Matching Items (65)
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Problem Statement: The onset of the COVID-19 pandemic led to intense challenges for health care providers. Outpatient primary care practices rapidly moved from in-person practice to video-conferencing telehealth appointments. This shift requires study, particularly how this has impacted the lived experience of providers. Purpose: This project aims to explore primary

Problem Statement: The onset of the COVID-19 pandemic led to intense challenges for health care providers. Outpatient primary care practices rapidly moved from in-person practice to video-conferencing telehealth appointments. This shift requires study, particularly how this has impacted the lived experience of providers. Purpose: This project aims to explore primary care provider satisfaction with telehealth in the wake of the COVID-19 pandemic. Methods: A point-in-time survey was administered to primary care providers at a large university health system. Participants were recruited at a monthly provider meeting and invited to complete an anonymous online survey. Satisfaction with video-conferencing patient visits was explored via Likert scale and write-in responses. Providers highlighted specific complaints, problems, and successes that impacted their practice and patients. Aggregate health data from this organization was also obtained for comparison. Statistical analysis was performed and recommendations made for future practice. Findings: The provider experience of telehealth was overwhelmingly positive. 85% (n=11) of providers agreed or strongly agreed that telehealth allows them to manage their patients effectively. Lack of physical exam findings was the most commonly cited concern (n=9). 100% (n=13) of providers would like to continue seeing patients via telehealth in the future. Conclusion: Videoconferencing appointments in university health primary care promote high provider satisfaction. Future policies and innovations should support the use of a telehealth platform.
ContributorsMcKernan, M. Katherine (Author) / Nunez, Diane (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-04-29
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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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This dissertation research studies long-term spatio-temporal patterns of surface urban heat island (SUHI) intensity, urban evapotranspiration (ET), and urban outdoor water use (OWU) using Phoenix metropolitan area (PMA), Arizona as the case study. This dissertation is composed of three chapters. The first chapter evaluates the SUHI intensity for PMA using

This dissertation research studies long-term spatio-temporal patterns of surface urban heat island (SUHI) intensity, urban evapotranspiration (ET), and urban outdoor water use (OWU) using Phoenix metropolitan area (PMA), Arizona as the case study. This dissertation is composed of three chapters. The first chapter evaluates the SUHI intensity for PMA using Moderate Resolution Imaging Spectroradiometer (MODIS) land surface temperature (LST) product and a time-series trend analysis to discover areas that experienced significant changes of SUHI intensity between 2000 and 2017. The heating and cooling effects of different urban land use land cover (LULC) types was also examined using classified Landsat satellite images. The second chapter is focused on urban ET and the impacts of urban LULC change on ET. An empirical model of urban ET for PMA was built using flux tower data and MODIS land products using multivariate regression analysis. A time-series trend analysis was then performed to discover areas in PMA that experienced significant changes of ET between 2001 and 2015. The impact of urban LULC change on ET was examined using classified LULC maps. The third chapter models urban OWU in PMA using a surface energy balance model named METRIC (Mapping Evapotranspiration at high spatial Resolution with Internalized Calibration) and time-series Landsat Thematic Mapper 5 imagery for 2010. The relationship between urban LULC types and OWU was examined with the use of very high-resolution land cover classification data generated from the National Agriculture Imagery Program (NAIP) imagery and regression analysis. Socio-demographic variables were selected from census data at the census track level and analyzed against OWU to study their relationship using correlation analysis. This dissertation makes significant contributions and expands the knowledge of long-term urban climate dynamics for PMA and the influence of urban expansion and LULC change on regional climate. Research findings and results can be used to provide constructive suggestions to urban planners, decision-makers, and city managers to formulate new policies and regulations when planning new constructions for the purpose of sustainable development for a desert city.
ContributorsWang, Chuyuan (Author) / Myint, Soe W. (Thesis advisor) / Brazel, Anthony J. (Committee member) / Wang, Zhihua (Committee member) / Hondula, David M. (Committee member) / Arizona State University (Publisher)
Created2018
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Many coastal cities around the world are becoming increasingly vulnerable to natural disasters, particularly flooding driven by tropical storm and hurricane storm surge – typically the most destructive feature of these storms, generating significant economic damage and loss of life. This increase in vulnerability is driven by the interactions between

