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 heat island effect is especially significant in semi-arid climates, generating a myriad of problems for large urban areas. Green space can mitigate warming, providing cooling benefits important to reducing energy consumption and improving human health. The arrangement of green space to reap the full potential of cooling benefits is a challenge, especially considering the diurnal variations of urban heat island effects. Surprisingly, methods that support the strategic placement of green space in the context of urban heat island are lacking. Integrating geographic information systems, remote sensing, spatial statistics and spatial optimization, we developed a framework to identify the best locations and configuration of new green space with respect to cooling benefits. The developed multi-objective model is applied to evaluate the diurnal cooling trade-offs in Phoenix, Arizona. As a result of optimal green space placement, significant cooling potentials can be achieved. A reduction of land surface temperature of approximately 1–2 °C locally and 0.5 °C regionally can be achieved by the addition of new green space. 96% of potential day and night cooling benefits can be achieved through simultaneous consideration. The results also demonstrate that clustered green space enhances local cooling because of the agglomeration effect; whereas, dispersed patterns lead to greater overall regional cooling. The optimization based framework can effectively inform planning decisions with regard to green space allocation to best ameliorate excessive heat.

Engineered pavements cover a large fraction of cities and offer significant potential for urban heat island mitigation. Though rapidly increasing research efforts have been devoted to the study of pavement materials, thermal interactions between buildings and the ambient environment are mostly neglected. In this study, numerical models featuring a realistic representation of building-environment thermal interactions, were applied to quantify the effect of pavements on the urban thermal environment at multiple scales. It was found that performance of pavements inside the canyon was largely determined by the canyon geometry. In a high-density residential area, modifying pavements had insignificant effect on the wall temperature and building energy consumption. At a regional scale, various pavement types were also found to have a limited cooling effect on land surface temperature and 2-m air temperature for metropolitan Phoenix. In the context of global climate change, the effect of pavement was evaluated in terms of the equivalent CO2 emission. Equivalent CO2 emission offset by reflective pavements in urban canyons was only about 13.9e46.6% of that without building canopies, depending on the canyon geometry. This study revealed the importance of building-environment thermal interactions in determining thermal conditions inside the urban canopy.

We use the Northeast US Urban Climate Archipelago as a case study to explore three key limitations of planning and policy initiatives to mitigate extreme urban heat. These limitations are: (1) a lack of understanding of spatial considerations—for example, how nearby urban areas interact, affecting, and being affected by, implementation of such policies; (2) an emphasis on air temperature reduction that neglects assessments of other important meteorological parameters, such as humidity, mixing heights, and urban wind fields; and (3) too narrow of a temporal focus—either time of day, season, or current vs. future climates. Additionally, the absence of a direct policy/planning linkage between heat mitigation goals and actual human health outcomes, in general, leads to solutions that only indirectly address the underlying problems. These issues are explored through several related atmospheric modeling case studies that reveal the complexities of designing effective urban heat mitigation strategies. We conclude with recommendations regarding how policy-makers can optimize the performance of their urban heat mitigation policies and programs. This optimization starts with a thorough understanding of the actual end-point goals of these policies, and concludes with the careful integration of scientific knowledge into the development of location-specific strategies that recognize and address the limitations discussed herein.

Urban Heat Island (UHI) has significant impacts on the buildings energy consumption and outdoor air quality (OAQ). Various approaches, including observation and simulation techniques, have been proposed to understand the causes of UHI formation and to find the corresponding mitigation strategies. However, the causes of UHI are not the same in different climates or city features. Thus, general conclusion cannot be made based on limited monitoring data.

With recent progress in computational tools, simulation methods have been used to study UHI. These approaches, however, are also not able to cover all the phenomena that simultaneously contribute to the formation of UHI. The shortcomings are mostly attributed to the weakness of the theories and computational cost.

This paper presents a review of the techniques used to study UHI. The abilities and limitations of each approach for the investigation of UHI mitigation and prediction are discussed. Treatment of important parameters including latent, sensible, storage, and anthropogenic heat in addition to treatment of radiation, effect of trees and pond, and boundary condition to simulate UHI is also presented. Finally, this paper discusses the application of integration approach as a future opportunity.

The City of Phoenix (Arizona, USA) developed a Tree and Shade Master Plan and a Cool Roofs initiative to ameliorate extreme heat during the summer months in their arid city. This study investigates the impact of the City's heat mitigation strategies on daytime microclimate for a pre-monsoon summer day under current climate conditions and two climate change scenarios. We assessed the cooling effect of trees and cool roofs in a Phoenix residential neighborhood using the microclimate model ENVI-met. First, using xeric landscaping as a base, we created eight tree planting scenarios (from 0% canopy cover to 30% canopy cover) for the neighborhood to characterize the relationship between canopy cover and daytime cooling benefit of trees. In a second set of simulations, we ran ENVI-met for nine combined tree planting and landscaping scenarios (mesic, oasis, and xeric) with regular roofs and cool roofs under current climate conditions and two climate change projections. For each of the 54 scenarios, we compared average neighborhood mid-afternoon air temperatures and assessed the benefits of each heat mitigation measure under current and projected climate conditions. Findings suggest that the relationship between percent canopy cover and air temperature reduction is linear, with 0.14 °C cooling per percent increase in tree cover for the neighborhood under investigation. An increase in tree canopy cover from the current 10% to a targeted 25% resulted in an average daytime cooling benefit of up to 2.0 °C in residential neighborhoods at the local scale. Cool roofs reduced neighborhood air temperatures by 0.3 °C when implemented on residential homes. The results from this city-specific mitigation project will inform messaging campaigns aimed at engaging the city decision makers, industry, and the public in the green building and urban forestry initiatives.

Rapid urbanization of the planet is occurring at an unprecedented pace, primarily in arid and semi-arid hot climates [Golden, J.S., 2004. The built environment induced urban heat island effect in rapidly urbanizing arid regions – a sustainable urban engineering complexity. Environ. Sci. J. Integr. Environ. Res. 1 (4), 321–349]. This growth has manifested itself as a cause of various impacts including elevated urban temperatures in comparison to rural sites known as the Urban Heat Island (UHI) effect [Oke, T.R., 1982. The energetic basis of the urban heat island. Q. J. R. Meteor. Soc. 108, 1–24]. Related are the increased demands for electric power as a result of population growth and increased need for mechanical cooling due to the UHI. In the United States, the Environmental Protection Agency has developed a three-prong approach of (1) cool pavements, (2) urban forestry and (3) cool roofs to mitigate the UHI. Researchers undertook an examination of micro scale benefits of the utilization of photovoltaic panels to reduce the thermal impacts to surface temperatures of pavements in comparison to urban forestry. The results of the research indicate that photovoltaic panels provide a greater thermal reduction benefit during the diurnal cycle in comparison to urban forestry while also providing the additional benefits of supporting peak energy demand, conserving water resources and utilizing a renewable energy source.