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Maricopa County, Arizona, anchor to the fastest growing megapolitan area in the United States, is located in a hot desert climate where extreme temperatures are associated with elevated risk of mortality. Continued urbanization in the region will impact atmospheric temperatures and, as a result, potentially affect human health. We aimed

Maricopa County, Arizona, anchor to the fastest growing megapolitan area in the United States, is located in a hot desert climate where extreme temperatures are associated with elevated risk of mortality. Continued urbanization in the region will impact atmospheric temperatures and, as a result, potentially affect human health. We aimed to quantify the number of excess deaths attributable to heat in Maricopa County based on three future urbanization and adaptation scenarios and multiple exposure variables.

Two scenarios (low and high growth projections) represent the maximum possible uncertainty range associated with urbanization in central Arizona, and a third represents the adaptation of high-albedo cool roof technology. Using a Poisson regression model, we related temperature to mortality using data spanning 1983–2007. Regional climate model simulations based on 2050-projected urbanization scenarios for Maricopa County generated distributions of temperature change, and from these predicted changes future excess heat-related mortality was estimated. Subject to urbanization scenario and exposure variable utilized, projections of heat-related mortality ranged from a decrease of 46 deaths per year (− 95%) to an increase of 339 deaths per year (+ 359%).

Projections based on minimum temperature showed the greatest increase for all expansion and adaptation scenarios and were substantially higher than those for daily mean temperature. Projections based on maximum temperature were largely associated with declining mortality. Low-growth and adaptation scenarios led to the smallest increase in predicted heat-related mortality based on mean temperature projections. Use of only one exposure variable to project future heat-related deaths may therefore be misrepresentative in terms of direction of change and magnitude of effects. Because urbanization-induced impacts can vary across the diurnal cycle, projections of heat-related health outcomes that do not consider place-based, time-varying urban heat island effects are neglecting essential elements for policy relevant decision-making.

ContributorsHondula, David M. (Author) / Georgescu, Matei (Author) / Balling, Jr., Robert C. (Author)
Created2014-04-28
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Description

Global environmental change and sustainability science increasingly recognize the need to address the consequences of changes taking place in the structure and function of the biosphere. These changes raise questions such as: Who and what are vulnerable to the multiple environmental changes underway, and where? Research demonstrates that vulnerability is

Global environmental change and sustainability science increasingly recognize the need to address the consequences of changes taking place in the structure and function of the biosphere. These changes raise questions such as: Who and what are vulnerable to the multiple environmental changes underway, and where? Research demonstrates that vulnerability is registered not by exposure to hazards (perturbations and stresses) alone but also resides in the sensitivity and resilience of the system experiencing such hazards. This recognition requires revisions and enlargements in the basic design of vulnerability assessments, including the capacity to treat coupled human–environment systems and those linkages within and without the systems that affect their vulnerability. A vulnerability framework for the assessment of coupled human–environment systems is presented.

Research on global environmental change has significantly improved our understanding of the structure and function of the biosphere and the human impress on both (1). The emergence of “sustainability science” (2–4) builds toward an understanding of the human–environment condition with the dual objectives of meeting the needs of society while sustaining the life support systems of the planet. These objectives, in turn, require improved dialogue between science and decision making (5–8). The vulnerability of coupled human–environment systems is one of the central elements of this dialogue and sustainability research (6, 9–11). It directs attention to such questions as: Who and what are vulnerable to the multiple environmental and human changes underway, and where? How are these changes and their consequences attenuated or amplified by different human and environmental conditions? What can be done to reduce vulnerability to change? How may more resilient and adaptive communities and societies be built?

Answers to these and related questions require conceptual frameworks that account for the vulnerability of coupled human–environment systems with diverse and complex linkages. Various expert communities have made considerable progress in pointing the way toward the design of these frameworks (10, 11). These advances are briefly reviewed here and, drawing on them, we present a conceptual framework of vulnerability developed by the Research and Assessment Systems for Sustainability Program (http://sust.harvard.edu) that produced the set of works in this Special Feature of PNAS. The framework aims to make vulnerability analysis consistent with the concerns of sustainability and global environmental change science. The case study by Turner et al. (12) in this issue of PNAS illustrates how the framework informs vulnerability assessments.