Many coastal cities around the world are becoming increasingly vulnerable to natural disasters, particularly flooding driven by tropical storm and hurricane storm surge – typically the most destructive feature of these storms, generating significant economic damage and loss of life. This increase in vulnerability is driven by the interactions between a wide number of complex social and climatic factors, including population growth, irresponsible urban development, a decrease in essential service provision, sea level rise, and changing storm regimes. These issues are exacerbated by the short-term strategic planning that dominates political action and economic decision-making, resulting in many vulnerable coastal communities being particularly unprepared for large, infrequent storm surge events. This lack of preparedness manifests in several ways, but one of the most visible is the lack of comprehensive evacuation and rescue operation plans for use after major storm surge flooding occurs. Typical evacuation or rescue plans are built using a model of a region’s intact road network. While useful for pre-disaster purposes, the immediate aftermath of large floods sees enormous swaths of a given region’s road system flooded, rendering most of these plans largely useless. Post-storm evacuation and rescue requires large amounts of atypical travel through a region (i.e., across non-road surfaces). Traditional road network models (such as those that are used to generate evacuation routes) are unable to conceptualize this type of transportation, and so are of limited utility during post-disaster scenarios. To solve these problems, this dissertation introduces an alternative network conceptualization that preserves important on-network information but also accounts for the possibility of off-network travel during a disaster. Providing this in situ context is necessary to adequately model transportation through a post-storm landscape, one in which evacuees and rescuers are regularly departing from roads and one in which many roads are completely interdicted by flooding. This modeling approach is used to automatically generate routes through a flooded coastal urban area, as well as to identify potentially critical road segments in advance of an actual storm. These tools may help both emergency managers better prepare for large storms, and urban planners in their efforts to mitigate flood damage.

ContributorsHelderop, Edward (Author) / Grubesic, Tony H. (Thesis advisor) / Kuby, Mike (Committee member) / Hondula, David M. (Committee member) / Arizona State University (Publisher)
Created2019
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Environmental heat is a growing concern in cities as a consequence of rapid urbanization and climate change, threatening human health and urban vitality. The transportation system is naturally embedded in the issue of urban heat and human heat exposure. Research has established how heat poses a threat to urban inhabitants

Environmental heat is a growing concern in cities as a consequence of rapid urbanization and climate change, threatening human health and urban vitality. The transportation system is naturally embedded in the issue of urban heat and human heat exposure. Research has established how heat poses a threat to urban inhabitants and how urban infrastructure design can lead to increased urban heat. Yet there are gaps in understanding how urban communities accumulate heat exposure, and how significantly the urban transportation system influences or exacerbates the many issues of urban heat. This dissertation focuses on advancing the understanding of how modern urban transportation influences urban heat and human heat exposure through three research objectives: 1) Investigate how human activity results in different outdoor heat exposure; 2) Quantify the growth and extent of urban parking infrastructure; and 3) Model and analyze how pavements and vehicles contribute to urban heat.

In the urban US, traveling outdoors (e.g. biking or walking) is the most frequent activity to cause heat exposure during hot periods. However, outdoor travel durations are often very short, and other longer activities such as outdoor housework and recreation contribute more to cumulative urban heat exposure. In Phoenix, parking and roadway pavement infrastructure contributes significantly to the urban heat balance, especially during summer afternoons, and vehicles only contribute significantly in local areas with high density rush hour vehicle travel. Future development of urban areas (especially those with concerns of extreme heat) should focus on ensuring access and mobility for its inhabitants without sacrificing thermal comfort. This may require urban redesign of transportation systems to be less auto-centric, but without clear pathways to mitigating impacts of urban heat, it may be difficult to promote transitions to travel modes that inherently necessitate heat exposure. Transportation planners and engineers need to be cognizant of the pathways to increased urban heat and human heat exposure when planning and designing urban transportation systems.

