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American Society for Parenteral and Enteral Nutrition and Academy of Nutrition and Dietetics: Revised 2014 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Nutrition Support Susan L. Brantley, Mary K. Russell, Kris M. Mogensen, Jennifer A. Wooley, Elizabeth Bobo, Yimin Chen, Ainsley Malone, Susan Roberts, Michelle M. Romano and Beth Taylor Nutr Clin Pract 2014 29: 792 originally published online 1 November 2014 DOI: 10.1177/0884533614554264 The online version of this article can be found at: http://ncp.sagepub.com/content/29/6/792

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NCPXXX10.1177/0884533614554264Nutrition in Clinical PracticeBrantley et al

Standards of Practice

American Society for Parenteral and Enteral Nutrition and Academy of Nutrition and Dietetics: Revised 2014 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Nutrition Support

Nutrition in Clinical Practice Volume 29 Number 6 December 2014 792­–828 © 2014 American Society for Parenteral and Enteral Nutrition and Academy of Nutrition and Dietetics DOI: 10.1177/0884533614554264 ncp.sagepub.com hosted at online.sagepub.com

Susan L. Brantley, MS, RD, CNSC, LDN1; Mary K. Russell, MS, RDN, LDN, FAND2; Kris M. Mogensen, MS, RD, LDN, CNSC3; Jennifer A. Wooley, MS, RD, CNSC4; Elizabeth Bobo, MS, RD, LD/N, CNSC5; Yimin Chen, MS, RD, CNSC6; Ainsley Malone, MS, RDN, LD, CNSC, FAND7; Susan Roberts, MS, RD, LD, CNSC8; Michelle M. Romano, RD, LD/N, CNSC9; and Beth Taylor, DCN, RD, LDN, CNSC, FCCM10

Abstract This 2014 revision of the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for Registered Dietitians Nutritionists (RDNs) in Nutrition Support represents an update of the 2007 Standards composed by content experts of the American Society for Parenteral and Enteral Nutrition and the Academy of Nutrition and Dietetics. The revision is based upon the Revised 2012 SOP in Nutrition Care and SOPP for RDs, which incorporates the Nutrition Care Process and the six domains of professionalism: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. These SOP and SOPP are designed to promote the provision of safe, effective, and efficient nutrition support services, facilitate evidence-based practice, and serve as a professional evaluation resource for RDNs who specialize or wish to specialize in nutrition support therapy. These standards should be applied in all patient/client care settings in which RDNs in nutrition support provide care. These settings include, but are not limited to, acute care, ambulatory/outpatient care, and home and alternate site care. The standards highlight the value of the nutrition support RDN’s roles in quality management, regulatory compliance, research, teaching, consulting, and writing for peer-reviewed professional publications. The standards assist the RDN in nutrition support to distinguish his or her level of practice (competent, proficient, or expert) and would guide the RDN in creating a personal development plan to achieve increasing levels of knowledge, skill, and ability in nutrition support practice. (Nutr Clin Pract. 2014;29:792-828)

Keywords nutritional support; dietitian; dietetics; professional role; nutrition therapy; clinical competence; nutrition support practice; nutrition care process

The Dietitians in Nutrition Support (DNS) Dietetic Practice Group of the Academy of Nutrition and Dietetics (Academy), and members of the Dietetics Practice Section of the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), under the guidance of the Academy Quality Management Committee and the A.S.P.E.N. Clinical Practice Committee, have revised the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for Registered Dietitians (RDs) in Nutrition Support, originally published in 2007 and extended to 2014.1,2 The revised documents, American Society for Parenteral and Enteral Nutrition and the Academy of Nutrition and Dietetics: Revised 2014 Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Nutrition Support, reflect advances in nutrition support practice during the past seven years and replace the 2007 Standards. These documents build on the Academy of Nutrition and Dietetics Revised 2012 SOP in Nutrition Care and SOPP

From the 1Metabolic Support Services Coordinator, University of Tennessee Medical Center, Pharmacy Department, Knoxville, Tennessee; 2Sr. Manager, Medical Affairs, Baxter Healthcare Corporation, Chicago, Illinois; 3Team Leader Dietitian, Department of Nutrition, Brigham and Women’s Hospital, Boston, Massachusetts; 4Clinical Nutrition Manager, University Hospital and Cardiovascular Center, University of Michigan Health System, Ann Arbor, Michigan; 5Clinical Dietitian, Nemours Children’s Clinic, Jacksonville, Florida; 6Advanced Level Dietitian, Rush University Medical Center, Chicago, Illinois; 7Nutrition Support Dietitian, Pharmacy Department, Mt. Carmel West Hospital, Columbus, Ohio; 8Area Director of Clinical NutritionAramark/Baylor Health Care System, Dietetic Internship Director–Baylor University Medical Center, Dallas, Texas; 9Nutrition Support Specialist, Mayo Clinic Florida, Jacksonville, Florida; and 10Nutrition Support Specialist, Barnes-Jewish Hospital, St Louis, Missouri. Nutrition in Clinical Practice and the Journal of the Academy of Nutrition and Dietetics have arranged to publish this article simultaneously in their publications. Minor differences in style may appear in each publication, but the article is substantially the same in each journal. Financial disclosure: None declared. This article originally appeared online on November 1, 2014.

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for RDs.3 The Academy of Nutrition and Dietetics/Commission on Dietetic Registration’s (CDR) Code of Ethics4 and the Academy of Nutrition and Dietetics Revised 2012 SOP in Nutrition Care and SOPP for RDs3 are tools within the Scope of Practice in Nutrition and Dietetics5 and Scope of Practice for the RD6 that guide the practice and performance of registered dietitian nutritionists (RDNs) in all settings. A.S.P.E.N. documents that guide the practice and performance of registered dietitian nutritionists (RDNs) in nutrition support practice include the A.S.P.E.N. Board of Directors approved clinical guidelines, standards, clinical recommendations, and position papers, which may be accessed once an account is created at www.nutritioncare.org. The Scope of Practice in Nutrition and Dietetics is composed of statutory and individual components, including the Code of Ethics, and encompasses the range of roles, activities, and regulations within which RDNs perform. For credentialed practitioners, scope of practice is typically established within the practice act and interpreted and controlled by the agency or board that regulates the practice of the profession in a given state.5 An RDN’s statutory scope of practice may delineate the services an RDN is authorized to perform, in a state where a practice act or certification exists. The RDN’s individual scope of practice is determined by education, training, credentialing, and demonstrated and documented competence to practice. Individual scope of practice in nutrition and dietetics has flexible boundaries to capture the breadth of the individual’s professional practice. The Scope of Practice Decision Tool, an online, interactive tool, permits an RDN to answer a series of questions to determine whether a particular activity is within his or her scope of practice. The tool is designed to assist an RDN in critically evaluating personal knowledge, skill, and demonstrated competence with criteria resources.7 The Medicare and Medicaid Programs; Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction; Part II Final Rule, effective July 11, 2014, for hospital conditions of participation, now allows a hospital and its medical staff the option of granting RDNs or other clinically qualified nutrition professionals ordering privileges for therapeutic diets and nutrition-related actions, including nutrition supplements and enteral and parenteral nutrition if consistent with state law. RDNs in hospital settings interested in obtaining ordering privileges must review state practice acts (licensure, certification, title protection) and state healthcare facility regulations to determine if there are any barriers that must be addressed. An RDN interested in obtaining ordering privileges should review the state analysis and regulation for a brief breakdown of each state’s relevant law8 and Practice Tips that outline the regulations and implementation steps for ordering privileges.9 Medical staff oversight of a RDN(s) occurs in one of two ways. A hospital has the regulatory flexibility to appoint the RDN(s) to the medical staff and grant the RDN(s) specific

nutrition ordering privileges, or can authorize the ordering privileges without appointment to the medical staff. The RDN ordering privileges must be ensured through the hospital’s medical staff rules, regulations, and bylaws, or other facilityspecific process.10

All registered dietitians are nutritionists—but not all nutritionists are registered dietitians. The Academy’s Board of Directors and Commission on Dietetic Registration have determined that those who hold the credential “Registered Dietitian” (RD) may optionally use “Registered Dietitian Nutritionist” (RDN) instead. The two credentials have identical meanings. In this document, the expert working group has chosen to use the term RDN to refer to both registered dietitians and registered dietitian nutritionists.

Approved August 2014 by the Quality Management Committee of the Academy of Nutrition and Dietetics (Academy), the Executive Committee of the DNS Dietetic Practice Group of the Academy, and the Clinical Practice Committee and the Board of Directors of the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). Scheduled review date: December 2018. Questions regarding the Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists in Nutrition Support may be addressed to Susan Brantley, MS, RD, CNSC, LDN, at sbrantle@ mc.utmck.edu.

The Academy’s Revised 2012 SOP in Nutrition Care and SOPP for RDs3 reflect the minimum competent level of nutrition and dietetics practice and professional performance for RDNs. These standards serve as blueprints for the development of focus area SOP and SOPP for RDNs in competent, proficient, and expert levels of practice. The SOP in Nutrition Care is composed of 4 standards representing the 4 steps of the Nutrition Care Process: nutrition assessment, nutrition diagnosis, nutrition intervention, and nutrition monitoring/evaluation as applied to the care of patients/clients.11 The SOPP consist of standards representing 6 domains of professionalism: quality in practice, competence and accountability, provision of services, application of research, communication and application of knowledge, and utilization and management of resources. The SOP and SOPP are designed to promote the provision of safe, effective, and efficient food and nutrition services, facilitate evidencebased practice, and serve as a professional evaluation resource. These focus area standards for RDNs in nutrition support provide a guide for self-evaluation and expanding practice, a means of identifying areas for professional development, and a mechanism for demonstrating competence and planning advan­ cement to a higher level of practice in the delivery of nutrition support services. A RDN interested in transitioning to a new

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focus area of practice such as nutrition support would use the standards to guide his/her knowledge and skill development. Like the SOP in Nutrition Care and SOPP for RDs,3 the indicators (ie, measureable action statements that illustrate how each standard can be applied in practice) (see Figures 1 and 2) for the SOP and SOPP for RDNs in Nutrition Support were revised with input and consensus from content experts representing diverse practice and geographic perspectives. The SOP and SOPP for RDNs in Nutrition Support were reviewed and approved by the DNS Dietetic Practice Group Executive Committee, the Academy Quality Management Committee, and the A.S.P.E.N. Clinical Practice Committee and Board of Directors.

Three Levels of Practice The Dreyfus model12 identifies levels of proficiency (novice, advanced beginner, competent, proficient, and expert) (refer to Figure 3) during the acquisition and development of knowledge and skills. The first 2 levels are components of the required didactic education (novice) and supervised practice experience (advanced beginner) that precede credentialing for dietetics and nutrition practitioners. Upon successfully attaining the Registered Dietitian Nutritionist credential (RDN), a practitioner enters professional practice at the competent level and manages his/her professional development to obtain individual professional goals. This model is helpful in understanding the levels of practice described in the SOP and SOPP for RDNs in Nutrition Support. In Academy focus areas (such as diabetes care, renal nutrition, nutrition support), these 3 levels are represented as competent, proficient, and expert practice levels.