ContributorsTurner II, B. L. (Author) / Kasperson, Roger E. (Author) / Matson, Pamela A. (Author) / McCarthy, James J. (Author) / Corell, Robert W. (Author) / Christensen, Lindsey (Author) / Eckley, Noelle (Author) / Kasperson, Jeanne X. (Author) / Luers, Amy (Author) / Martello, Marybeth L. (Author) / Polsky, Colin (Author) / Pulsipher, Alexander (Author) / Schiller, Andrew (Author)
Created2003-03-07
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Description
Purpose: Patient portals are widely available online applications with many health-related tools that facilitate patient engagement and enhance communication with providers yet are highly underutilized. The purpose of this evidence-based practice (EBP) project was to explore an English and Spanish patient portal educational video's impact on patient engagement in a

Purpose: Patient portals are widely available online applications with many health-related tools that facilitate patient engagement and enhance communication with providers yet are highly underutilized. The purpose of this evidence-based practice (EBP) project was to explore an English and Spanish patient portal educational video's impact on patient engagement in a Federally Qualified Health Center (FQHC). The social cognitive theory underpins the project because patients' portal use behavior can change if changing their environmental factors in the clinic with educational videos. Methods: The Universities Institutional Review Board granted exempt approval to ensure human subject protection. The participants included bilingual adult patients in an FQHC who have access to the internet and email addresses who visited the center during the implementation period. The tablets in the patient rooms displayed the English and Spanish educational video on step-by-step instructions on accessing, using the patient portal, and the benefits of use. The information technology technician pulled aggregate data from the analytics component of the patient portal before and after the four-week implementation period. The data included total number of clinic patients, number of active portal users, number of monthly logins, and gender. The project facilitator used descriptive statistics to compare pre-and post-intervention analytics. Results: Active portal users increased by 0.22% and monthly logins increased by 390 logins. Only aggregate data was collected so the statistical significance was not calculated. Conclusion: This EBP project enhances knowledge on patient portal utilization's impact on patient engagement and may apply to current practice.
Created2022-04-29
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Description
Background/Objective: As a part of the Affordable Care Act of 2010, the Medicare Annual Wellness Visit (AWV) was intended to reduce health disparities and improve health outcomes through providing wellness visits for all Medicare recipients at no cost. However, adoption has been minimal since its inception, particularly in

Background/Objective: As a part of the Affordable Care Act of 2010, the Medicare Annual Wellness Visit (AWV) was intended to reduce health disparities and improve health outcomes through providing wellness visits for all Medicare recipients at no cost. However, adoption has been minimal since its inception, particularly in rural populations Study Design: A top priority of a rural federally qualified healthcare organization (FQHC) was to improve utilization of the AWV due to a patient response well below the national average. A six-week trial was conducted that examined a patient information campaign combined with a strategic workflow that encouraged interoffice collaboration. Methods: The office staff of a pilot medical clinic was selected by the FQHC quality improvement committee as the project site. A Relational Coordination survey (RC) was administered before and after the intervention to determine if the intervention improved interoffice collaboration regarding the AWV. Descriptive questions were used to determine which aspects of the intervention proved useful. Reliability of the survey results was verified by a Crohnbach’s ? > 0.08. An independent samples t test was used with p value < 0.05 to determine statistical significance and confidence intervals. Results: The patient information brochure demonstrated improved patient understanding of the AWV from the office staff perspective as demonstrated by an independent samples t test comparing pre and post survey responses (t(32) = -4.14, p < .001, CI 95%). The RC survey results identified an area for collaborative for improvement between the front office and medical staff.
Created2022-04-29
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Description
Background and Purpose: Across the United States, there are low adherence rates of prenatal care visits, primarily among the low-income and ethnic populations. Inadequate prenatal care education contributes to low appointment adherence and missed prenatal care during their first trimester. The project aim is to assess the current use of paper-based prenatal education