ContributorsHoehne, Christopher Glenn (Author) / Chester, Mikhail V (Thesis advisor) / Hondula, David M. (Committee member) / Sailor, David (Committee member) / Pendyala, Ram M. (Committee member) / Arizona State University (Publisher)
Created2019
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This study investigated the effect of environmental heat stress on physiological and performance measures during a ~4 mi time trial (TT) mountain hike in the Phoenix metropolitan area. Participants (n = 12; 7M/5F; age 21.6 ± 2.47 [SD]) climbed ‘A’ mountain (~1 mi) four times on a hot day (HOT;

This study investigated the effect of environmental heat stress on physiological and performance measures during a ~4 mi time trial (TT) mountain hike in the Phoenix metropolitan area. Participants (n = 12; 7M/5F; age 21.6 ± 2.47 [SD]) climbed ‘A’ mountain (~1 mi) four times on a hot day (HOT; wet bulb globe temperature [WBGT] = 31.6°C) and again on a moderate day (MOD; WBGT = 19.0°C). Physiological and performance measures were made before and throughout the course of each hike. Mean pre-hike hydration status (urine specific gravity [USG]) indicated that participants began both HOT and MOD trials in a euhydrated state (1.016 ± 0.010 and 1.010 ± 0.008, respectively) and means did not differ significantly between trials (p = .085). Time trial performance was impaired by -11% (11.1 minutes) in the HOT trial (105 ± 21.7 min), compared to MOD (93.9 ± 13.1 min) (p = .013). Peak core temperatures were significantly higher in HOT (38.5 ± 0.36°C) versus MOD (38.0 ± 0.30°C) with progressively increasing differences between trials over time (p < .001). Peak ratings of perceived exertion were significantly higher in HOT (14.2 ± 2.38) compared to MOD (11.9 ± 2.02) (p = .007). Relative intensity (percent of age-predicted maximal heart rate [HR]), estimated absolute intensity (metabolic equivalents [METs]), and estimated energy expenditure (MET-h) were all increased in HOT, but not significantly so. The HOT condition reduced predicted maximal aerobic capacity (CRFp) by 6% (p = .026). Sweat rates differed significantly between HOT (1.38 ± 0.53 L/h) and MOD (0.84 ± 0.27 L/h) (p = .01). Percent body mass loss (PBML) did not differ significantly between HOT (1.06 ± 0.95%) and MOD (0.98 ± 0.84%) (p = .869). All repeated measures variables showed significant between-subjects effects (p < .05), indicating individual differences in response to test conditions. Heat stress was shown to negatively affect physiological and performance measures in recreational mountain hikers. However, considerable variation exists between individuals, and the degree of physiological and performance impairment is probably due, in part, to differences in aerobic fitness and acclimatization status rather than pre- or during-performance hydration status.

ContributorsLinsell, Joshua (Author) / Wardenaar, Floris (Thesis advisor) / Berger, Christopher (Committee member) / Forzani, Erica (Committee member) / Hondula, David M. (Committee member) / Arizona State University (Publisher)
Created2019
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The Maricopa County Heat Relief Network (HRN) is an ad-hoc partially self-organized network with some attributes of hierarchical coordination that forms each year to provide heat relief and hydration to residents in need by operating as cooling centers. These HRN organizations are a collection of non-profit, governmental and religious organizations.

The Maricopa County Heat Relief Network (HRN) is an ad-hoc partially self-organized network with some attributes of hierarchical coordination that forms each year to provide heat relief and hydration to residents in need by operating as cooling centers. These HRN organizations are a collection of non-profit, governmental and religious organizations. This dissertation looks at the HRN from a complexity governance perspective and engaged different parts of the network in interviews to learn more about their perspective in delivering heat relief. Further, participatory modeling with a prototype agent based model was done with the HRN coordinating agencies to look for emergent outcomes in the HRN system and learn from their perspective. Chapter one evaluates organizational theory and complexity with climate adaptation, hazard preparedness and resilience in the HRN. Chapter two presents results from interviews with HRN facility managers and evaluates their perspective on how they function to offer heat relief. Chapter three finds that the HRN is a good example of complexity governance when engaged through a participatory agent based modeling approach. Chapter four engages the HRN coordinators in participatory agent based modeling interviews to increase their systems level awareness, learn about their perspective on heat relief delivery, and how the system can be improved. Chapter five looks across the different levels of the HRN investigated, the facility managers and coordinators, for differences and similarities in perspectives. The research conducted in this dissertation shows different levels of systems awareness of the different parts of the HRN and how participatory modeling can be used to increase systems awareness. Results indicate that there was very little horizontal network connection between HRN facility managers and most of the interaction was vertically coordinated indicating opportunities for increased network communication in the future both horizontally and vertically if communication interventions were put in place.

