat pipes are undertaken with different important parameters and the manner in which these parameters affect heat pipe operation. Analytical and experimental studies have proven that the radially rotating miniature heat pipes have an incredibly high effective thermal conductance and an enormous heat transfer capability. Concurrently, the heat pipe has an uncomplicated structure and relatively low manufacturing costs. The heat pipe can also resist strong vibrations and is well suited for a high temperature environment. Hence, the heat pipes with a common reservoir make incorporation of heat pipes into turbo-machinery much more feasible and cost effective.

Friends of the Everglades

Marjory Stoneman Douglass delivering presentation, April 3, 1973. Marjory Stoneman Douglas was born on April 7, 1890. In South Florida she is best known for her environmental advocacy passionately fighting for the protection and preservation of the Florida Everglades. As a writer, her most influential book was the book The Everglades: River of Grass (1947), which redefined the popular conception of the Everglades as a treasured river instead of a worthless swamp. Moving to South Florida to pursuit a career in journalism, she began writing for the Miami Herald newspaper and then worked as freelance writer, producing over one hundred short stories that were published in popular magazines. Throughout her long life (lived until age 108), she received numerous awards, including the Presidential Medal of Freedom and was inducted into several halls of fame. She died on May 14, 1998. A statue of her invites visitors at Fairchild Tropical Botanic Garden in Miami, Florida to sit with her statue and contemplate the garden. Two South Florida public schools are named in her honor: Broward County Public Schools' Marjory Stoneman Douglas High School and Miami-Dade County Public Schools' Marjory Stoneman Douglas Elementary School.

Friends of the Everglades

Charles Perry shaking hands with Marjory Stoneman Douglas in front of easel with map of Florida. Charles Edward Perry (Chuck), 1937-1999, was the founding president of Florida International University in Miami, Florida. He grew up in Logan County, West Virginia and received his bachelor's and masters's degrees from Bowling Green State University. He married Betty Laird in 1960. In 1969, at the age of 32, Perry was the youngest president of any university in the nation. The name of the university reflects Perry’s desire for a title that would not limit the scope of the institution and would support his vision of having close ties to Latin America. Perry and a founding corps opened FIU to 5,667 students in 1972 with only one large building housing six different schools. Perry left the office of President of FIU in 1976 when the student body had grown to 10,000 students and the university had six buildings, offered 134 different degrees and was fully accredited. Charles Perry died on August 30, 1999 at his home in Rockwall, Texas. He is buried on the FIU campus in front of the Graham Center entrance. Marjory Stoneman Douglas was born on April 7, 1890. In South Florida she is best known for her environmental advocacy passionately fighting for the protection and preservation of the Florida Everglades. As a writer, her most influential book was the book The Everglades: River of Grass (1947), which redefined the popular conception of the Everglades as a treasured river instead of a worthless swamp. Moving to South Florida to pursuit a career in journalism, she began writing for the Miami Herald newspaper and then worked as freelance writer, producing over one hundred short stories that were published in popular magazines. Throughout her long life (lived until age 108), she received numerous awards, including the Presidential Medal of Freedom and was inducted into several halls of fame. She died on May 14, 1998. A statue of her invites visitors at Fairchild Tropical Botanic Garden in Miami, Florida to sit with her statue and contemplate the garden. Two South Florida public schools are named in her honor: Broward County Public Schools' Marjory Stoneman Douglas High School and Miami-Dade County Public Schools' Marjory Stoneman Douglas Elementary School.