Background and Purpose: Across the United States, there are low adherence rates of prenatal care visits, primarily among the low-income and ethnic populations. Inadequate prenatal care education contributes to low appointment adherence and missed prenatal care during their first trimester. The project aim is to assess the current use of paper-based prenatal education in a Federally Qualified Health Center (FQHC) in southwestern Arizona and inquire if patients would elect to engage in a phone application for prenatal education with appointment reminders. Approach/Methods: The Theory of Planned Behavior was the theoretical framework utilized to guide this project. The Quality Improvement (QI) project gathered information regarding patient technology use and accessibility as well as utilization of FQHC prenatal booklet, collected with a 13-question survey. A non-identifying demographic questionnaire was also distributed during the prenatal visit. Results: Survey responses indicated that patients find utility in prenatal education and appointment reminders provided through a phone application. Out of the total participants (n=23), only 18 had received the prenatal care booklet and completed the entire survey. 80% of participants expressed they would use the phone application while 84% find prenatal education on the phone helpful. In comparison, less than 28% of respondents planned to continue to use the prenatal booklet they were provided at the clinic during their pregnancy. Outcomes: There is potential in utilizing digital platform and appointment reminders at FQHC to improve appointment adherence and early entry to prenatal care. The results will be used to inform FQHC on decisions regarding continuing prenatal booklet use and integration of techbased education formatting.
Created2022-05-02
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Description
Background: People with diabetes are at greater risk for comorbid cardiovascular disease, end stage organ damage, disability, and early death. There is substantial evidence that individualizing self-care education, such as eating a healthy diet, greatly improves diabetes management. Objective: The purpose of this paper is to review the

Background: People with diabetes are at greater risk for comorbid cardiovascular disease, end stage organ damage, disability, and early death. There is substantial evidence that individualizing self-care education, such as eating a healthy diet, greatly improves diabetes management. Objective: The purpose of this paper is to review the outcomes of a diabetes education program offered to underserved women in the Southwestern United States. Methods: Four weekly nutrition classes were individualized and taught at a nonprofit organization in the southwest United States. Behavior change was measured using the Summary of Diabetes Self-Care Activities (SDSCA) tool. Classes were advertised via the center’s monthly class calendar and fliers. A total of nine participants (N=9) came to every class and took the SDSCA survey before and after class instruction. Results: Descriptive statistics and two 2-tailed t-tests with the critical value set at p<0.05 were used for data analysis. The participants were Hispanic women, most between the ages of 40-49, and had an income between $0-14,000. The mean difference between the variables of both general diet and specific diet pre and post-tests were significantly different from zero. The assumptions of normality and homogeneity were met. The results of both two-tailed paired sample t-tests were significant suggesting the means of general and specific diet pre-tests were significantly lower than the means of the general and specific diet post-tests. Discussion: The assumptions of normality and homogeneity were met and the results were significant. The pre-intervention scores for both categories were statistically significantly lower than the post-intervention scores for both categories. Thus, the desired outcome of helping clients within the organization modify, adapt, or change self-care behaviors related to diet was met.
Created2022-04-26
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Description
Background: The cost of health care for end-stage kidney disease patients has exponentially increased over the years, costing 91,000 annually per patient. Peritoneal dialysis has proven to be a cost-effective renal replacement therapy compared to in-center hemodialysis. Quality evidence from a systematic literature review indicates that peritonitis is one of