Competent Practitioner In nutrition and dietetics, a competent practitioner is an RDN who has recently obtained RDN registration by the Commission on Dietetic Registration and is just beginning practice, or an experienced RDN who has recently assumed nutrition services responsibility in a new focus area. A focus area is defined as an area of nutrition and dietetics practice that requires specific, targeted knowledge, skills, and experience.13 A new competent RDN practitioner in professional employment acquires additional on-the-job skills and engages in tailored continuing education to further enhance knowledge and skills acquired in formal education. An RDN begins with technical training and professional interaction to facilitate career advancement and expand competence. A general practice RDN may assume responsibilities across several areas of practice, including, but not limited to: community, clinical, consultation and business, research, education, and food and nutrition management.13

Proficient Practitioner A proficient practitioner is an RDN who is generally 3 or more years beyond entry into the profession, who has obtained

operational job performance skills, and is successful in the RDN’s chosen focus area of practice.13 The proficient practitioner demonstrates knowledge, skills, and experience beyond entry level in a focus area of nutrition and dietetics practice. A practitioner may acquire specialist credentials, if available, to demonstrate proficiency in a focus area of practice.

Expert Practitioner An expert practitioner is an RDN who is recognized within the profession and has mastered the highest degree of skill in or knowledge of a certain focused or generalized area of nutrition and dietetics through additional knowledge, experience, or training.13 An expert practitioner exhibits a set of characteristics that include a broad, multifocal knowledge base, leadership and vision, and demonstrates effectiveness in planning, achieving, evaluating, and communicating targeted outcomes. An expert practitioner may have an expanded or specialist role or both, and may possess an advanced credential, if available, in a focus area of practice. Generally, the expert practitioner works at a complex level with a high degree of professional autonomy and responsibility. These standards, along with the Academy/CDR Code of Ethics,4 answer the questions: Why is an RDN uniquely qualified to provide nutrition support services? What knowledge, skills, and competencies does an RDN need to demonstrate for the provision of safe, effective, and quality nutrition support service at the competent, proficient, and expert levels?

Overview RDNs who practice in nutrition support represent a significant focus area within the Academy of Nutrition and Dietetics, and the largest credentialed A.S.P.E.N. practitioner group. RDNs who specialize in nutrition support therapy practice in a variety of patient care settings, including acute care, ambulatory/outpatient settings, and home and alternate site care.1,2,14 In addition, RDNs practicing in nutrition support therapy may (solely or in combination with a clinical practice) conduct research, teach, consult, and write for peerreviewed professional publications. Nutrition support encompasses provision of oral, enteral, or parenteral nutrients with therapeutic intent. This includes, but is not limited to, provision of enteral and/or parenteral nutrition to maintain or restore optimal nutrition status and health. The RDN practicing in this focus area collaborates with physicians, physician assistants, nurse practitioners, nurses, pharmacists, case managers, speech pathologists, respiratory therapists, and social workers to support optimal nutrition health in individuals with known or potential compromised nutrition status.1,2 An interdisciplinary team approach has been shown to enhance quality of care, improve patient safety and outcomes, and reduce healthcare costs.15 Within the interdisciplinary team, the RDN is a key resource (Text continues on p. 806.)

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Figure 1.  (continued)

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Nutrition in Clinical Practice 29(6)

/ŶĚŝĐĂƚŽƌƐĨŽƌ^ƚĂŶĚĂƌĚϭ͗EƵƚƌŝƚŝŽŶƐƐĞƐƐŵĞŶƚ ŽůĚ&ŽŶƚ/ŶĚŝĐĂƚŽƌƐƌĞĐĂĚĞŵLJŽƌĞZE^ƚĂŶĚĂƌĚƐŽĨ dŚĞ͞y͟ƐŝŐŶŝĨŝĞƐƚŚĞŝŶĚŝĐĂƚŽƌƐĨŽƌ WƌĂĐƚŝĐĞ/ŶĚŝĐĂƚŽƌƐ ƚŚĞůĞǀĞůŽĨƉƌĂĐƚŝĐĞ ĂĐŚZE͗ ŽŵƉĞƚĞŶƚ WƌŽĨŝĐŝĞŶƚ džƉĞƌƚ  ϭ͘ϯ hƐĞƐǀĂůŝĚĂƚĞĚŽƌĐŽŵŵŽŶůLJĂĐĐĞƉƚĞĚĚĞǀĞůŽƉŵĞŶƚĂů͕ĨƵŶĐƚŝŽŶĂůĂŶĚ y y y ŵĞŶƚĂůƐƚĂƚƵƐĞǀĂůƵĂƚŝŽŶƚŽŽůƐƚŚĂƚĐŽŶƐŝĚĞƌĐƵůƚƵƌĂů͕ĞƚŚŶŝĐĂŶĚůŝĨĞƐƚLJůĞ ĨĂĐƚŽƌƐ  ϭ͘ϯ ǀĂůƵĂƚĞƐĞdžŝƐƚŝŶŐĂŶĚƉŽƚĞŶƚŝĂůĂĐĐĞƐƐƐŝƚĞƐĨŽƌĚĞůŝǀĞƌLJŽĨŶƵƚƌŝƚŝŽŶ  y y ƐƵƉƉŽƌƚƚŚĞƌĂƉLJ;ŝĞ͕ĞŶƚĞƌĂůŶƵƚƌŝƚŝŽŶ΀E΁ŽƌƉĂƌĞŶƚĞƌĂůŶƵƚƌŝƚŝŽŶ΀WE΁Ϳ  ϭ͘ϯ ZĞĐŽŐŶŝnjĞƐ͕ƚƌŽƵďůĞƐŚŽŽƚƐ͕ĂŶĚĐŽŵŵƵŶŝĐĂƚĞƐĐŽŵƉůŝĐĂƚŝŽŶƐŽĨƉĂƌĞŶƚĞƌĂů  y ĂŶĚͬŽƌĞŶƚĞƌĂůŶƵƚƌŝƚŝŽŶĂŶĚͬŽƌĂƐƐŽĐŝĂƚĞĚĂĐĐĞƐƐĚĞǀŝĐĞƐ͖ĂůĞƌƚƐ ĂƉƉƌŽƉƌŝĂƚĞƉĂƚŝĞŶƚĐĂƌĞƐƚĂĨĨŽĨĨŝŶĚŝŶŐƐŝŶĂƚŝŵĞůLJŵĂŶŶĞƌ  ϭ͘ϯ WĞƌĨŽƌŵƐ͕ǁŝƚŚĚŽĐƵŵĞŶƚĞĚƐŬŝůů͕ ĐŽŵƉƌĞŚĞŶƐŝǀĞŶƵƚƌŝƚŝŽŶĨŽĐƵƐĞĚ  y ƉŚLJƐŝĐĂůĞdžĂŵŝŶĐůƵĚŝŶŐĂďĚŽŵŝŶĂůĂŶĚĐŚĞƐƚͬůƵŶŐĞdžĂŵǁŚĞŶĂƉƉƌŽƉƌŝĂƚĞ ϭ͘ϰ &ŽŽĚĂŶĚŶƵƚƌŝƚŝŽŶͲƌĞůĂƚĞĚŚŝƐƚŽƌLJĂƐƐĞƐƐŵĞŶƚ;ŽĨƚĞŶƌĞĨĞƌƌĞĚƚŽĂƐĚŝĞƚĂƌLJ y y y ĂƐƐĞƐƐŵĞŶƚ͗ƐƐĞƐƐĞƐ  ϭ͘ϰ &ŽŽĚĂŶĚŶƵƚƌŝĞŶƚŝŶƚĂŬĞŝŶĐůƵĚŝŶŐ ŝƚƐ ĐŽŵƉŽƐŝƚŝŽŶĂŶĚĂĚĞƋƵĂĐLJ ŽĨĨŽŽĚ y y y ĂŶĚŶƵƚƌŝĞŶƚŝŶƚĂŬĞ͕ŵĞĂůĂŶĚƐŶĂĐŬƉĂƚƚĞƌŶƐ͕ĂŶĚĨŽŽĚĂůůĞƌŐŝĞƐĂŶĚ ŝŶƚŽůĞƌĂŶĐĞƐ  ϭ͘ϰ &ŽŽĚĂŶĚŶƵƚƌŝĞŶƚĂĚŵŝŶŝƐƚƌĂƚŝŽŶŝŶĐůƵĚŝŶŐĐƵƌƌĞŶƚĂŶĚƉƌĞǀŝŽƵƐĚŝĞƚƐ͕ y y y ĚŝĞƚƉƌĞƐĐƌŝƉƚŝŽŶƐĂŶĚĨŽŽĚŵŽĚŝĨŝĐĂƚŝŽŶƐ͕ĞĂƚŝŶŐĞŶǀŝƌŽŶŵĞŶƚ͕ĂŶĚ ĞŶƚĞƌĂůĂŶĚƉĂƌĞŶƚĞƌĂůŶƵƚƌŝƚŝŽŶĂĚŵŝŶŝƐƚƌĂƚŝŽŶ  ϭ͘ϰ DĞĚŝĐĂƚŝŽŶĂŶĚĚŝĞƚĂƌLJĂŶĚŚĞƌďĂůƐƵƉƉůĞŵĞŶƚƵƐĞ ŝŶĐůƵĚŝŶŐ y y y ƉƌĞƐĐƌŝƉƚŝŽŶĂŶĚŽǀĞƌͲƚŚĞͲĐŽƵŶƚĞƌŵĞĚŝĐĂƚŝŽŶƐ͕ŚĞƌďĂůƉƌĞƉĂƌĂƚŝŽŶƐ͕ĂŶĚ ĐŽŵƉůĞŵĞŶƚĂƌLJŵĞĚŝĐŝŶĞƉƌŽĚƵĐƚƐƵƐĞĚ   ϭ͘ϰϭ ZĞĐŽŵŵĞŶĚƐ͕ĂŶĚŝŶĐŽŶƐƵůƚĂƚŝŽŶǁŝƚŚƉŚĂƌŵĂĐŝƐƚ͕ƐƵŐŐĞƐƚƐ  y y ĂůƚĞƌŶĂƚŝǀĞŵĞƚŚŽĚƐ͕ĂƐĂƉƉůŝĐĂďůĞƚŽƚŚĞƐŝƚƵĂƚŝŽŶ͕ƚŽ ŵŝŶŝŵŝnjĞĚƌƵŐͬŶƵƚƌŝĞŶƚŝŶƚĞƌĂĐƚŝŽŶƐƌĞůĂƚĞĚƚŽŶƵƚƌŝƚŝŽŶ ƐƵƉƉŽƌƚƚŚĞƌĂƉLJ͕ŝŶĐůƵĚŝŶŐƌĞǀŝĞǁŽĨƚŚĞǀĞŚŝĐůĞƵƐĞĚĨŽƌĚƌƵŐ ĚĞůŝǀĞƌLJ;ĞŐ͕ƉĂƌĞŶƚĞƌĂůĚƌƵŐƉƌŽĚƵĐƚƐĐŽŶƚĂŝŶŝŶŐŐůƵĐŽƐĞ͕ ůŝƉŝĚƐ͕ƐŽĚŝƵŵͿ   ϭ͘ϰϮ ŽŶƐŝĚĞƌƐƚŚĞŶĞĞĚƚŽĂĚĚŽƌĚŝƐĐŽŶƚŝŶƵĞŵĞĚŝĐĂƚŝŽŶƐƚŚĂƚ  y ŵĂLJĂůƚĞƌŶƵƚƌŝƚŝŽŶƐƚĂƚƵƐ  ϭ͘ϰ ĞĂĚĞƌƐŚŝƉ͕YƵĂůŝƚLJŽĨKƌŐĂŶŝnjĂƚŝŽŶ͕ YƵĂůŝƚLJŽĨWƌĂĐƚŝĐĞ͕ĂŶĚYƵĂůŝƚLJŽĨKƵƚĐŽŵĞƐϭ  ϯ͘ϭ hƚŝůŝnjĞƐƚŚĞŶĞĞĚƐ͕ĞdžƉĞĐƚĂƚŝŽŶƐ͕ ĂŶĚĚĞƐŝƌĞĚŽƵƚĐŽŵĞƐŽĨƚŚĞ ĐƵƐƚŽŵĞƌ;ĞŐ͕ƉĂƚŝĞŶƚͬĐůŝĞŶƚ͕ĂĚŵŝŶŝƐƚƌĂƚŽƌ͕ĐůŝĞŶƚŽƌŐĂŶŝnjĂƚŝŽŶ΀Ɛ΁ͿŝŶ ƉƌŽŐƌĂŵͬƐĞƌǀŝĐĞĚĞǀĞůŽƉŵĞŶƚ   ϯ͘ϭϭ ĞǀĞůŽƉƐŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚƚŚĞƌĂƉLJƐĞƌǀŝĐĞƐͬƉƌŽŐƌĂŵƐƚŽ ĂĐĐŽŵŵŽĚĂƚĞƉĂƚŝĞŶƚͬĐůŝĞŶƚŶĞĞĚƐĂŶĚůŝĨĞƐƚLJůĞƐǁŝƚŚƚŚĞ ĐŽŶƐŝĚĞƌĂƚŝŽŶŽĨĂŶĚŝŶƉƵƚĨƌŽŵĐĂƌĞŐŝǀĞƌƐ͕ǁŚĞŶ ĂƉƉƌŽƉƌŝĂƚĞ   ϯ͘ϭϮ ^LJŶƚŚĞƐŝnjĞƐƚŚĞƌĞƐƵůƚƐĂŶĚŽƵƚĐŽŵĞƐŽĨƚŚĞƐĞƌǀŝĐĞƐĂŶĚ ƉƌŽŐƌĂŵƐƚŽĐƌĞĂƚĞŶĞǁĂŶĚƵŶŝƋƵĞŽĨĨĞƌŝŶŐƐƚŽŵĞĞƚ ƉĂƚŝĞŶƚƐͬĐůŝĞŶƚƐĂŶĚĐĂƌĞŐŝǀĞƌƐŶĞĞĚƐ  ϯ͘ϭ DĂŬĞƐĚĞĐŝƐŝŽŶƐĂŶĚƌĞĐŽŵŵĞŶĚĂƚŝŽŶƐƚŚĂƚƌĞĨůĞĐƚƐƚĞǁĂƌĚƐŚŝƉŽĨ ƚŝŵĞ͕ƚĂůĞŶƚ͕ĨŝŶĂŶĐĞƐ͕ĂŶĚĞŶǀŝƌŽŶŵĞŶƚ  ϯ͘ϭ WƌŽƉŽƐĞƐƉƌŽŐƌĂŵƐĂŶĚƐĞƌǀŝĐĞƐƚŚĂƚĂƌĞĐƵƐƚŽŵĞƌͲĐĞŶƚĞƌĞĚ͕ ĐƵůƚƵƌĂůůLJĂƉƉƌŽƉƌŝĂƚĞ͕ĂŶĚŵŝŶŝŵŝnjĞŚĞĂůƚŚĚŝƐƉĂƌŝƚŝĞƐ Figure 2.  (continued)



