Programs and Communities

Diabetes, a common chronic condition, effects many individuals causing poor quality of life, expensive medical bills, and devastating medical complications. While health care providers try to manage diabetes during short office visits, many patients still struggle to control their diabetes at home. Lack of diabetes self-management (DSM) is a potential barrier for people with diabetes having to maintain healthy hemoglobin A1cs (HgA1c).

In hopes of addressing this concern, an evidenced-based intervention; diabetic education and phone calls, using the chronic care model as its framework was implemented. The intervention targeted people with type II diabetes at a transitional care setting. Measured variables included HgA1c and DSM. Statistically significant improvements were seen in reported physical activity. Average improvements were seen in HgA1c and DSM after three months of diabetes self-management education (DSME). Attrition, cultural sensitivity, and increasing DSME hours should be further evaluated for future projects.

Background and Purpose: Over 30 million people in the United States (U.S.) have diabetes mellitus, which comprises about 9% of the population, and about 90% of individuals with diabetes have type 2 diabetes (Centers for Disease Control and Prevention [CDC], 2017). Adults with type 2 diabetes at a local internal medicine clinic were consistently having high glycated hemoglobin (HbA1C) levels, demonstrated by data collected from the electronic health record (EHR), and there was no ordering process for referring patients to diabetes management education and support (DSMES) services. The purpose of this project was to improve glycemic control, demonstrated by lower HbA1C levels, and reach a diabetes education attendance rate of 62.5% at an internal medicine clinic in Chandler, Arizona.

Methods: An electronic health record (EHR) template was created and brief staff training was completed to connect patients with diabetes in the community to a local formal diabetes education program. HbA1C levels were measured before and three months after adults with education program. HbA1C levels were measured before and three months after adults with type 2 diabetes mellitus (T2DM) received physicians’ orders for a DSMES program, and rates of attendance to the program were calculated. Data was collected through the EHR and through feedback from the DSMES program. Descriptive statistics were used in data analysis.

Outcomes: The participants’ results did not demonstrate significant differences in pre-referral and post-referral HbA1C results after they were ordered DSMES services (p = .506). The proportion of education attendance (30%) was lower than the project goal of 62.5%, but increased from the clinic baseline.

Conclusions: EHR template implementation for referral to DSMES may increase rates of formal diabetes education and improve glycemic control. Larger sample sizes, longer project periods, alternative methods of communication, and increased follow-up of participants may be required to produce significant results.

Background: The global prevalence of all types of diabetes increased from 108 million in 1980 to 422 million in 2014 (Nazir et al., 2018). The Centers for Disease Control and Prevention (2017) ranks diabetes as the 7th leading cause of death in the United States with an estimated annual expense of $327 billion. Within the rural setting, patients typically have less resources available for the treatment and self-management of their diseases. It is important to explore self-management techniques that can be utilized by patients with type 2 diabetes living in rural areas. Research demonstrating the importance of education, exercise, diet, glucose monitoring, medications, and supportive measures is prominent throughout the literature.

Objective: The purpose of this Doctor of Nursing Practice (DNP) applied project is to investigate the effects of delivering biweekly text messages containing diabetes self-management education (DSME) materials to patients in an effort to support successful self-care.

Methods: During an 8 week period, DSME was provided via text messaging, bi-weekly (Sunday and Wednesday), to 23 rural participants with type 2 diabetes, in a family clinic in Payson, Arizona. Participants were asked to complete the Skills, Confidence, and Preparedness Index both pre- and post-intervention to evaluate their knowledge of diabetes self-management.

Results: Twenty-three adults aged 52 to 78 years (M = 64.91) participated in the project. Of the participants, 57% (13/23) were female. The majority of participants had T2DM diagnosis less than 10 years (M=13.8 years). There was a statistical difference between the pre- and post-Skills, Confidence and Preparedness Index questionnaire (p < .001) indicating an improvement in self-efficacy scores post- intervention.

Conclusion: DSME delivered via text message is a cost-effective way to increase patients' self-efficacy and potentially improve their ability to successfully self-manage their disease.

The urban thermal environment varies not only from its rural surroundings but also within the urban area due to intra-urban differences in land-use and surface characteristics. Understanding the causes of this intra-urban variability is a first step in improving urban planning and development. Toward this end, a method for quantifying causes of spatial variability in the urban heat island has been developed. This paper presents the method as applied to a specific test case of Portland, Oregon. Vehicle temperature traverses were used to determine spatial differences in summertime ~2 m air temperature across the metropolitan area in the afternoon. A tree-structured regression model was used to quantify the land-use and surface characteristics that have the greatest influence on daytime UHI intensity. The most important urban characteristic separating warmer from cooler regions of the Portland metropolitan area was canopy cover. Roadway area density was also an important determinant of local UHI magnitudes. Specifically, the air above major arterial roads was found to be warmer on weekdays than weekends, possibly due to increased anthropogenic activity from the vehicle sector on weekdays. In general, warmer regions of the city were associated with industrial and commercial land-use. The downtown core, whilst warmer than the rural surroundings, was not the warmest part of the Portland metropolitan area. This is thought to be due in large part to local shading effects in the urban canyons.