Background: The cost of health care for end-stage kidney disease patients has exponentially increased over the years, costing 91,000 annually per patient. Peritoneal dialysis has proven to be a cost-effective renal replacement therapy compared to in-center hemodialysis. Quality evidence from a systematic literature review indicates that peritonitis is one of the leading causes of patients' ability to maintain peritoneal dialysis. Evidence suggests that enhanced patient education on infection control practices beyond standard education effectively reduces peritonitis incidents. Methods: Enhanced education on infection control practices was delivered to 18 peritoneal dialysis patients in Southern Arizona through the application of determinants of the Health Belief Model utilizing the principles of the ADKAR framework. Data analysis will be available through facility-specific quality metrics of decreased peritonitis and modality loss episodes. Each of these measures is to have data compared to pre/post-intervention. Results: All participants in the study were able to sustain peritoneal dialysis as their renal replacement therapy. Of the 18 participants, one patient episode of peritonitis occurred three months before the intervention, and zero episodes were reported during the first three months of monthly infection control education. Facility-specific peritonitis and modality loss measures are not available until after project publication. Conclusion: To decrease peritonitis rates and modality loss, the intervention will continue for eight to 12 months to determine success. More time is needed to determine if patients adhere to monthly infection control practices taught during enhanced education.
ContributorsSchneeweis, A. Danielle (Author) / Rauton, Monica (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-04-29
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The City of Phoenix Street Transportation Department partnered with the Rob and Melani Walton Sustainability Solutions Service at Arizona State University (ASU) and researchers from various ASU schools to evaluate the effectiveness, performance, and community perception of the new pavement coating. The data collection and analysis occurred across multiple neighborhoods

The City of Phoenix Street Transportation Department partnered with the Rob and Melani Walton Sustainability Solutions Service at Arizona State University (ASU) and researchers from various ASU schools to evaluate the effectiveness, performance, and community perception of the new pavement coating. The data collection and analysis occurred across multiple neighborhoods and at varying times across days and/or months over the course of one year (July 15, 2020–July 14, 2021), allowing the team to study the impacts of the surface treatment under various weather conditions.

Created2021-09
Description
Islands are some of the smallest contributors to global carbon emissions, yet are among the most vulnerable to the impacts of climate change (e.g. rising sea levels, extreme storms, and declining fish populations due to warming seas). At the same time, due to their smaller scale and local limitations on

Islands are some of the smallest contributors to global carbon emissions, yet are among the most vulnerable to the impacts of climate change (e.g. rising sea levels, extreme storms, and declining fish populations due to warming seas). At the same time, due to their smaller scale and local limitations on resources, island communities have been driving adaptation efforts for responding to the impacts of climate change based on their lived experiences and indigenous knowledge. Recognizing that local community members are in the best position to advance sustainability solutions in their respective island communities, our project sought to uncover best practices of islands that are collaboratively working with their communities to promote sustainable development and adapt to climate change, while leading the way in measuring progress on the SDGs. To this end, we interviewed island leaders from Hawaii, Guam, and Tasmania, who have already launched strategies for achieving these goals, and combined their experiences into a framework requested by other island leaders to encourage locally-driven, culturally-relevant green growth initiatives in partnership with our project partner, the Local2030 Islands Network (Local2030IN). Through designing the framework, we learned 17 possible actions islands can take when developing their own green growth initiative, key insights for implementing the SDGs on islands, and how to work alongside a project partner to create a final deliverable.
Created2021-04-28
Description
Members of the United States Climate Alliance, all of which have committed to the goals of the Paris Agreement, are actively pursuing ways to mitigate climate change. This project is intended to support the integration of agriculture into U.S. state and territory efforts by aiding in the creation of an

Members of the United States Climate Alliance, all of which have committed to the goals of the Paris Agreement, are actively pursuing ways to mitigate climate change. This project is intended to support the integration of agriculture into U.S. state and territory efforts by aiding in the creation of an agricultural policy toolkit for Alliance members in partnership with the American Farmland Trust and the Coalition on Agricultural Greenhouse Gases. My contribution was phase one of the toolkit, for which I created fourteen state profiles of existing efforts related to agriculture and climate change and used these for a comparative analysis. I also developed an outline of the toolkit based on conversations and a list of partner ideas I maintained and drafted an internal protocol to assist in development and implementation. Further, I analyzed the outline using a sustainability framework to identify additional efforts that could strengthen the toolkit’s sustainability. In April 2019 I presented my phase 1 efforts and the toolkit plans alongside my partners at a C-AGG conference. Overall, through this project, I generated forward momentum for integrating and supporting agriculture in climate change efforts
ContributorsHarmon, Anna (Author)
Created2019-05-15