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Brantley et al

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/ŶĚŝĐĂƚŽƌƐĨŽƌ^ƚĂŶĚĂƌĚϯ͗WƌŽǀŝƐŝŽŶŽĨ^ĞƌǀŝĐĞƐ ŽůĚ&ŽŶƚ/ŶĚŝĐĂƚŽƌƐĂƌĞĐĂĚĞŵLJŽƌĞZE^ƚĂŶĚĂƌĚƐŽĨWƌŽĨĞƐƐŝŽŶĂů dŚĞ͞y͟ƐŝŐŶŝĨŝĞƐƚŚĞŝŶĚŝĐĂƚŽƌƐĨŽƌ WĞƌĨŽƌŵĂŶĐĞ/ŶĚŝĐĂƚŽƌƐ ƚŚĞůĞǀĞůŽĨƉƌĂĐƚŝĐĞ ĂĐŚZE͗ ŽŵƉĞƚĞŶƚ WƌŽĨŝĐŝĞŶƚ džƉĞƌƚ   ϯ͘ϭϭ ĚĂƉƚƐƉƌĂĐƚŝĐĞƐƚŽŵŝŶŝŵŝnjĞŽƌĞůŝŵŝŶĂƚĞŚĞĂůƚŚĚŝƐƉĂƌŝƚŝĞƐ y y y ĂƐƐŽĐŝĂƚĞĚǁŝƚŚĐƵůƚƵƌĞ͕ƌĂĐĞ͕ŐĞŶĚĞƌ͕ƐŽĐŝŽĞĐŽŶŽŵŝĐ ƐƚĂƚƵƐ͕ĂŐĞ͕ĂŶĚŽƚŚĞƌĨĂĐƚŽƌƐ ϯ͘Ϯ WƌŽŵŽƚĞƐƉƵďůŝĐĂĐĐĞƐƐĂŶĚƌĞĨĞƌƌĂůƚŽĐƌĞĚĞŶƚŝĂůĞĚŶƵƚƌŝƚŝŽŶĂŶĚĚŝĞƚĞƚŝĐƐ y y y ƉƌĂĐƚŝƚŝŽŶĞƌƐĨŽƌƋƵĂůŝƚLJĨŽŽĚ͕ŶƵƚƌŝƚŝŽŶ͕ĂŶĚŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚƚŚĞƌĂƉLJ ƉƌŽŐƌĂŵƐĂŶĚƐĞƌǀŝĐĞƐ  ϯ͘Ϯ ŽŶƚƌŝďƵƚĞƐƚŽŽƌĚĞƐŝŐŶƐƌĞĨĞƌƌĂůƐLJƐƚĞŵƐƚŚĂƚƉƌŽŵŽƚĞĂĐĐĞƐƐƚŽ y y y ƋƵĂůŝĨŝĞĚ͕ĐƌĞĚĞŶƚŝĂůĞĚĚŝĞƚĞƚŝĐƐƉƌĂĐƚŝƚŝŽŶĞƌƐ  ϯ͘Ϯ ĞƐŝŐŶƐƌĞĨĞƌƌĂůƐLJƐƚĞŵƐƚŚĂƚŵĂƚĐŚƋƵĂůŝĨŝĞĚĐƌĞĚĞŶƚŝĂůĞĚZEƐŝŶ  y y ŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚƉƌĂĐƚŝĐĞǁŝƚŚƚŚĞŶĞĞĚƐŽĨƚŚĞƉƵďůŝĐ   ϯ͘Ϯϭ ^LJŶƚŚĞƐŝnjĞƐƌĞƐƵůƚƐŽĨƌĞĨĞƌƌĂůƐƚŽĚĞǀĞůŽƉƉůĂŶƐĨŽƌ   y ŵĞĚŝĐĂůŚŽŵĞŽƌĂĐĐŽƵŶƚĂďůĞĐĂƌĞŐƌŽƵƉǁŝƚŚŝŶƚŚĞ ŽƌŐĂŶŝnjĂƚŝŽŶ  ϯ͘Ϯ ZĞĨĞƌƐƉĂƚŝĞŶƚƐͬĐůŝĞŶƚƐͬĐƵƐƚŽŵĞƌƐƚŽĂƉƉƌŽƉƌŝĂƚĞƉƌŽǀŝĚĞƌƐǁŚĞŶ y y y ƌĞƋƵĞƐƚĞĚƐĞƌǀŝĐĞƐŽƌŝĚĞŶƚŝĨŝĞĚŶĞĞĚƐĞdžĐĞĞĚƚŚĞZE͛ƐŝŶĚŝǀŝĚƵĂů ƐĐŽƉĞŽĨƉƌĂĐƚŝĐĞ   ϯ͘Ϯϭ ZĞĨĞƌƐƉĂƚŝĞŶƚƐͬĐůŝĞŶƚƐͬĐƵƐƚŽŵĞƌƐ ƚŽŽƚŚĞƌŚĞĂůƚŚĐĂƌĞ y y y ƉƌŽĨĞƐƐŝŽŶĂůƐ͕ƐƵĐŚĂƐƐƉĞĞĐŚƉĂƚŚŽůŽŐŝƐƚƐ͕ŚŽŵĞĐĂƌĞ ŶƵƌƐĞƐ͕ƉŚĂƌŵĂĐŝƐƚƐ͕ĂŶĚƐŽĐŝĂůǁŽƌŬĞƌƐ  ϯ͘Ϯ DŽŶŝƚŽƌƐĞĨĨĞĐƚŝǀĞŶĞƐƐŽĨƌĞĨĞƌƌĂůƐLJƐƚĞŵƐĂŶĚŵŽĚŝĨŝĞƐĂƐŶĞĞĚĞĚ y y y ƚŽĂĐŚŝĞǀĞĚĞƐŝƌĂďůĞŽƵƚĐŽŵĞƐ   ϯ͘Ϯϭ ŽĐƵŵĞŶƚƐƚŚĞĞĨĨĞĐƚŝǀĞŶĞƐƐŽĨŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚƌĞĨĞƌƌĂů  y y ƉƌŽĐĞƐƐĞƐĂŶĚƐLJƐƚĞŵƐƵƐŝŶŐĂƋƵĂůŝƚLJŝŵƉƌŽǀĞŵĞŶƚŵŽĚĞů   ϯ͘ϮϮ >ĞĂĚƐŚĞĂůƚŚĐĂƌĞƚĞĂŵƚŽĐƌĞĂƚĞĂƉƉƌŽƉƌŝĂƚĞĐŚĂŶŐĞƐƚŽ   y ĞdžŝƐƚŝŶŐƌĞĨĞƌƌĂůƐLJƐƚĞŵƐ͕ŽƌƚŽĐƌĞĂƚĞŶĞǁŽŶĞƐ ϯ͘ϯ ŽŶƚƌŝďƵƚĞƐƚŽŽƌĚĞƐŝŐŶƐŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚͬĐƵƐƚŽŵĞƌͲĐĞŶƚĞƌĞĚƐĞƌǀŝĐĞƐ y y y  ϯ͘ϯ ƐƐĞƐƐĞƐŶĞĞĚƐ͕ďĞůŝĞĨƐͬǀĂůƵĞƐ͕ŐŽĂůƐ͕ĂŶĚƌĞƐŽƵƌĐĞƐŽĨƚŚĞĐƵƐƚŽŵĞƌ y y y   ϯ͘ϯϭ ƉƉůŝĞƐƉĂƚŝĞŶƚͬĐůŝĞŶƚ ǀĂůƵĞƐĂŶĚŐŽĂůƐƚŽƚŚĞƉƌŽǀŝƐŝŽŶŽĨ y y y ŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚƚŚĞƌĂƉLJ   ϯ͘ϯϮ ŶƚŝĐŝƉĂƚĞƐƚŚĞŶĞĞĚƐ͕ŐŽĂůƐĂŶĚƌĞƐŽƵƌĐĞƐŽĨ  y y ƉĂƚŝĞŶƚƐͬĐůŝĞŶƚƐƌĞĐĞŝǀŝŶŐŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚƚŚĞƌĂƉLJ  ϯ͘ϯ hƚŝůŝnjĞƐŬŶŽǁůĞĚŐĞŽĨƚŚĞĐƵƐƚŽŵĞƌ͛ƐͬƚĂƌŐĞƚƉŽƉƵůĂƚŝŽŶ͛ƐŚĞĂůƚŚ y y y ĐŽŶĚŝƚŝŽŶƐ͕ĐƵůƚƵƌĂůďĞůŝĞĨƐ͕ĂŶĚďƵƐŝŶĞƐƐŽďũĞĐƚŝǀĞƐͬƐĞƌǀŝĐĞƐƚŽŐƵŝĚĞ ĚĞƐŝŐŶĂŶĚĚĞůŝǀĞƌLJŽĨĐƵƐƚŽŵĞƌͲĐĞŶƚĞƌĞĚƐĞƌǀŝĐĞƐ   ϯ͘ϯϭ ƐƚĂďůŝƐŚĞƐƐLJƐƚĞŵĂƚŝĐƉƌŽĐĞƐƐĞƐƚŽŝĚĞŶƚŝĨLJ͕ƚƌĂĐŬ͕ ĂŶĚ  y y ƵƉĚĂƚĞĂǀĂŝůĂďůĞŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚƌĞƐŽƵƌĐĞƐĨŽƌ ƉĂƚŝĞŶƚƐͬĐůŝĞŶƚƐ  ϯ͘ϯ ŽŵŵƵŶŝĐĂƚĞƐƉƌŝŶĐŝƉůĞƐŽĨĚŝƐĞĂƐĞƉƌĞǀĞŶƚŝŽŶĂŶĚďĞŚĂǀŝŽƌĂů y y y ĐŚĂŶŐĞĂƉƉƌŽƉƌŝĂƚĞƚŽƚŚĞĐƵƐƚŽŵĞƌŽƌƚĂƌŐĞƚƉŽƉƵůĂƚŝŽŶ   ϯ͘ϯϭ hŶĚĞƌƐƚĂŶĚƐƚŚĞŽƌĞƚŝĐĂůƐƚƌĂƚĞŐŝĞƐƌĞůĂƚĞĚƚŽďĞŚĂǀŝŽƌ  y y ĐŚĂŶŐĞĂŶĚƐƵƉƉŽƌƚƐƉĂƚŝĞŶƚƐͬĐůŝĞŶƚƐƌĞĂĚŝŶĞƐƐƚŽ ĐŚĂŶŐĞ   ϯ͘ϯϮ ƉƉůŝĞƐďĞŚĂǀŝŽƌĐŚĂŶŐĞƐƚƌĂƚĞŐŝĞƐƚŽƉĂƚŝĞŶƚͬĐůŝĞŶƚ ŐŽĂůͲ   y ƐĞƚƚŝŶŐĂŶĚƚŚĞƌĂƉLJĐŽŵƉůŝĂŶĐĞ  ϯ͘ϯ ŽůůĂďŽƌĂƚĞƐǁŝƚŚƚŚĞĐƵƐƚŽŵĞƌƐƚŽƐĞƚƉƌŝŽƌŝƚŝĞƐ͕ĞƐƚĂďůŝƐŚŐŽĂůƐ͕ y y y ĂŶĚĐƌĞĂƚĞĐƵƐƚŽŵĞƌͲĐĞŶƚĞƌĞĚĂĐƚŝŽŶƉůĂŶƐƚŽĂĐŚŝĞǀĞĚĞƐŝƌĂďůĞ ŽƵƚĐŽŵĞƐ   ϯ͘ϯϭ ŽůůĂďŽƌĂƚĞƐǁŝƚŚŽƚŚĞƌŚĞĂůƚŚĐĂƌĞƉƌŽǀŝĚĞƌƐƚŽĚĞƐŝŐŶ y y y ŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚƚŚĞƌĂƉLJƚŚĂƚƌĞĨůĞĐƚƉĂƚŝĞŶƚ͛ƐͬĐůŝĞŶƚΖƐ ŶĞĞĚƐĂŶĚǁŝƐŚĞƐ Figure 2.  (continued)