Friends of the Everglades

Charles Perry and Marjory Stoneman Douglas in front of easel with map of Florida. Charles Edward Perry (Chuck), 1937-1999, was the founding president of Florida International University in Miami, Florida. He grew up in Logan County, West Virginia and received his bachelor's and masters's degrees from Bowling Green State University. He married Betty Laird in 1960. In 1969, at the age of 32, Perry was the youngest president of any university in the nation. The name of the university reflects Perry’s desire for a title that would not limit the scope of the institution and would support his vision of having close ties to Latin America. Perry and a founding corps opened FIU to 5,667 students in 1972 with only one large building housing six different schools. Perry left the office of President of FIU in 1976 when the student body had grown to 10,000 students and the university had six buildings, offered 134 different degrees and was fully accredited. Charles Perry died on August 30, 1999 at his home in Rockwall, Texas. He is buried on the FIU campus in front of the Graham Center entrance. Marjory Stoneman Douglas was born on April 7, 1890. In South Florida she is best known for her environmental advocacy passionately fighting for the protection and preservation of the Florida Everglades. As a writer, her most influential book was the book The Everglades: River of Grass (1947), which redefined the popular conception of the Everglades as a treasured river instead of a worthless swamp. Moving to South Florida to pursuit a career in journalism, she began writing for the Miami Herald newspaper and then worked as freelance writer, producing over one hundred short stories that were published in popular magazines. Throughout her long life (lived until age 108), she received numerous awards, including the Presidential Medal of Freedom and was inducted into several halls of fame. She died on May 14, 1998. A statue of her invites visitors at Fairchild Tropical Botanic Garden in Miami, Florida to sit with her statue and contemplate the garden. Two South Florida public schools are named in her honor: Broward County Public Schools' Marjory Stoneman Douglas High School and Miami-Dade County Public Schools' Marjory Stoneman Douglas Elementary School.

Tubular and Sector Heat Pipes with Interconnected Branches for Gas Turbine and/or Compressor Cooling

Designing turbines for either aerospace or power production is a daunting task for any heat transfer scientist or engineer. Turbine designers are continuously pursuing better ways to convert the stored chemical energy in the fuel into useful work with maximum efficiency. Based on thermodynamic principles, one way to improve thermal efficiency is to increase the turbine inlet pressure and temperature. Generally, the inlet temperature may exceed the capabilities of standard materials for safe and long-life operation of the turbine. Next generation propulsion systems, whether for new supersonic transport or for improving existing aviation transport, will require more aggressive cooling system for many hot-gas-path components of the turbine. Heat pipe technology offers a possible cooling technique for the structures exposed to the high heat fluxes. Hence, the objective of this dissertation is to develop new radially rotating heat pipe systems that integrate multiple rotating miniature heat pipes with a common reservoir for a more effective and practical solution to turbine or compressor cooling. In this dissertation, two radially rotating miniature heat pipes and two sector heat pipes are analyzed and studied by utilizing suitable fluid flow and heat transfer modeling along with experimental tests. Analytical solutions for the film thickness and the lengthwise vapor temperature distribution for a single heat pipe are derived. Experimental tests on single radially rotating miniature heat pipes and sector heat pipes are undertaken with different important parameters and the manner in which these parameters affect heat pipe operation. Analytical and experimental studies have proven that the radially rotating miniature heat pipes have an incredibly high effective thermal conductance and an enormous heat transfer capability. Concurrently, the heat pipe has an uncomplicated structure and relatively low manufacturing costs. The heat pipe can also resist strong vibrations and is well suited for a high temperature environment. Hence, the heat pipes with a common reservoir make incorporation of heat pipes into turbo-machinery much more feasible and cost effective.

Dynamic Behavior and Fatigue Life of Highway Bridges Due to Doubling Heavy Vehicles

An increase in the demand for the freight shipping in the United States has been predicted for the near future and Longer Combination Vehicles (LCVs), which can carry more loads in each trip, seem like a good solution for the problem. Currently, utilizing LCVs is not permitted in most states of the US and little research has been conducted on the effects of these heavy vehicles on the roads and bridges. In this research, efforts are made to study these effects by comparing the dynamic and fatigue effects of LCVs with more common trucks. Ten Steel and prestressed concrete bridges with span lengths ranging from 30’ to 140’ are designed and modeled using the grid system in MATLAB. Additionally, three more real bridges including two single span simply supported steel bridges and a three span continuous steel bridge are modeled using the same MATLAB code. The equations of motion of three LCVs as well as eight other trucks are derived and these vehicles are subjected to different road surface conditions and bumps on the roads and the designed and real bridges. By forming the bridge equations of motion using the mass, stiffness and damping matrices and considering the interaction between the truck and the bridge, the differential equations are solved using the ODE solver in MATLAB and the results of the forces in tires as well as the deflections and moments in the bridge members are obtained. The results of this study show that for most of the bridges, LCVs result in the smallest values of Dynamic Amplification Factor (DAF) whereas the Single Unit Trucks cause the highest values of DAF when traveling on the bridges. Also in most cases, the values of DAF are observed to be smaller than the 33% threshold suggested by the design code. Additionally, fatigue analysis of the bridges in this study confirms that by replacing the current truck traffic with higher capacity LCVs, in most cases, the remaining fatigue life of the bridge is only slightly decreased which means that taking advantage of these larger vehicles can be a viable option for decision makers.