ContributorsUebelherr, Joshua (Author) / Johnston, Erik W., 1977- (Thesis advisor) / Hondula, David M. (Committee member) / Mossberger, Karen (Committee member) / Gerber, Brian (Committee member) / Arizona State University (Publisher)
Created2017
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Exertional heat stroke continues to be one of the leading causes of illness and death in sport in the United States, with an athlete’s experienced microclimate varying by venue design and location. A limited number of studies have attempted to determine the relationship between observed wet bulb globe temperature (WBGT)

Exertional heat stroke continues to be one of the leading causes of illness and death in sport in the United States, with an athlete’s experienced microclimate varying by venue design and location. A limited number of studies have attempted to determine the relationship between observed wet bulb globe temperature (WBGT) and WBGT derived from regional weather station data. Moreover, only one study has quantified the relationship between regionally modeled and on-site measured WBGT over different athletic surfaces (natural grass, rubber track, and concrete tennis court). The current research expands on previous studies to examine how different athletic surfaces influence the thermal environment in the Phoenix Metropolitan Area using a combination of fieldwork, modeling, and statistical analysis. Meteorological data were collected from 0700–1900hr across 6 days in June and 5 days in August 2019 in Tempe, Arizona at various Sun Devil Athletics facilities. This research also explored the influence of surface temperatures on WBGT and the changes projected under a future warmer climate. Results indicate that based on American College of Sports Medicine guidelines practice would not be cancelled in June (WBGT≥32.3°C); however, in August, ~33% of practice time was lost across multiple surfaces. The second-tier recommendations (WBGT≥30.1°C) to limit intense exercise were reached an average of 7 hours each day for all surfaces in August. Further, WBGT was calculated using data from four Arizona Meteorological Network (AZMET) weather stations to provide regional WBGT values for comparison. The on-site (field/court) WBGT values were consistently higher than regional values and significantly different (p<0.05). Thus, using regionally-modeled WBGT data to guide activity or clothing modification for heat safety may lead to misclassification and unsafe conditions. Surface temperature measurements indicate a maximum temperature (170°F) occurring around solar noon, yet WBGT reached its highest level mid-afternoon and on the artificial turf surface (2–5PM). Climate projections show that WBGT values are expected to rise, further restricting the amount of practice and games than can take place outdoors during the afternoon. The findings from this study can be used to inform athletic trainers and coaches about the thermal environment through WBGT values on-field.

ContributorsGuyer, Haven Elizabeth (Author) / Vanos, Jennifer K. (Thesis advisor) / Georgescu, Matei (Thesis advisor) / Hondula, David M. (Committee member) / Arizona State University (Publisher)
Created2020
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Interdisciplinary research has highlighted how social-ecological dynamics drive the structure and function of the urban landscape across multiple scales. Land management decisions operate across various levels, from individuals in their backyard to local municipalities and broader political-economic forces. These decisions then scale up and down across the landscape to influence

Interdisciplinary research has highlighted how social-ecological dynamics drive the structure and function of the urban landscape across multiple scales. Land management decisions operate across various levels, from individuals in their backyard to local municipalities and broader political-economic forces. These decisions then scale up and down across the landscape to influence ecological functioning, such as the provisioning of biodiversity. Likewise, people are influenced by, and respond to, their environment. However, there is a lack of integrated research, especially research that considers the spatial and temporal complexities of social-ecological dynamics, to fully understand how people influence ecosystems or how the resulting landscape in turn influences human decision making, attitudes, and well-being.