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/ŶĚŝĐĂƚŽƌƐĨŽƌ^ƚĂŶĚĂƌĚϯ͗WƌŽǀŝƐŝŽŶŽĨ^ĞƌǀŝĐĞƐ ŽůĚ&ŽŶƚ/ŶĚŝĐĂƚŽƌƐĂƌĞĐĂĚĞŵLJŽƌĞZE^ƚĂŶĚĂƌĚƐŽĨWƌŽĨĞƐƐŝŽŶĂů dŚĞ͞y͟ƐŝŐŶŝĨŝĞƐƚŚĞŝŶĚŝĐĂƚŽƌƐĨŽƌ WĞƌĨŽƌŵĂŶĐĞ/ŶĚŝĐĂƚŽƌƐ ƚŚĞůĞǀĞůŽĨƉƌĂĐƚŝĐĞ ĂĐŚZE͗ ŽŵƉĞƚĞŶƚ WƌŽĨŝĐŝĞŶƚ džƉĞƌƚ  ϯ͘ϯ /ŶǀŽůǀĞƐƉĂƚŝĞŶƚƐͬĐůŝĞŶƚƐͬĐƵƐƚŽŵĞƌƐŝŶĚĞĐŝƐŝŽŶ ŵĂŬŝŶŐ y y y   ϯ͘ϯϭ ĞƐŝŐŶƐŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚƚŚĞƌĂƉLJĂĐĐŽƌĚŝŶŐƚŽ y y y ƉĂƚŝĞŶƚƐ͛ͬĐůŝĞŶƚƐΖŶĞĞĚƐĂŶĚůŝĨĞƐƚLJůĞƐǁŝƚŚĐŽŶƐŝĚĞƌĂƚŝŽŶŽĨ ĂŶĚŝŶƉƵƚĨƌŽŵĐĂƌĞŐŝǀĞƌƐǁŚĞŶĂƉƉƌŽƉƌŝĂƚĞ   ϯ͘ϯϮ 'ƵŝĚĞƐĂŶĚƚĞĂĐŚĞƐƉĂƚŝĞŶƚƐͬĐůŝĞŶƚƐ ĂŶĚƚŚĞŝƌƐƵƉƉŽƌƚ  y y ŶĞƚǁŽƌŬƐŝŶŚĞĂůƚŚĐĂƌĞĚĞĐŝƐŝŽŶŵĂŬŝŶŐĂŶĚŐŽĂůƐĞƚƚŝŶŐƚŽ ŵĂdžŝŵŝnjĞƚŚĞƉŽƐŝƚŝǀĞĞĨĨĞĐƚƐŽĨŝŶƚĞƌǀĞŶƚŝŽŶƐĂŶĚ ŽƵƚĐŽŵĞŵĞĂƐƵƌĞƐ  ϯ͘ϯ& ZĞĐŽŐŶŝnjĞƐƉĂƚŝĞŶƚͬĐůŝĞŶƚĐŽŶĐĞƉƚƐŽĨŝůůŶĞƐƐĂŶĚƚŚĞŝƌĐƵůƚƵƌĂůďĞůŝĞĨƐ y y y   ϯ͘ϯ&ϭ ĚĂƉƚƐƉƌĂĐƚŝĐĞƐƚŽŵĞĞƚƚŚĞŶĞĞĚƐŽĨĐƵůƚƵƌĂůůLJ;ƌĂĐĞ͕ y y y ĞƚŚŶŝĐŝƚLJ͕ĂŐĞͿĚŝǀĞƌƐĞƉŽƉƵůĂƚŝŽŶƐ   ϯ͘ϯ&Ϯ ĚƵĐĂƚĞƐƉĂƚŝĞŶƚƐͬĐůŝĞŶƚƐͬĐŽŶƐƵŵĞƌƐͬĐƵƐƚŽŵĞƌƐĂŶĚŽƚŚĞƌ   y ĐĂƌĞŐŝǀĞƌƐŝŶŵĂŬŝŶŐŝŶĨŽƌŵĞĚĐŚŽŝĐĞƐŝŶƚŚĞƉƌŽǀŝƐŝŽŶŽĨ ŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚĂƐƌĞůĂƚĞĚƚŽĞƚŚŝĐĂůŝƐƐƵĞƐ ϯ͘ϰ džĞĐƵƚĞƐŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚƉƌŽŐƌĂŵƐͬƐĞƌǀŝĐĞƐŝŶĂŶŽƌŐĂŶŝnjĞĚ͕ĐŽůůĂďŽƌĂƚŝǀĞ y y y ĂŶĚĐƵƐƚŽŵĞƌͲĐĞŶƚĞƌĞĚŵĂŶŶĞƌ  ϯ͘ϰ ŽůůĂďŽƌĂƚĞƐĂŶĚĐŽŽƌĚŝŶĂƚĞƐǁŝƚŚƉĞĞƌƐ͕ĐŽůůĞĂŐƵĞƐ͕ĂŶĚǁŝƚŚŝŶ y y y ŝŶƚĞƌĚŝƐĐŝƉůŝŶĂƌLJƚĞĂŵƐ   ϯ͘ϰϭ ZĞǀŝĞǁƐƉĂƚŝĞŶƚͬĐůŝĞŶƚ ĐĂƌĞƉůĂŶǁŝƚŚƚŚĞŝŶƚĞƌĚŝƐĐŝƉůŝŶĂƌLJ y y y ƚĞĂŵĂƚƌĞŐƵůĂƌŝŶƚĞƌǀĂůƐƚŽƉƌŽǀŝĚĞƐĂĨĞ͕ĞĨĨŝĐĂĐŝŽƵƐ͕ĂŶĚ ĞǀŝĚĞŶĐĞͲďĂƐĞĚŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚƚŚĞƌĂƉLJ   ϯ͘ϰϮ 'ĞŶĞƌĂƚĞƐĂƉƉƌŽƉƌŝĂƚĞŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚƚŚĞƌĂƉLJĐĂƌĞ  y y ƉůĂŶƐǁŝƚŚƚŚĞŝŶƚĞƌĚŝƐĐŝƉůŝŶĂƌLJƚĞĂŵƚŽŵĞĞƚƵŶŝƋƵĞŶĞĞĚƐ ŽĨƉĂƚŝĞŶƚƐͬĐůŝĞŶƚƐǁŝƚŚĐŽŵƉůĞdž͕ĐŚƌŽŶŝĐĐŽŶĚŝƚŝŽŶƐ   ϯ͘ϰϯ ^ĞƌǀĞƐĂƐĂƌĞƐŽƵƌĐĞĨŽƌŽƚŚĞƌŚĞĂůƚŚĐĂƌĞƉƌŽǀŝĚĞƌƐŽŶ   y ĞƚŚŝĐĂůŝƐƐƵĞƐƌĞůĂƚĞĚƚŽŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚƚŚĞƌĂƉLJ  ϯ͘ϰ WĂƌƚŝĐŝƉĂƚĞƐŽƌůĞĂĚƐŝŶƚŚĞĚĞƐŝŐŶ͕ĞdžĞĐƵƚŝŽŶ͕ĂŶĚĞǀĂůƵĂƚŝŽŶŽĨ y y y ŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚƉƌŽŐƌĂŵƐĂŶĚƐĞƌǀŝĐĞƐ;ĞŐ͕ŶƵƚƌŝƚŝŽŶƐĐƌĞĞŶŝŶŐ ƐLJƐƚĞŵ͕ŵĞĚŝĐĂůĂŶĚƌĞƚĂŝůĨŽŽĚƐĞƌǀŝĐĞ͕ĞůĞĐƚƌŽŶŝĐŚĞĂůƚŚƌĞĐŽƌĚƐ͕ ŝŶƚĞƌĚŝƐĐŝƉůŝŶĂƌLJƉƌŽŐƌĂŵƐ͕ĐŽŵŵƵŶŝƚLJĞĚƵĐĂƚŝŽŶͿĨŽƌ ƉĂƚŝĞŶƚƐͬĐůŝĞŶƚƐͬĐƵƐƚŽŵĞƌƐ   ϯ͘ϰϭ ŽŽƌĚŝŶĂƚĞƐƉƌŽĐĞƐƐ͕ ǁŝƚŚŝŶƚŚĞŝŶƚĞƌĚŝƐĐŝƉůŝŶĂƌLJŶƵƚƌŝƚŝŽŶ  y y ƐƵƉƉŽƌƚƚĞĂŵŽƌƐĞƌǀŝĐĞ͕ƚŽƌĞǀŝĞǁĂŶĚƌĞǀŝƐĞŶƵƚƌŝƚŝŽŶ ƐƵƉƉŽƌƚƐĐƌĞĞŶŝŶŐƚŽŽůƐĂŶĚƉƌŽĐĞĚƵƌĞƐ   ϯ͘ϰϮ >ĞĂĚƐĂŶŝŶƚĞƌĚŝƐĐŝƉůŝŶĂƌLJŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚƚĞĂŵ͕ƵƐŝŶŐ   y ĞdžƉĞƌƚŬŶŽǁůĞĚŐĞĂŶĚĐƌŝƚŝĐĂůƚŚŝŶŬŝŶŐ͕ƚŽĚĞǀĞůŽƉĂŶĚ ŝŵƉůĞŵĞŶƚŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚƚĞĂŵƐĞƌǀŝĐĞƐĂŶĚƉŽůŝĐŝĞƐ  ϯ͘ϰ ĞǀĞůŽƉƐŽƌĐŽŶƚƌŝďƵƚĞƐƚŽĚĞƐŝŐŶĂŶĚŵĂŝŶƚĞŶĂŶĐĞŽĨŶƵƚƌŝƚŝŽŶ y y y ƐƵƉƉŽƌƚͲƌĞůĂƚĞĚƉŽůŝĐŝĞƐ͕ƉƌŽĐĞĚƵƌĞƐ͕ƉƌŽƚŽĐŽůƐ͕ƐƚĂŶĚĂƌĚƐŽĨĐĂƌĞ͕ ƚĞĐŚŶŽůŽŐLJƌĞƐŽƵƌĐĞƐ͕ĂŶĚƚƌĂŝŶŝŶŐŵĂƚĞƌŝĂůƐƚŚĂƚƌĞĨůĞĐƚĞǀŝĚĞŶĐĞͲ ďĂƐĞĚƉƌĂĐƚŝĐĞŝŶĂĐĐŽƌĚĂŶĐĞǁŝƚŚĂƉƉůŝĐĂďůĞůĂǁƐĂŶĚƌĞŐƵůĂƚŝŽŶƐ   ϯ͘ϰϭ WůĂŶƐĂŶĚŝŵƉůĞŵĞŶƚƐ ƐLJƐƚĞŵƐŽĨĐĂƌĞĂŶĚƐĞƌǀŝĐĞƐĨŽƌ  y y ŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚƚŚĞƌĂƉLJƉƌĞĚŝĐĂƚĞĚŽŶĞǀŝĚĞŶĐĞͲďĂƐĞĚ ƐƚƌĂƚĞŐŝĞƐƚŽƉƌĞǀĞŶƚĂŶĚͬŽƌƚƌĞĂƚĚŝƐĞĂƐĞ   ϯ͘ϰϮ ĞǀĞůŽƉƐĂŶĚͬŽƌƉƌĞƐĞŶƚƐƉƌŽŐƌĂŵƐĞŵƉŚĂƐŝnjŝŶŐƚŚĞƐĂĨĞ  y y ĂŶĚĞĨĨĞĐƚŝǀĞĚĞůŝǀĞƌLJŽĨŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚƚŚĞƌĂƉLJ   ϯ͘ϰϯ >ĞĂĚƐƐLJƐƚĞŵƐŽĨĐĂƌĞĂŶĚƐĞƌǀŝĐĞƐĨŽƌƚŚĞƉƌŽǀŝƐŝŽŶŽĨ   y ŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚƚŚĞƌĂƉŝĞƐ͕ĐŽŽƌĚŝŶĂƚŝŶŐŶƵƚƌŝƚŝŽŶĐĂƌĞ ƐĞƌǀŝĐĞƐǁŝƚŚŽƚŚĞƌĚĞƉĂƌƚŵĞŶƚƐ͕ĂŶĚŚŽŵĞĐĂƌĞ ƐĞƌǀŝĐĞƐ Figure 2.  (continued)