Making Life Choices Program: A psychoeducational intervention for promoting critical cognitive and affective competencies in adolescents at-risk for problem behaviors

The long term goal of the work described is to contribute to the emerging literature of prevention science in general, and to school-based psychoeducational interventions in particular. The psychoeducational intervention reported in this study used a main effects prevention intervention model. The current study focused on promoting optimal cognitive and affective functioning. The goal of this intervention was to increase potential protective factors such as critical cognitive and communicative competencies (e.g., critical problem solving and decision making) and affective competencies (e.g., personal control and responsibility) in middle adolescents who have been identified by the school system as being at-risk for problem behaviors. The current psychoeducational intervention draws on an ongoing program of theory and research (Berman, Berman, Cass Lorente, Ferrer Wreder, Arrufat, & Kurtines 1996; Ferrer Wreder, 1996; Kurtines, Berman, Ittel, & Williamson, 1995) and extends it to include Freire's (1970) concept of transformative pedagogy in developing school-based psychoeducational programs that target troubled adolescents. The results of the quantitative and qualitative analyses indicated trends that were generally encouraging with respect to the effects of the intervention on increasing critical cognitive and affective competencies. ^

Durability assessment of polymer trileaflet heart valves

The durability of a polymer trileaflet valve is dependent on leaflet stress concentrations, so valve designs that reduce stress can, hypothetically, increase durability. Design aspects that are believed to contribute to reduced leaflet stress include stent flexibility, parabolic coaptation curvature, and leaflet anisotropy. With this in mind, the purpose of this investigation was to elucidate what specific combinations of these parameters promote optimal acute and long-term valve function. A combination of four stent designs, seven leaflet reinforcement materials, and three coaptation geometries were evaluated through a combination of experimentation and modeling. Static tensile and Poisson’s ratio tests and dynamic tensile fatigue testing were used to evaluate the individual leaflet components; and hydrodynamic testing and accelerated valve fatigue was used to assess complete valve prototypes. The two most successful designs included a 0.40 mm thick knit-reinforced valve with a fatigue life of 10.35 years, and a 0.20 mm thick knit-reinforced valve with a 28.9 mmHg decrease in pressure drop over the former. A finite element model was incorporated to verify the impact of the above-mentioned parameters on leaflet stress concentrations. Leaflet anisotropy had a large impact on stress concentrations, and matching the circumferential modulus to that of the natural valve showed the greatest benefit. Varying the radial modulus had minimal impact. Varying coaptation geometry had no impact, but stent flexibility did have a marked effect on the stress at the top of the commissure, where a completely rigid stent resulted in a higher peak stress than a flexible stent (E = 385 MPa). In conclusion, stent flexibility and leaflet anisotropy do effect stress concentrations in the SIBS trileaflet valve, but coaptation geometry does not. Regions of high stress concentrations were linked to failure locations in vitro, so a fatigue prediction model was developed from the S/N curves generated during dynamic tensile testing of the 0.20 mm knit-reinforced leaflets. Failure was predicted at approximately 400 million cycles (10 years) at the top of the commissure. In vitro fatigue of this valve showed failure initiation after approximately 167 million cycles (4.18 years), but it was related to a design defect that is subsequently being changed.

Glycemic control: Risk factors, quality of life, workforce participation, and mortality among US adults with type 2 diabetes