Modeling results incorporating several distinct urban expansion futures for the United States in 2100 show that, in the absence of any adaptive urban design, megapolitan expansion, alone and separate from greenhouse gas-induced forcing, can be expected to raise near-surface temperatures 1–2 °C not just at the scale of individual cities but over large regional swaths of the country. This warming is a significant fraction of the 21st century greenhouse gas-induced climate change simulated by global climate models. Using a suite of regional climate simulations, we assessed the efficacy of commonly proposed urban adaptation strategies, such as green, cool roof, and hybrid approaches, to ameliorate the warming. Our results quantify how judicious choices in urban planning and design cannot only counteract the climatological impacts of the urban expansion itself but also, can, in fact, even offset a significant percentage of future greenhouse warming over large scales. Our results also reveal tradeoffs among different adaptation options for some regions, showing the need for geographically appropriate strategies rather than one size fits all solutions.

Because of a projected surge of several billion urban inhabitants by mid-century, a rising urgency exists to advance local and strategically deployed measures intended to ameliorate negative consequences on urban climate (e.g., heat stress, poor air quality, energy/water availability). Here we highlight the importance of incorporating scale-dependent built environment induced solutions within the broader umbrella of urban sustainability outcomes, thereby accounting for fundamental physical principles. Contemporary and future design of settlements demands cooperative participation between planners, architects, and relevant stakeholders, with the urban and global climate community, which recognizes the complexity of the physical systems involved and is ideally fit to quantitatively examine the viability of proposed solutions. Such participatory efforts can aid the development of locally sensible approaches by integrating across the socioeconomic and climatic continuum, therefore providing opportunities facilitating comprehensive solutions that maximize benefits and limit unintended consequences.

The spatial configuration of cities can affect how urban environments alter local energy balances. Previous studies have reached the paradoxical conclusions that both sprawling and high-density urban development can amplify urban heat island intensities, which has prevented consensus on how best to mitigate the urban heat island effect via urban planning. To investigate this apparent dichotomy, we estimated the urban heat island intensities of the 50 most populous cities in the United States using gridded minimum temperature data sets and quantified each city's urban morphology with spatial metrics. The results indicated that the spatial contiguity of urban development, regardless of its density or degree of sprawl,was a critical factor that influenced the magnitude of the urban heat island effect. A ten percentage point increase in urban spatial contiguity was predicted to enhance the minimum temperature annual average urban heat island intensity by between 0.3 and 0.4 °C. Therefore, city contiguity should be considered when devising strategies for urban heat island mitigation, with more discontiguous development likely to ameliorate the urban heat island effect. Unraveling how urban morphology influences urban heat island intensity is paramount given the human health consequences associated with the continued growth of urban populations in the future.

Outdoor human comfort is determined for the remodelled downtown of Tempe, Arizona, USA, an acclaimed example of New Urbanist infill. The authors desired to know whether changes were accompanied by more comfortable conditions, especially in hot, dry summer months. The physiological equivalent temperature provided an assessment of year-round outdoor human comfort. Building compactness and tree shade that became part of the changes in the downtown provided more overall daytime human comfort than open nearby streets; however some downtown sites were less comfortable at night, but below 40°C, a threshold for human comfort in this desert environment.

We examined the horizontal and vertical nocturnal cooling influence of a small park with irrigated lawn and xeric surfaces (∼3 ha) within a university campus of a hot arid city. Temperature data from 0.01- to 3-m heights observed during a bicycle traverse of the campus were combined with modeled spatial temperature data simulated from a three-dimensional microclimate model (ENVI-met 3.1). A distinct park cool island, with mean observed magnitudes of 0.7–3.6°C, was documented for both traverse and model data with larger cooling intensities measured closer to surface level. Modeled results possessed varying but generally reasonable accuracy in simulating both spatial and temporal temperature data, although some systematic errors exist. A combination of several factors, such as variations in surface thermal properties, urban geometry, building orientation, and soil moisture, was likely responsible for influencing differential urban and non-urban near-surface temperatures. A strong inversion layer up to 1 m over non-urban surfaces was detected, contrasting with near-neutral lapse rates over urban surfaces. A key factor in the spatial expansion of the park cool island was the advection of cooler park air to adjacent urban surfaces, although this effect was mostly concentrated from 0- to 1-m heights over urban surfaces that were more exposed to the atmosphere.

Field observations were carried out to determine the influence of a park on the urban summer climate in the nearby areas. The possibilities of reduction in air conditioning energy were investigated. Air temperature, relative humidity and other meteorological factors were measured at many locations inside a park and in the surrounding areas in the Tama New Town, a city in the west of the Tokyo Metropolitan Area, Japan. The observations indicated that vegetation could significantly alter the climate in the town. At noon, the highest temperature of the ground surface of the grass field in the park was 40.3 °C, which was 19 °C lower than that of the asphalt surface or 15 °C lower than that of the concrete surface in the parking or commercial areas. At the same time, air temperature measured at 1.2 m above the ground at the grass field inside the park was more than 2 °C lower than that measured at the same height in the surrounding commercial and parking areas. Soon after sunset, the temperature of the ground surface at the grass field in the park became lower than that of the air, and the park became a cool island whereas paved asphalt or concrete surfaces in the town remained hotter than the overlying air even late at night. With a size of about 0.6 km2, at noon, the park can reduce by up to 1.5 °C the air temperature in a busy commercial area 1 km downwind. This can lead to a significant decrease of in air conditioning energy in the commercial area.