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/ŶĚŝĐĂƚŽƌƐĨŽƌ^ƚĂŶĚĂƌĚϯ͗WƌŽǀŝƐŝŽŶŽĨ^ĞƌǀŝĐĞƐ ŽůĚ&ŽŶƚ/ŶĚŝĐĂƚŽƌƐĂƌĞĐĂĚĞŵLJŽƌĞZE^ƚĂŶĚĂƌĚƐŽĨWƌŽĨĞƐƐŝŽŶĂů dŚĞ͞y͟ƐŝŐŶŝĨŝĞƐƚŚĞŝŶĚŝĐĂƚŽƌƐĨŽƌ WĞƌĨŽƌŵĂŶĐĞ/ŶĚŝĐĂƚŽƌƐ ƚŚĞůĞǀĞůŽĨƉƌĂĐƚŝĐĞ ĂĐŚZE͗ ŽŵƉĞƚĞŶƚ WƌŽĨŝĐŝĞŶƚ džƉĞƌƚ  ϯ͘ϲ WĂƌƚŝĐŝƉĂƚĞƐŝŶ͕ĐŽŶƐƵůƚƐ͕ŽƌůĞĂĚƐŝŶƚĞƌĚŝƐĐŝƉůŝŶĂƌLJƉƌŽĐĞƐƐĨŽƌ y y y ĚĞƚĞƌŵŝŶŝŶŐŶƵƚƌŝƚŝŽŶĂůƐƵƉƉůĞŵĞŶƚƐ͕ĚŝĞƚĂƌLJƐƵƉƉůĞŵĞŶƚƐ͕ĞŶƚĞƌĂů ĂŶĚƉĂƌĞŶƚĞƌĂůŶƵƚƌŝƚŝŽŶĨŽƌŵƵůĂƌŝĞƐĂŶĚĚĞůŝǀĞƌLJƐLJƐƚĞŵƐĨŽƌƚĂƌŐĞƚ ƉŽƉƵůĂƚŝŽŶ;ƐͿ   ϯ͘ϲϭ ĐƚŝǀĞůLJƉĂƌƚŝĐŝƉĂƚĞƐŝŶƚŚĞƉƌŽĐĞƐƐĨŽƌĚĞƚĞƌŵŝŶŝŶŐĞŶƚĞƌĂů y y y ĂŶĚͬŽƌƉĂƌĞŶƚĞƌĂůĨŽƌŵƵůĂƐĂŶĚĚĞůŝǀĞƌLJƐLJƐƚĞŵƐ   ϯ͘ϲϮ ŽůůĞĐƚƐĐŽŶƚŝŶƵŽƵƐƋƵĂůŝƚLJŝŵƉƌŽǀĞŵĞŶƚĚĂƚĂĂŶĚ  y y ƉƌŽǀŝĚĞƐĨĞĞĚďĂĐŬŽŶĐƵƌƌĞŶƚŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚĨŽƌŵƵůĂƌŝĞƐ ĂŶĚĚĞůŝǀĞƌLJƐLJƐƚĞŵƐ   ϯ͘ϲϯ >ĞĂĚƐĚĞĐŝƐŝŽŶͲŵĂŬŝŶŐƉƌŽĐĞƐƐĞƐŝŶĐĂƐĞŽĨƐŚŽƌƚĂŐĞƐĂŶĚ   y ƐƵďƐƚŝƚƵƚŝŽŶƐŶĞĞĚĞĚŝŶĞŶƚĞƌĂůĂŶĚͬŽƌƉĂƌĞŶƚĞƌĂů ĨŽƌŵƵůĂƚŝŽŶƐĂŶĚĚĞůŝǀĞƌLJƐLJƐƚĞŵƐďĂƐĞĚŽŶƉĂƚŝĞŶƚͬĐůŝĞŶƚ ƉŽƉƵůĂƚŝŽŶĂŶĚƐĂĨĞƚLJŝƐƐƵĞƐ ϯ͘ϳ DĂŝŶƚĂŝŶƐƌĞĐŽƌĚƐŽĨƐĞƌǀŝĐĞƐƉƌŽǀŝĚĞĚ y y y  ϯ͘ϳ ŽĐƵŵĞŶƚƐĂĐĐŽƌĚŝŶŐƚŽŽƌŐĂŶŝnjĂƚŝŽŶƉŽůŝĐLJ͕ƐƚĂŶĚĂƌĚƐ͕ĂŶĚƐLJƐƚĞŵ y y y ŝŶĐůƵĚŝŶŐĞůĞĐƚƌŽŶŝĐŚĞĂůƚŚƌĞĐŽƌĚƐ   ϯ͘ϳϭ ĞǀĞůŽƉƐĚŽĐƵŵĞŶƚĂƚŝŽŶͬĚĂƚĂĐŽůůĞĐƚŝŽŶƉƌŽĐĞĚƵƌĞƐ  y y ƐƉĞĐŝĨŝĐĂůůLJƐƵŝƚĂďůĞĨŽƌŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚƚŚĞƌĂƉLJ   ϯ͘ϳϮ ^ƉĞĂƌŚĞĂĚƐĚĞǀĞůŽƉŵĞŶƚŽĨĞůĞĐƚƌŽŶŝĐŽƌŽƚŚĞƌƚŽŽůƐ   y ƐƵŝƚĞĚĨŽƌŵĞĂƐƵƌŝŶŐĂŶĚƌĞƉŽƌƚŝŶŐŽƵƚĐŽŵĞƐŽĨŶƵƚƌŝƚŝŽŶ ƐƵƉƉŽƌƚƚŚĞƌĂƉLJ  ϯ͘ϳ /ŵƉůĞŵĞŶƚƐĚĂƚĂŵĂŶĂŐĞŵĞŶƚƐLJƐƚĞŵƐƚŽƐƵƉƉŽƌƚĚĂƚĂĐŽůůĞĐƚŝŽŶ͕ y y y ŵĂŝŶƚĞŶĂŶĐĞ͕ĂŶĚƵƚŝůŝnjĂƚŝŽŶ  ϯ͘ϳ hƐĞƐĚĂƚĂƚŽĚŽĐƵŵĞŶƚŽƵƚĐŽŵĞƐŽĨƐĞƌǀŝĐĞƐ;ĞŐ͕ƐƚĂĨĨƉƌŽĚƵĐƚŝǀŝƚLJ͕ y y y ĐŽƐƚͬďĞŶĞĨŝƚ͕ďƵĚŐĞƚĐŽŵƉůŝĂŶĐĞ͕ƋƵĂůŝƚLJŽĨƐĞƌǀŝĐĞƐͿĂŶĚƉƌŽǀŝĚĞ ũƵƐƚŝĨŝĐĂƚŝŽŶĨŽƌŵĂŝŶƚĞŶĂŶĐĞŽƌĞdžƉĂŶƐŝŽŶŽĨƐĞƌǀŝĐĞƐ   ϯ͘ϳϭ hƐĞƐĂĐŽŶƚŝŶƵŽƵƐƋƵĂůŝƚLJĂŶĚƉƌŽĐĞƐƐŝŵƉƌŽǀĞŵĞŶƚ  y y ĂƉƉƌŽĂĐŚƚŽŵĞĂƐƵƌĞƵƐĞŽĨŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚƚŚĞƌĂƉLJ ĂŐĂŝŶƐƚŝƚƐŽƵƚĐŽŵĞƐ   ϯ͘ϳϮ ŽŶĚƵĐƚƐĚĂƚĂĂŶĂůLJƐŝƐ͕ĚĞǀĞůŽƉƐƌĞƉŽƌƚŽĨŽƵƚĐŽŵĞƐĂŶĚ   y ŝŵƉƌŽǀĞŵĞŶƚƌĞĐŽŵŵĞŶĚĂƚŝŽŶƐ͕ĂŶĚĚŝƐƐĞŵŝŶĂƚĞƐĨŝŶĚŝŶŐƐ  ϯ͘ϳ hƐĞƐĚĂƚĂƚŽĚĞŵŽŶƐƚƌĂƚĞĐŽŵƉůŝĂŶĐĞǁŝƚŚĂĐĐƌĞĚŝƚĂƚŝŽŶƐƚĂŶĚĂƌĚƐ͕ y y y ůĂǁƐĂŶĚƌĞŐƵůĂƚŝŽŶƐ  ϯ͘ϳ ƐƐĞƐƐĞƐĞĨĨĞĐƚŝǀĞŶĞƐƐŽĨŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚƚŚĞƌĂƉLJŝŶĚŝǀĞƌƐĞ  y y ƉŽƉƵůĂƚŝŽŶƐ ϯ͘ϴ ĚǀŽĐĂƚĞƐĨŽƌƉƌŽǀŝƐŝŽŶŽĨƋƵĂůŝƚLJĨŽŽĚ͕ŶƵƚƌŝƚŝŽŶ͕ĂŶĚŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚ y y y ƐĞƌǀŝĐĞƐĂƐƉĂƌƚŽĨƉƵďůŝĐƉŽůŝĐLJ  ϯ͘ϴ ŽŵŵƵŶŝĐĂƚĞƐǁŝƚŚƉŽůŝĐLJŵĂŬĞƌƐƌĞŐĂƌĚŝŶŐƚŚĞďĞŶĞĨŝƚͬĐŽƐƚŽĨ y y y ƋƵĂůŝƚLJĨŽŽĚ͕ŶƵƚƌŝƚŝŽŶ͕ĂŶĚŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚƐĞƌǀŝĐĞƐ   ϯ͘ϴϭ ĚǀŽĐĂƚĞƐĨŽƌŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚƚŚĞƌĂƉLJĂƚƚŚĞƉŽůŝĐLJůĞǀĞů y y y ;ĞŐĂĚĚƌĞƐƐŝŶŐĚƌƵŐƐŚŽƌƚĂŐĞƐ͕ƌĞŝŵďƵƌƐĞŵĞŶƚͿ   ϯ͘ϴϮ WƌŽŵŽƚĞƐƉƌŽǀŝƐŝŽŶŽĨĂŶĚĂĐĐĞƐƐƚŽŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚ  y y ƚŚĞƌĂƉLJŝŶŚĞĂůƚŚĐĂƌĞŽƌŐĂŶŝnjĂƚŝŽŶƐĂŶĚĂƚŚŽŵĞďLJ ƉĂƌƚŝĐŝƉĂƚŝŶŐŝŶůĞŐŝƐůĂƚŝǀĞĂŶĚƉŽůŝĐLJͲŵĂŬŝŶŐĂĐƚŝǀŝƚŝĞƐƚŚĂƚ ŝŶĨůƵĞŶĐĞŚĞĂůƚŚƐĞƌǀŝĐĞƐĂŶĚƉƌĂĐƚŝĐĞƐ   ϯ͘ϴϯ >ĞĂĚƐĂĚǀŽĐĂĐLJĂĐƚŝǀŝƚŝĞƐͬŝƐƐƵĞƐďLJĂƵƚŚŽƌŝŶŐĂƌƚŝĐůĞƐŽƌ   y ĚĞůŝǀĞƌŝŶŐƉƌĞƐĞŶƚĂƚŝŽŶƐŽŶƚŽƉŝĐƐƌĞůĂƚĞĚƚŽŶƵƚƌŝƚŝŽŶ ƐƵƉƉŽƌƚƚŚĞƌĂƉLJ   ϯ͘ϴϰ WƌŽǀŝĚĞƐƚĞƐƚŝŵŽŶLJĂƚůĞŐŝƐůĂƚŝǀĞĂŶĚƌĞŐƵůĂƚŽƌLJŚĞĂƌŝŶŐƐ   y ĂŶĚŵĞĞƚŝŶŐƐ Figure 2.  (continued)