Despite research showing the benefits of glycemic control, it remains suboptimal among adults with diabetes in the United States. Possible reasons include unaddressed risk factors as well as lack of awareness of its immediate and long term consequences. The objectives of this study were to, using cross-sectional data, (1) ascertain the association between suboptimal (Hemoglobin A1c (HbA1c) .7%), borderline (HbA1c 7-8.9%), and poor (HbA1c .9%) glycemic control and potentially new risk factors (e.g. work characteristics), and (2) assess whether aspects of poor health and well-being such as poor health related quality of life (HRQOL), unemployment, and missed-work are associated with glycemic control; and (3) using prospective data, assess the relationship between mortality risk and glycemic control in US adults with type 2 diabetes. Data from the 1988-1994 and 1999-2004 National Health and Nutrition Examination Surveys were used. HbA1c values were used to create dichotomous glycemic control indicators. Binary logistic regression models were used to assess relationships between risk factors, employment status and glycemic control. Multinomial logistic regression analyses were conducted to assess relationships between glycemic control and HRQOL variables. Zero-inflated Poisson regression models were used to assess relationships between missed work days and glycemic control. Cox-proportional hazard models were used to assess effects of glycemic control on mortality risk. Using STATA software, analyses were weighted to account for complex survey design and non-response. Multivariable models adjusted for socio-demographics, body mass index, among other variables. Results revealed that being a farm worker and working over 40 hours/week were risk factors for suboptimal glycemic control. Having greater days of poor mental was associated with suboptimal, borderline, and poor glycemic control. Having greater days of inactivity was associated with poor glycemic control while having greater days of poor physical health was associated with borderline glycemic control. There were no statistically significant relationships between glycemic control, self-reported general health, employment, and missed work. Finally, having an HbA1c value less than 6.5% was protective against mortality. The findings suggest that work-related factors are important in a person’s ability to reach optimal diabetes management levels. Poor glycemic control appears to have significant detrimental effects on HRQOL.^

Design and performance assessment of aortic heart valve for tissue engineering

Current artificial heart valves are classified as mechanical and bioprosthetic. An appealing pathway that promises to overcome the shortcomings of commercially available heart valves is offered by the interdisciplinary approach of cardiovascular tissue engineering. However, the mechanical properties of the Tissue Engineering Heart Valves (TEHV) are limited and generally fail in the long-term use. To meet this performance challenge novel biodegradable triblock copolymer poly(ethylene oxide)-polypropylene oxide)-poly(ethylene oxide) (PEO-PPO-PEO or F108) crosslinked to Silk Fibroin (F108-SilkC) to be used as tri-leaflet heart valve material was investigated. ^ Synthesis of ten polymers with varying concentration and thickness (55 µm, 75 µm and 100 µm) was achieved via a covalent crosslinking scheme using bifunctional polyethylene glycol diglycidyl ether (PEGDE). Static and fatigue testing were used to assess mechanical properties of films, and hydrodynamic testing was performed to determine performance under a simulated left ventricular flow regime. The crosslinked copolymer (F108-Silk C) showed greater flexibility and resilience, but inferior ultimate tensile strength, by increasing concentration of PEGDE. Concentration molar ratio of 80:1 (F108: Silk) and thickness of 75 µm showed longer fatigue life for both tension-tension and bending fatigue tests. Four valves out of twelve designed satisfactorily complied with minimum performance requirement ISO 5840, 2005. ^ In conclusion, it was demonstrated that the applicability of a degradable polymer in conjugation with silk fibroin for tissue engineering cardiovascular use, specifically for aortic valve leaflet design, met the performance demands. Thinner thicknesses (t<75 µm) in conjunction with stiffness lower than 320 MPa (80:1, F108: Silk) are essential for the correct functionality of proposed heart valve biomaterial F108-SilkC. Fatigue tests were demonstrated to be a useful tool to characterize biomaterials that undergo cyclic loading. ^

Pressure ulcers and nutritional deficits in elderly long-term care patients: Effects of a comprehensive nutritional program on pressure ulcer healing, length of hospital stay and charges to patients

The elderly are at the highest risk of developing pressure ulcers that result in prolonged hospitalization, high health care costs, increased mortality, and decreased quality of life. The burden of pressure ulcers will intensify because of a rapidly increasing elderly population in the United States (US). Poor nutrition is a major predictor of pressure ulcer formation. The purpose of this study was to examine the effects of a comprehensive, interdisciplinary nutritional protocol on: (1) pressure ulcer wound healing (2) length of hospital stays, and (3) charges for pressure ulcer management. Using a pre-intervention/post intervention quasi-experimental design the study sample was composed of 100 patients 60 years or older, admitted with or acquiring a pressure ulcer. A pre-intervention group (n= 50) received routine pressure ulcer care (standard diet, dressing changes, and equipment). A post-intervention group received routine care plus an interdisciplinary nutrition intervention (physical therapy, speech therapy, occupational therapy, added protein and calories to the diet). Research questions were analyzed using descriptive statistics, frequencies, Chi-Square Tests, and T-tests. Findings indicated that the comprehensive, interdisciplinary nutritional protocol had a significant effect on the rate of wound healing in Week3 and Week4, total hospital length of stay (pre-intervention M= 43.2 days, SD=31.70 versus M=31.77, SID-12.02 post-intervention), and pressure ulcer length of stay (pre-intervention 25.28 days, SD5.60 versus 18.40 days, SD 5.27 post-intervention). Although there was no significant difference in total charges for the pre-intervention group ($727,245.00) compared to the post-intervention group ($702,065.00), charges for speech (m=$5885.12, SD=$332.55), pre albumin (m=$808.52,SD= $332.55), and albumin($278 .88, SD=55.00) were higher in the pre-intervention group and charges for PT ($5721.26, SD$3655.24) and OT($2544 .64, SD=1712.863) were higher in the post-intervention group. Study findings indicate that this comprehensive nutritional intervention was effective in improving pressure ulcer wound healing, decreasing both hospital length of stay for treatment of pressure ulcer and total hospital length of stay while showing no significant additional charges for treatment of pressure ulcers.

