Matching Items (6)
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Description
Critical care environments are complex in nature. Fluctuating team dynamics and the plethora of technology and equipment create unforeseen demands on clinicians. Such environments become chaotic very quickly due to the chronic exposure to unpredictable clusters of events. In order to cope with this complexity, clinicians tend to develop ad-hoc

Critical care environments are complex in nature. Fluctuating team dynamics and the plethora of technology and equipment create unforeseen demands on clinicians. Such environments become chaotic very quickly due to the chronic exposure to unpredictable clusters of events. In order to cope with this complexity, clinicians tend to develop ad-hoc adaptations to function in an effective manner. It is these adaptations or "deviations" from expected behaviors that provide insight into the processes that shape the overall behavior of the complex system. The research described in this manuscript examines the cognitive basis of clinicians' adaptive mechanisms and presents a methodology for studying the same. Examining interactions in complex systems is difficult due to the disassociation between the nature of the environment and the tools available to analyze underlying processes. In this work, the use of a mixed methodology framework to study trauma critical care, a complex environment, is presented. The hybrid framework supplements existing methods of data collection (qualitative observations) with quantitative methods (use of electronic tags) to capture activities in the complex system. Quantitative models of activities (using Hidden Markov Modeling) and theoretical models of deviations were developed to support this mixed methodology framework. The quantitative activity models developed were tested with a set of fifteen simulated activities that represent workflow in trauma care. A mean recognition rate of 87.5% was obtained in automatically recognizing activities. Theoretical models, on the other hand, were developed using field observations of 30 trauma cases. The analysis of the classification schema (with substantial inter-rater reliability) and 161 deviations identified shows that expertise and role played by the clinician in the trauma team influences the nature of deviations made (p<0.01). The results shows that while expert clinicians deviate to innovate, deviations of novices often result in errors. Experts' flexibility and adaptiveness allow their deviations to generate innovative ideas, in particular when dynamic adjustments are required in complex situations. The findings suggest that while adherence to protocols and standards is important for novice practitioners to reduce medical errors and ensure patient safety, there is strong need for training novices in coping with complex situations as well.
ContributorsVankipuram, Mithra (Author) / Greenes, Robert A (Thesis advisor) / Patel, Vimla L. (Thesis advisor) / Petitti, Diana B. (Committee member) / Dinu, Valentin (Committee member) / Smith, Marshall L. (Committee member) / Arizona State University (Publisher)
Created2012
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Description

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

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.

ContributorsHart, Melissa A. (Author) / Sailor, David (Author)
Created2008-05-07
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Description

Objectives: We estimated neighborhood effects of population characteristics and built and natural environments on deaths due to heat exposure in Maricopa County, Arizona (2000–2008).

Methods: We used 2000 U.S. Census data and remotely sensed vegetation and land surface temperature to construct indicators of neighborhood vulnerability and a geographic information system to

Objectives: We estimated neighborhood effects of population characteristics and built and natural environments on deaths due to heat exposure in Maricopa County, Arizona (2000–2008).

Methods: We used 2000 U.S. Census data and remotely sensed vegetation and land surface temperature to construct indicators of neighborhood vulnerability and a geographic information system to map vulnerability and residential addresses of persons who died from heat exposure in 2,081 census block groups. Binary logistic regression and spatial analysis were used to associate deaths with neighborhoods.

Results: Neighborhood scores on three factors—socioeconomic vulnerability, elderly/isolation, and unvegetated area—varied widely throughout the study area. The preferred model (based on fit and parsimony) for predicting the odds of one or more deaths from heat exposure within a census block group included the first two factors and surface temperature in residential neighborhoods, holding population size constant. Spatial analysis identified clusters of neighborhoods with the highest heat vulnerability scores. A large proportion of deaths occurred among people, including homeless persons, who lived in the inner cores of the largest cities and along an industrial corridor.

Conclusions: Place-based indicators of vulnerability complement analyses of person-level heat risk factors. Surface temperature might be used in Maricopa County to identify the most heat-vulnerable neighborhoods, but more attention to the socioecological complexities of climate adaptation is needed.

ContributorsHarlan, Sharon L. (Author) / Declet-Barreto, Juan H. (Author) / Stefanov, William L. (Author) / Petitti, Diana B. (Author)
Created2013-02-01
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Description

In this study we characterized the relationship between temperature and mortality in central Arizona desert cities that have an extremely hot climate. Relationships between daily maximum apparent temperature (ATmax) and mortality for eight condition-specific causes and all-cause deaths were modeled for all residents and separately for males and females ages