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/ŶĚŝĐĂƚŽƌƐĨŽƌ^ƚĂŶĚĂƌĚϯ͗WƌŽǀŝƐŝŽŶŽĨ^ĞƌǀŝĐĞƐ ŽůĚ&ŽŶƚ/ŶĚŝĐĂƚŽƌƐĂƌĞĐĂĚĞŵLJŽƌĞZE^ƚĂŶĚĂƌĚƐŽĨWƌŽĨĞƐƐŝŽŶĂů WĞƌĨŽƌŵĂŶĐĞ/ŶĚŝĐĂƚŽƌƐ ĂĐŚZE͗  ϯ͘ϴ ĚǀŽĐĂƚĞƐŝŶƐƵƉƉŽƌƚŽĨĨŽŽĚĂŶĚŶƵƚƌŝƚŝŽŶƉƌŽŐƌĂŵƐĂŶĚƐĞƌǀŝĐĞƐ ĨŽƌƉŽƉƵůĂƚŝŽŶƐǁŝƚŚƐƉĞĐŝĂůŶĞĞĚƐ   ϯ͘ϴϭ ZĞǀŝĞǁƐĞǀŝĚĞŶĐĞͲďĂƐĞĚƌĞƐĞĂƌĐŚƚŽŝĚĞŶƚŝĨLJĂŶĚĂĚǀŽĐĂƚĞ ĨŽƌƐƉĞĐŝĂůŶĞĞĚƐƉŽƉƵůĂƚŝŽŶƐǁŚŽƐĞŚĞĂůƚŚƐƚĂƚƵƐǁŝůů ďĞŶĞĨŝƚĨƌŽŵŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚƚŚĞƌĂƉLJ

dŚĞ͞y͟ƐŝŐŶŝĨŝĞƐƚŚĞŝŶĚŝĐĂƚŽƌƐĨŽƌ ƚŚĞůĞǀĞůŽĨƉƌĂĐƚŝĐĞ ŽŵƉĞƚĞŶƚ WƌŽĨŝĐŝĞŶƚ džƉĞƌƚ y y y y