Living positive: Life in community among Puerto Rican men living with HIV in Boston

Negative experiences of stigmatization, discrimination, and rejection are common among people living with HIV in the United States, and particularly when they are also members of a minority group. Some three decades after the first cases of AIDS were identified, people infected with HIV continue to be perceived and characterized negatively. While an HIV/AIDS diagnosis is typically associated with negativity, this study investigates the extent to which collective experiences among HIV-positive people result in healthy responses and positive social adjustment. This study is focused on the ways in which HIV-positive Puerto Rican men in Boston live positive despite being diagnosed with HIV. Rather than wrapping themselves in the social stigma of HIV and the isolation that entails, they participate in processes that affirm themselves and their peers. In so doing, they help generate both healthy and meaningful lives for themselves and others. The study examines the process in which Puerto Rican men living with HIV in Boston participate, promote, and reaffirm an HIV community, la comunidad, as a social entity with a unique culture and identity. This study also investigates how this community influences, supports, and encourages the adoption of positive transformations for living long term with HIV. On the basis of nine months of field research, this qualitative study employed both focus groups and interviews with fifty HIV-positive Puerto Rican men in Boston. These men were recruited, using convenience sampling, from different community-based organizations (CBOs) that provide HIV/AIDS services in Boston. The study finds that HIV-positive Puerto Rican men in Boston build community, not in response to social exclusion, but built on shared positive practices and strategies for living healthy with HIV. These men come together to negotiate and form a unique cultural community expressed in norms, beliefs, and practices that, although centered on HIV, are designed for living healthy. These expressions reaffirm a sense of community in everyday settings and transform the lives of these men with positive behaviors and healthy lifestyles. The findings reveal that this transformation takes place in the context of a community, with the support, encouragement, and at times, policing of others. La comunidad is where the lives of these men are transformed as they learn, adopt, and experience living positive with HIV.

Children with special health care needs: Comparison of the effects of home care setting, prescribed pediatric extended care setting, and long-term care setting on child and family health outcomes and health care service use

Technological advances during the past 30 years have dramatically improved survival rates for children with life-threatening conditions (preterm births, congenital anomalies, disease, or injury) resulting in children with special health care needs (CSHCN), children who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who require health and related services beyond that required by children generally. There are approximately 10.2 million of these children in the United States or one in five households with a child with special health care needs. Care for these children is limited to home care, medical day care (Prescribed Pediatric Extended Care; P-PEC) or a long term care (LTC) facility. There is very limited research examining health outcomes of CSHCN and their families. The purpose of this research was to compare the effects of home care settings, P-PEC settings, and LTC settings on child health and functioning, family health and function, and health care service use of families with CSHCN. Eighty four CSHCN ages 2 to 21 years having a medically fragile or complex medical condition that required continual monitoring were enrolled with their parents/guardians. Interviews were conducted monthly for five months using the PedsQL™ Generic Core Module for child health and functioning, PedsQL™ Family Impact Module for family health and functioning, and Access to Care from the NS-CSHCN survey for health care services. Descriptive statistics, chi square, and ANCOVA were conducted to determine differences across care settings. Children in the P-PEC settings had a highest health care quality of life (HRQL) overall including physical and psychosocial functioning. Parents/guardians with CSHCN in LTC had the highest HRQL including having time and energy for a social life and employment. Parents/guardians with CSHCN in home care settings had the poorest HRQL including physical and psychosocial functioning with cognitive difficulties, difficulties with worry, communication, and daily activities. They had the fewest hours of employment and the most hours providing direct care for their children. Overall health care service use was the same across the care settings.