In this study we characterized the relationship between temperature and mortality in central Arizona desert cities that have an extremely hot climate. Relationships between daily maximum apparent temperature (ATmax) and mortality for eight condition-specific causes and all-cause deaths were modeled for all residents and separately for males and females ages <65 and ≥65 during the months May–October for years 2000–2008. The most robust relationship was between ATmax on day of death and mortality from direct exposure to high environmental heat. For this condition-specific cause of death, the heat thresholds in all gender and age groups (ATmax = 90–97 °F; 32.2‒36.1 °C) were below local median seasonal temperatures in the study period (ATmax = 99.5 °F; 37.5 °C). Heat threshold was defined as ATmax at which the mortality ratio begins an exponential upward trend. Thresholds were identified in younger and older females for cardiac disease/stroke mortality (ATmax = 106 and 108 °F; 41.1 and 42.2 °C) with a one-day lag. Thresholds were also identified for mortality from respiratory diseases in older people (ATmax = 109 °F; 42.8 °C) and for all-cause mortality in females (ATmax = 107 °F; 41.7 °C) and males <65 years (ATmax = 102 °F; 38.9 °C). Heat-related mortality in a region that has already made some adaptations to predictable periods of extremely high temperatures suggests that more extensive and targeted heat-adaptation plans for climate change are needed in cities worldwide.

ContributorsHarlan, Sharon L. (Author) / Chowell, Gerardo (Author) / Yang, Shuo (Author) / Petitti, Diana B. (Author) / Morales Butler, Emmanuel J. (Author) / Ruddell, Benjamin L. (Author) / Ruddell, Darren M. (Author)
Created2014-05-20
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Description

Background: Extreme heat is a public health challenge. The scarcity of directly comparable studies on the association of heat with morbidity and mortality and the inconsistent identification of threshold temperatures for severe impacts hampers the development of comprehensive strategies aimed at reducing adverse heat-health events.

Objectives: This quantitative study was designed

Background: Extreme heat is a public health challenge. The scarcity of directly comparable studies on the association of heat with morbidity and mortality and the inconsistent identification of threshold temperatures for severe impacts hampers the development of comprehensive strategies aimed at reducing adverse heat-health events.

Objectives: This quantitative study was designed to link temperature with mortality and morbidity events in Maricopa County, Arizona, USA, with a focus on the summer season.
Methods: Using Poisson regression models that controlled for temporal confounders, we assessed daily temperature–health associations for a suite of mortality and morbidity events, diagnoses, and temperature metrics. Minimum risk temperatures, increasing risk temperatures, and excess risk temperatures were statistically identified to represent different “trigger points” at which heat-health intervention measures might be activated.

Results: We found significant and consistent associations of high environmental temperature with all-cause mortality, cardiovascular mortality, heat-related mortality, and mortality resulting from conditions that are consequences of heat and dehydration. Hospitalizations and emergency department visits due to heat-related conditions and conditions associated with consequences of heat and dehydration were also strongly associated with high temperatures, and there were several times more of those events than there were deaths. For each temperature metric, we observed large contrasts in trigger points (up to 22°C) across multiple health events and diagnoses.

Conclusion: Consideration of multiple health events and diagnoses together with a comprehensive approach to identifying threshold temperatures revealed large differences in trigger points for possible interventions related to heat. Providing an array of heat trigger points applicable for different end-users may improve the public health response to a problem that is projected to worsen in the coming decades.

Created2015-07-28
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Description

Given increasing utility of numerical models to examine urban impacts on meteorology and climate, there exists an urgent need for accurate representation of seasonally and diurnally varying anthropogenic heating data, an important component of the urban energy budget for cities across the world. Incorporation of anthropogenic heating data as inputs

Given increasing utility of numerical models to examine urban impacts on meteorology and climate, there exists an urgent need for accurate representation of seasonally and diurnally varying anthropogenic heating data, an important component of the urban energy budget for cities across the world. Incorporation of anthropogenic heating data as inputs to existing climate modeling systems has direct societal implications ranging from improved prediction of energy demand to health assessment, but such data are lacking for most cities. To address this deficiency we have applied a standardized procedure to develop a national database of seasonally and diurnally varying anthropogenic heating profiles for 61 of the largest cities in the United Stated (U.S.). Recognizing the importance of spatial scale, the anthropogenic heating database developed includes the city scale and the accompanying greater metropolitan area.

Our analysis reveals that a single profile function can adequately represent anthropogenic heating during summer but two profile functions are required in winter, one for warm climate cities and another for cold climate cities. On average, although anthropogenic heating is 40% larger in winter than summer, the electricity sector contribution peaks during summer and is smallest in winter. Because such data are similarly required for international cities where urban climate assessments are also ongoing, we have made a simple adjustment accounting for different international energy consumption rates relative to the U.S. to generate seasonally and diurnally varying anthropogenic heating profiles for a range of global cities. The methodological approach presented here is flexible and straightforwardly applicable to cities not modeled because of presently unavailable data. Because of the anticipated increase in global urban populations for many decades to come, characterizing this fundamental aspect of the urban environment – anthropogenic heating – is an essential element toward continued progress in urban climate assessment.

ContributorsSailor, David (Author) / Georgescu, Matei (Author) / Milne, Jeffrey M. (Author) / Hart, Melissa A. (Author)
Created2015-07-17