y

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  džĂŵƉůĞƐŽĨKƵƚĐŽŵĞƐĨŽƌ^ƚĂŶĚĂƌĚϯ͗WƌŽǀŝƐŝŽŶŽĨ^ĞƌǀŝĐĞƐ ͻ WƌŽŐƌĂŵͬƐĞƌǀŝĐĞĚĞƐŝŐŶĂŶĚƐLJƐƚĞŵƐƌĞĨůĞĐƚŽƌŐĂŶŝnjĂƚŝŽŶͬďƵƐŝŶĞƐƐĂŶĚĐƵƐƚŽŵĞƌŶĞĞĚƐĂŶĚĞdžƉĞĐƚĂƚŝŽŶƐ ͻ ƵƐƚŽŵĞƌƐƉĂƌƚŝĐŝƉĂƚĞŝŶĞƐƚĂďůŝƐŚŝŶŐŐŽĂůƐĂŶĚĐƵƐƚŽŵĞƌͲĨŽĐƵƐĞĚĂĐƚŝŽŶƉůĂŶƐ ͻ ƵƐƚŽŵĞƌƐ͛ŶĞĞĚƐĂƌĞŵĞƚ ͻ ƵƐƚŽŵĞƌƐĂƌĞƐĂƚŝƐĨŝĞĚǁŝƚŚƐĞƌǀŝĐĞƐĂŶĚƉƌŽĚƵĐƚƐ ͻ ǀĂůƵĂƚŝŽŶƐƌĞĨůĞĐƚĞdžƉĞĐƚĞĚŽƵƚĐŽŵĞƐ ͻ ĨĨĞĐƚŝǀĞƐĐƌĞĞŶŝŶŐĂŶĚƌĞĨĞƌƌĂůƐĞƌǀŝĐĞƐĂƌĞĞƐƚĂďůŝƐŚĞĚ ͻ ƵƐƚŽŵĞƌƐŚĂǀĞĂĐĐĞƐƐƚŽĨŽŽĚĂƐƐŝƐƚĂŶĐĞ ͻ ƵƐƚŽŵĞƌƐŚĂǀĞĂĐĐĞƐƐƚŽĨŽŽĚĂŶĚŶƵƚƌŝƚŝŽŶƐĞƌǀŝĐĞƐ x ^ƵƉƉŽƌƚƉĞƌƐŽŶŶĞůĂƌĞƐƵƉĞƌǀŝƐĞĚǁŚĞŶƉƌŽǀŝĚŝŶŐŶƵƚƌŝƚŝŽŶĐĂƌĞƚŽĐƵƐƚŽŵĞƌƐ x ƚŚŝĐĂůďŝůůŝŶŐƉƌĂĐƚŝĐĞƐĂƌĞƵƚŝůŝnjĞĚ   ^ƚĂŶĚĂƌĚϰ͗ƉƉůŝĐĂƚŝŽŶŽĨZĞƐĞĂƌĐŚ dŚĞƌĞŐŝƐƚĞƌĞĚĚŝĞƚŝƚŝĂŶŶƵƚƌŝƚŝŽŶŝƐƚ;ZEͿĂƉƉůŝĞƐ͕ƉĂƌƚŝĐŝƉĂƚĞƐŝŶ͕ŽƌŐĞŶĞƌĂƚĞƐƌĞƐĞĂƌĐŚƚŽĞŶŚĂŶĐĞƉƌĂĐƚŝĐĞ͘ǀŝĚĞŶĐĞͲ ďĂƐĞĚƉƌĂĐƚŝĐĞŝŶĐŽƌƉŽƌĂƚĞƐƚŚĞďĞƐƚĂǀĂŝůĂďůĞƌĞƐĞĂƌĐŚͬĞǀŝĚĞŶĐĞŝŶƚŚĞĚĞůŝǀĞƌLJŽĨŶƵƚƌŝƚŝŽŶĂŶĚĚŝĞƚĞƚŝĐƐƐĞƌǀŝĐĞƐ͘ ZĂƚŝŽŶĂůĞ͗ ƉƉůŝĐĂƚŝŽŶ͕ƉĂƌƚŝĐŝƉĂƚŝŽŶ͕ĂŶĚŐĞŶĞƌĂƚŝŽŶŽĨƌĞƐĞĂƌĐŚƉƌŽŵŽƚĞŝŵƉƌŽǀĞĚƐĂĨĞƚLJĂŶĚƋƵĂůŝƚLJŽĨŶƵƚƌŝƚŝŽŶĂŶĚĚŝĞƚĞƚŝĐƐ ƉƌĂĐƚŝĐĞĂŶĚƐĞƌǀŝĐĞƐ͘

  /ŶĚŝĐĂƚŽƌƐĨŽƌ^ƚĂŶĚĂƌĚϰ͗ƉƉůŝĐĂƚŝŽŶŽĨZĞƐĞĂƌĐŚ ŽůĚ&ŽŶƚ/ŶĚŝĐĂƚŽƌƐĂƌĞĐĂĚĞŵLJŽƌĞZE^ƚĂŶĚĂƌĚƐŽĨWƌŽĨĞƐƐŝŽŶĂů WĞƌĨŽƌŵĂŶĐĞ/ŶĚŝĐĂƚŽƌƐ ĂĐŚZE͗ ϰ͘ϭ ĐĐĞƐƐĞƐĂŶĚƌĞǀŝĞǁƐďĞƐƚĂǀĂŝůĂďůĞƌĞƐĞĂƌĐŚͬĞǀŝĚĞŶĐĞĨŽƌĂƉƉůŝĐĂƚŝŽŶƚŽ ƉƌĂĐƚŝĐĞ  ϰ͘ϭ ƌŝƚŝĐĂůůLJĞǀĂůƵĂƚĞƐĐůŝŶŝĐĂůůŝƚĞƌĂƚƵƌĞĂŶĚƌĞƐĞĂƌĐŚĨŝŶĚŝŶŐƐĨŽƌ ĂƉƉůŝĐĂƚŝŽŶƚŽŶƵƚƌŝƚŝŽŶĂŶĚ ĚŝĞƚĞƚŝĐƐƉƌĂĐƚŝĐĞ  ϰ͘ϭ ^ĞĞŬƐĂŶĚŝĚĞŶƚŝĨŝĞƐĞǀŝĚĞŶĐĞĚͲďĂƐĞĚƌĞƐŽƵƌĐĞƐƚŽƐƵƉƉŽƌƚĐƵƌƌĞŶƚ ƉƌĂĐƚŝĐĞ  ϰ͘ϭ ƐƐŝŵŝůĂƚĞƐŶĞǁƌĞƐĞĂƌĐŚŽƵƚĐŽŵĞƐĂŶĚƚƌĂŶƐůĂƚĞƐƌĞƐƵůƚƐŝŶƚŽ ƉƌĂĐƚŝĐĞ  ϰ͘ϭ /ĚĞŶƚŝĨŝĞƐŬĞLJƋƵĞƐƚŝŽŶƐŝŶĐůŝŶŝĐĂůĚĞĐŝƐŝŽŶŵĂŬŝŶŐ͕ĞdžƚƌĂĐƚƐƌĞƐĞĂƌĐŚ͕ ĂŶĚĂĚũƵƐƚƐƉƌĂĐƚŝĐĞďĂƐĞĚŽŶƐƚƌĞŶŐƚŚŽĨƚŚŝƐĞǀŝĚĞŶĐĞ  ϰ͘ϭ >ĞĂĚƐĂƉƉůŝĐĂƚŝŽŶŽĨŶĞǁĞǀŝĚĞŶĐĞŝŶƚŚĞƉƌĂĐƚŝĐĞƐĞƚƚŝŶŐ ϰ͘Ϯ hƚŝůŝnjĞƐďĞƐƚĂǀĂŝůĂďůĞƌĞƐĞĂƌĐŚͬĞǀŝĚĞŶĐĞĂƐƚŚĞĨŽƵŶĚĂƚŝŽŶĨŽƌĞǀŝĚĞŶĐĞͲ ďĂƐĞĚƉƌĂĐƚŝĐĞ  ϰ͘Ϯ hƚŝůŝnjĞƐĞǀŝĚĞŶĐĞͲďĂƐĞĚƚŽŽůƐĂŶĚƌĞƐĞĂƌĐŚǁŚĞŶĚĞƚĞƌŵŝŶŝŶŐ ŶƵƚƌŝƚŝŽŶĚŝĂŐŶŽƐĞƐ͕ŝĚĞŶƚŝĨLJŝŶŐŝŶƚĞƌǀĞŶƚŝŽŶ;ƐͿ͕ĂŶĚŵŽŶŝƚŽƌŝŶŐ ƌĞƐƉŽŶƐĞ Figure 2.  (continued)



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dŚĞ͞y͟ƐŝŐŶŝĨŝĞƐƚŚĞŝŶĚŝĐĂƚŽƌƐĨŽƌ ƚŚĞůĞǀĞůŽĨƉƌĂĐƚŝĐĞ ŽŵƉĞƚĞŶƚ WƌŽĨŝĐŝĞŶƚ džƉĞƌƚ y y y y

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Nutrition in Clinical Practice 29(6)