My dissertation connects these interdisciplinary themes to examine three questions linked by their investigation of the interactions between people and biodiversity: (1) How do the social and spatial patterns within an arid city affect people’s attitudes about their regional desert environment? (2) How are novel communities in cities assembled given the social-ecological dynamics that influence the processes that structure ecological communities? (3) How can we reposition bird species traits into a conservation framework that explains the complexity of the interactions between people and urban bird communities? I found that social-ecological dynamics between people, the environment, and biodiversity are tightly interwoven in urban ecosystems. The regional desert environment shapes people’s attitudes along spatial and social configurations, which holds implications for yard management decisions. Multi-scalar management decisions then influence biodiversity throughout cities, which shifts public perceptions of urban nature. Overall, my research acts as a bridge between social and ecological sciences to theoretically and empirically integrate research focused on biodiversity conservation in complex, social-ecological systems. My goal as a scholar is to understand the balance between social and ecological implications of landscape change to support human well-being and promote biodiversity conservation.

ContributorsAndrade, Riley (Author) / Franklin, Janet (Thesis advisor) / Larson, Kelli L (Thesis advisor) / Hondula, David M. (Committee member) / Lerman, Susannah B (Committee member) / Arizona State University (Publisher)
Created2020
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This study aimed to investigate the effects of specific macronutrient feedings on competitive golf performance and perceived levels of fatigue and alertness. Participants played three, nine hole rounds of golf, consuming an isocaloric beverage as a control (CON), with the addition of carbohydrate (CHO), or combination of protein and carbohydrate

This study aimed to investigate the effects of specific macronutrient feedings on competitive golf performance and perceived levels of fatigue and alertness. Participants played three, nine hole rounds of golf, consuming an isocaloric beverage as a control (CON), with the addition of carbohydrate (CHO), or combination of protein and carbohydrate (COM). Physiological and performance measurements were taken before, during, and following each nine hole round. Performance measurements include driving accuracy (DA), driving distance (DD), iron accuracy (IA), chipping accuracy (CA), and putting accuracy (PA). Pre-golf hydration status (urine specific gravity [USG]) and Sweat Rate during golf performance showed no significant differences between trials. All nine hole rounds were performed in ~2 hours. Environmental conditions were similar for all three testing days (mean WBGT=10.946). No significant differences were seen in Driving Distance, Driving Accuracy, and Iron Accuracy for all nine holes between groups receiving different macronutrient feedings. Chipping Accuracy was significantly better in CON trial compared to CHO (p=0.004) and COM (p=0.019). No significant differences were seen in putting make percentages. COM trial significantly lowered Perceived Levels of Fatigue (p=0.019) compared to CON. The CHO trial showed significant improvements in DA compared to CON (13.7 vs. 44.1, p=0.012) and COM (13.7 vs. 33.6, p=0.004) in the first four holes. In the last five holes, the COM trial showed significant improvements in DA compared to CHO (17.5 vs. 29.7, p=0.007). Low Handicap golfers (3 +/- 3) performed significantly better than High Handicap golfers (14 +/- 3.6) in DD (265 vs. 241, p<0.001), DA (15.0 vs. 29.3, p=0.004), IA (15.2 vs. 25.2, p<0.001), CA (52.0 vs. 61.5, p=0.027), and PA 5ft (64% vs. 40%, p=0.003). High Handicap players showed no significant differences between the three trials for any golf performance measurements. Low Handicap players showed significant improvements in DA for COM trial compared to CON trial (13.6 vs. 27.6, p=0.003). The results suggest that carbohydrates at the start and a combination of carbohydrate and protein is beneficial at the second part of 9 holes to improve golf performance and maintain levels of fatigue, however, it needs to be investigated how this knowledge will relate to playing more holes.

ContributorsThompsett, Daniel James (Author) / Wardenaar, Floris (Thesis advisor) / Der Ananian, Cheryl (Committee member) / Hondula, David M. (Committee member) / Arizona State University (Publisher)
Created2020