/ŶĚŝĐĂƚŽƌƐĨŽƌ^ƚĂŶĚĂƌĚϰ͗ƉƉůŝĐĂƚŝŽŶŽĨZĞƐĞĂƌĐŚ ŽůĚ&ŽŶƚ/ŶĚŝĐĂƚŽƌƐĂƌĞĐĂĚĞŵLJŽƌĞZE^ƚĂŶĚĂƌĚƐŽĨWƌŽĨĞƐƐŝŽŶĂů dŚĞ͞y͟ƐŝŐŶŝĨŝĞƐƚŚĞŝŶĚŝĐĂƚŽƌƐĨŽƌ WĞƌĨŽƌŵĂŶĐĞ/ŶĚŝĐĂƚŽƌƐ ƚŚĞůĞǀĞůŽĨƉƌĂĐƚŝĐĞ ĂĐŚZE͗ ŽŵƉĞƚĞŶƚ WƌŽĨŝĐŝĞŶƚ džƉĞƌƚ  ϰ͘Ϯ /ŶĐŽƌƉŽƌĂƚĞƐĞǀŝĚĞŶĐĞͲďĂƐĞĚƌĞƐĞĂƌĐŚŝŶƚŽƉƌĂĐƚŝĐĞĂŶĚŝƐĂďůĞƚŽ  y y ƐƵŵŵĂƌŝnjĞĂŶĚĐŝƚĞƌĞĐĞŶƚůŝƚĞƌĂƚƵƌĞƚŚĂƚƐƵƉƉŽƌƚƐƚŚĞŽƉƚŝŵĂů ĂƉƉƌŽĂĐŚĨŽƌƚŚĞƌŽƵƚŝŶĞƉƌŽǀŝƐŝŽŶŽĨƐĂĨĞ͕ĞĨĨĞĐƚŝǀĞŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚ ƚŚĞƌĂƉLJ  ϰ͘Ϯ /ŶƚĞŐƌĂƚĞƐŝŶƚŽƉƌĂĐƚŝĐĞŬŶŽǁůĞĚŐĞŽĨƚŚĞƌĞƐĞĂƌĐŚĂƐƐŽĐŝĂƚĞĚǁŝƚŚƚŚĞ   y ƐĐŝĞŶĐĞ͕ƉŚLJƐŝŽůŽŐLJ͕ĂŶĚƉĂƚŚŽƉŚLJƐŝŽůŽŐLJŽĨĐŽŵƉůĞdžĚŝƐĞĂƐĞ ƉƌŽĐĞƐƐĞƐ͕ĂŶĚƵƚŝůŝnjĞƐƚŚŝƐŬŶŽǁůĞĚŐĞǁŚĞŶƌĞĐŽŵŵĞŶĚŝŶŐĂŶĚ ƉƌŽǀŝĚŝŶŐŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚƚŚĞƌĂƉLJ ϰ͘ϯ /ŶƚĞŐƌĂƚĞƐďĞƐƚĂǀĂŝůĂďůĞƌĞƐĞĂƌĐŚͬĞǀŝĚĞŶĐĞǁŝƚŚďĞƐƚƉƌĂĐƚŝĐĞƐ͕ĐůŝŶŝĐĂů͕ ĂŶĚ y y y ŵĂŶĂŐĞƌŝĂůĞdžƉĞƌƚŝƐĞ͕ĂŶĚĐƵƐƚŽŵĞƌǀĂůƵĞƐ  ϰ͘ϯ &ĂĐŝůŝƚĂƚĞƐƚŚĞŝŶĐŽƌƉŽƌĂƚŝŽŶŽĨƉŽƉƵůĂƚŝŽŶͲƐƉĞĐŝĨŝĐ͕ ĞǀŝĚĞŶĐĞͲďĂƐĞĚ  y y ƌĞƐĞĂƌĐŚĨŝŶĚŝŶŐƐŝŶƚŽĐůŝŶŝĐĂůƉŽůŝĐŝĞƐĂŶĚƉƌŽĐĞĚƵƌĞƐͬƉƌŽƚŽĐŽůƐ   ϰ͘ϯϭ ƐƐĞƐƐĞƐƐLJƐƚĞŵďĂƌƌŝĞƌƐĂŶĚĨĂĐŝůŝƚĂƚŽƌƐƚŽĂĚŽƉƚŝŽŶŽĨ  y y ĞǀŝĚĞŶĐĞͲďĂƐĞĚƉŽůŝĐŝĞƐĂŶĚƉƌŽĐĞĚƵƌĞƐ   ϰ͘ϯϮ /ŶĐŽƌƉŽƌĂƚĞƐŬŶŽǁůĞĚŐĞŽĨĐƵůƚƵƌĂůĚŝǀĞƌƐŝƚLJǁŚĞŶ  y y ŝŶƚĞŐƌĂƚŝŶŐƌĞƐĞĂƌĐŚŝŶĂƐƉĞĐŝĨŝĐƉĂƚŝĞŶƚͬĐůŝĞŶƚƉŽƉƵůĂƚŝŽŶ   ϰ͘ϯϯ ZĞǀŝĞǁƐƉŽůŝĐŝĞƐĂŶĚƉƌŽĐĞĚƵƌĞƐͬƉƌŽƚŽĐŽůƐĂŶĚƌĞǀŝƐĞƐĂƐ  y y ĂƉƉƌŽƉƌŝĂƚĞ ϰ͘ϰ ŽŶƚƌŝďƵƚĞƐƚŽƚŚĞĚĞǀĞůŽƉŵĞŶƚŽĨŶĞǁŬŶŽǁůĞĚŐĞĂŶĚƌĞƐĞĂƌĐŚŝŶŶƵƚƌŝƚŝŽŶ y y y ĂŶĚĚŝĞƚĞƚŝĐƐ  ϰ͘ϰ ĞŵŽŶƐƚƌĂƚĞƐŬŶŽǁůĞĚŐĞŽĨƚŚĞƐƚĂŶĚĂƌĚƐŽĨƉƌŽĨĞƐƐŝŽŶĂůĂŶĚĞƚŚŝĐĂů y y y ĐŽŶĚƵĐƚĞƐƚĂďůŝƐŚĞĚƚŽŐƵŝĚĞƌĞƐĞĂƌĐŚĞƌƐŝŶƉƌŽƚĞĐƚŝŶŐƚŚĞƌŝŐŚƚƐ͕ ǁĞůůďĞŝŶŐ͕ĂŶĚĚŝŐŶŝƚLJŝŶƚŚĞƌĞĐƌƵŝƚŵĞŶƚĂŶĚƌĞƚĞŶƚŝŽŶŽĨŚƵŵĂŶ ƐƵďũĞĐƚƐŝŶĐůŝŶŝĐĂůƌĞƐĞĂƌĐŚ  ϰ͘ϰ /ĚĞŶƚŝĨŝĞƐŶƵƚƌŝƚŝŽŶƐƵƉƉŽƌƚͲƌĞůĂƚĞĚƌĞƐĞĂƌĐŚƋƵĞƐƚŝŽŶƐĨŽƌĂďƌŽĂĚ y y y ƉĂƚŝĞŶƚͬĐůŝĞŶƚƉŽƉƵůĂƚŝŽŶ  ϰ͘ϰ &ŽƌŵƵůĂƚĞƐĂǁĞůůͲĚĞĨŝŶĞĚƌĞƐĞĂƌĐŚƋƵĞƐƚŝŽŶĨŽƌĂƐƉĞĐŝĨŝĐ  y y ƉĂƚŝĞŶƚͬĐůŝĞŶƚƉŽƉƵůĂƚŝŽŶ  ϰ͘ϰ ĞƐŝŐŶƐĂƌĞƐĞĂƌĐŚƐƚƵĚLJƉƌŽƚŽĐŽůƚŽĂĚĚƌĞƐƐƚŚĞĐůŝŶŝĐĂůƌĞƐĞĂƌĐŚ  y y ƋƵĞƐƚŝŽŶ   ϰ͘ϰϭ /ĚĞŶƚŝĨŝĞƐƚŚĞƚĂƌŐĞƚƉŽƉƵůĂƚŝŽŶ  y y   ϰ͘ϰϮ /ĚĞŶƚŝĨŝĞƐŵĞĂƐƵƌĞƐƚŽďĞĂƉƉůŝĞĚƚŽƚŚĞĐůŝŶŝĐĂůƌĞƐĞĂƌĐŚ  y y ƉƌŽũĞĐƚ   ϰ͘ϰϯ WƌŽƉŽƐĞƐĂƌĞƐĞĂƌĐŚĚĂƚĂĂŶĂůLJƐŝƐƉůĂŶďĂƐĞĚŽŶƉƌŽǀĞŶ  y y ƐƚĂƚŝƐƚŝĐĂůŵĞƚŚŽĚƐ   ϰ͘ϰϰ KďƚĂŝŶƐĂƉƉƌŽǀĂů͕ŝŶĚĞƉĞŶĚĞŶƚůLJ͕ĨƌŽŵƉĞƌƚŝŶĞŶƚŐŽǀĞƌŶŝŶŐ   y ďŽĚŝĞƐ;ĞŐ͕/ŶƐƚŝƚƵƚŝŽŶĂůZĞǀŝĞǁŽĂƌĚ΀/Z΁Ϳ   ϰ͘ϰϱ ŽŵƉĞƚĞƐƐƵĐĐĞƐƐĨƵůůLJĨŽƌƉĞĞƌͲƌĞǀŝĞǁĞĚŐƌĂŶƚƐ   y   ϰ͘ϰϲ KǀĞƌƐĞĞƐĂůůƐƚĞƉƐŽĨƌĞƐĞĂƌĐŚƉƌŽĐĞƐƐĂŶĚĞŶƐƵƌĞƐ   y ĂĚŚĞƌĞŶĐĞƚŽƚŝŵĞůŝŶĞĂŶĚďƵĚŐĞƚ ϰ͘ϱ WƌŽŵŽƚĞƐƌĞƐĞĂƌĐŚƚŚƌŽƵŐŚĂůůŝĂŶĐĞƐĂŶĚĐŽůůĂďŽƌĂƚŝŽŶǁŝƚŚĨŽŽĚĂŶĚ y y y ŶƵƚƌŝƚŝŽŶƉƌĂĐƚŝƚŝŽŶĞƌƐĂŶĚŽƚŚĞƌƉƌŽĨĞƐƐŝŽŶĂůƐĂŶĚŽƌŐĂŶŝnjĂƚŝŽŶƐ  ϰ͘ϱ ŽůůĂďŽƌĂƚĞƐǁŝƚŚƌĞƐĞĂƌĐŚƚĞĂŵƚŽĐŽůůĞĐƚĂŶĚĂŶĂůLJnjĞĚĂƚĂ y y y   ϰ͘ϱϭ ĚǀŽĐĂƚĞƐĨŽƌĂŶĚĚĞǀĞůŽƉƐƚŚĞƵƐĞŽĨĚĂƚĂĐŽůůĞĐƚŝŽŶƚŽŽůƐ  y y   ϰ͘ϱϮ hƚŝůŝnjĞƐĚĂƚĂĂŶĂůLJƐŝƐƐŽĨƚǁĂƌĞĂŶĚͬŽƌĐŽŶƐƵůƚƐǁŝƚŚ  y y ƐƚĂƚŝƐƚŝĐŝĂŶƚŽƉĞƌĨŽƌŵĂƉƉƌŽƉƌŝĂƚĞƐƚĂƚŝƐƚŝĐĂůĂŶĂůLJƐŝƐ  ϰ͘ϱ ĞƐŝŐŶƐĂŶĚͬŽƌŝŵƉůĞŵĞŶƚƐƐƚƵĚŝĞƐǁŝƚŚĂŵƵůƚŝĚŝƐĐŝƉůŝŶĂƌLJƚĞĂŵ  y y  ϰ͘ϱ WĂƌƚŶĞƌƐǁŝƚŚƌĞƐĞĂƌĐŚƚĞĂŵŵĞŵďĞƌƐƚŽĚŝƐƐĞŵŝŶĂƚĞƌĞƐĞĂƌĐŚ y y y ĨŝŶĚŝŶŐƐƚŚƌŽƵŐŚƚŚĞƵƐĞŽĨĚŝĚĂĐƚŝĐƉƌĞƐĞŶƚĂƚŝŽŶƐĂŶĚͬŽƌŵĂŶƵƐĐƌŝƉƚ ƉƌĞƉĂƌĂƚŝŽŶĂŶĚƐƵďŵŝƐƐŝŽŶĨŽƌƉƵďůŝĐĂƚŝŽŶ Figure 2.  (continued)



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Brantley et al

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Figure 2.  (continued)



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Nutrition in Clinical Practice 29(6)

^ƚĂŶĚĂƌĚϱ͗ŽŵŵƵŶŝĐĂƚŝŽŶĂŶĚƉƉůŝĐĂƚŝŽŶŽĨ

American Society for Parenteral and Enteral Nutrition and Academy of Nutrition and Dietetics: Revised 2014 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Nutrition Support.

This 2014 revision of the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for Registered Dietitians Nutritionists (RDNs) ...
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