An Evaluation of Respiratory Exacerbation in New York City Given Current Trends in Climate Variability and Predictive Sociodemographic Factors

Background: Within the last century, the massive increase in emissions due to economic growth has made climate variability a major problem for many of the industrialized countries and an emerging problem for the rest of the world. With an increasing number of extreme weather events, such as heat waves, cold fronts, floods, heavy rain, and storms, individuals with Chronic Obstructive Pulmonary Disease (COPD) and asthma remain a vulnerable population, placing them at highest risk of respiratory exacerbation. This dissertation aims to contribute to our understanding of how climate variability, which can influence patterns of rainfall, temperature and other variables on a wide range of timescales, and sociodemographic factors impact respiratory disease exacerbation among New York City (NYC) residents. Methods: Outcome variables of asthma and COPD exacerbation occurring in the inpatient and outpatient medical settings are from the New York State Department of Health Statewide Planning and Research Cooperative System (SPARCS). Secondary outcome variables of hospital length of stay (LOS) and total charges for the third study are also from SPARCS. Additional datasets include products for climate (temperature, precipitation, wind, relative humidity, PM 2.5) and sociodemographic potential predictor covariates (sex, age, race, income, poverty, educational attainment, and type of house heating fuel). The first study uses a space-time permutation model to determine spatial and temporal clusters of increased risk of respiratory exacerbation episodes across NYC neighborhoods. The second study uses Poisson regression using a series of three models (general linear model (GLM), general linear mixed model (GLMM) and a Bayesian spatio-temporal model) to further quantify the complexity of factors such as overall climate and socioeconomic status (SES). The third study applies Bayesian spatio-temporal modelling to predict the expected cases into the year 2039, total hospital charges and length of stay (inpatient setting only) based on Intergovernmental Panel on Climate Change (IPCC) predictive climatic factors and other predictive socio-demographic and SES factors. Results: The first study determined temporal and spatial variation of respiratory exacerbation episodes across NYC neighborhoods throughout the study period, with disproportionate increases in ZCTAs demonstrating geographic and hypothesized socioeconomic disparity. Results from the second study indicate the associations between respiratory exacerbation and predictive climate and sociodemographic factors vary according to location and are both positive and negative (increase and decrease risk). The third study found respiratory exacerbation, hospital length of stay and total hospital charges had a combination of positive (increase risk, increase LOS and increase total hospital costs), negative (decrease risk, LOS, cost) and zero associations into the year 2039 with increased temperature and precipitation projections by the IPCC well as predictive sociodemographic and SES factors. Conclusion: The studies in this dissertation provide additional evidence for the relationships between climate variability, sociodemographic factors and respiratory exacerbation in New York City. Spatio-temporal methods identify both time periods and spatial locations of increased risk and the role of predictive factors in certain neighborhoods. For example, the first and second studies determined neighborhoods in the south Bronx, upper Manhattan, eastern Brooklyn (as well as parts of north-western Brooklyn), north-central Queens (near LaGuardia airport) and southern Queens (near John F. Kennedy airport) all presented with elevated risk. These neighborhoods are in proximity to major highways and/or airports and are known to have the highest rates of populations that are either in poverty or black regardless of ethnicity. Race and poverty were consistent risk factors throughout the second and third studies, whereas increased temperatures were protective suggesting cooler temperatures may potentially increase risk instead. The third study determined long-term implications of IPCC projected climatic trends and predictive factors: factors determining SES (black, poverty status) would be predictive of respiratory exacerbation into 2039, and so would age for COPD outcomes; hospital LOS and total charges would be impacted by SES, age and IPCC projected precipitation increase, but for COPD outcomes only. The findings from this research support on-going respiratory management goals, which aim to improve disease management through underlying clinical components including proper medication reconciliation, follow-up on medication adherence, education on diagnosis/prognosis and access to resources to better track environmental conditions (e.g., weather, pollutant levels). The results also support adaptation measures, which are aimed at factors that are difficult to change in themselves, such as living in disadvantaged neighborhoods that are more vulnerable to the impacts of climate variability. The findings can further translate into pragmatic and practical measures to alleviate the variation observed in risk factors of respiratory exacerbation, including the promotion of increased annual primary care physician visits, increased access to specialty care within the outpatient setting, population health informatics tools to easily connect patients to medical resources, and coalitions with local environmental justice groups to help carry out these measures. Limitations, including spatial, temporal, and methodological issues with the data sources are discussed, as are suggestions for future research

Access beyond geographic accessibility: understanding opportunities to human needs in a physical-virtual world

Access to basic human needs, such as food and healthcare, is conceptually understood to be comprised of multiple spatial and aspatial dimensions. However, research in this area has traditionally been explored with spatial accessibility measures that almost exclusively focus on just two dimensions. Namely, the availability of resources, services, and facilities, and the accessibility or ease to which locations of these opportunities can be reached with existing land-use and transport systems under temporal constraints and considering individual characteristics of people. These calculated measures are insufficient in holistically capturing available opportunities as they ignore other components, such as the emergence of virtual space to carry out activities and interactions enabled by modern information and communication technologies (ICT). Human dynamics today exist in a hybrid physical-virtual space, and recent research has highlighted the importance of understanding ICT, individual behavior, local context, social relations, and human perceptions in identifying opportunities available to people. However, there lacks a holistic approach that relates these different aspects to access research. This dissertation addresses this gap by proposing a new conceptual framework for the geography of access for various kinds of human needs, using food access as a case study to illustrate how the proposed framework can be applied to address critical societal issues. An interactive multispace geographic information system (GIS) web application is developed to better understand and visualize individual potential food access based on the conceptual framework. This dissertation contributes to the body of research with a proposed conceptual framework of access in a hybrid physical-virtual world, integration of various big and small data sources to reveal information relating to the access of people, and novel development of a multi-space GIS to analyze and visualize access to opportunities

Climate resilient and sustainable forest management : IBFRA conference 28-31 August 2023. Book of abstracts

The 20th IBFRA (The International Boreal Forest Research Association) conference held in Helsinki Finland 28-31 August 2023 brings together researchers, companies, policy makers and members of the civil society. The conference main theme is Climate resilient and sustainable forest management. The abstracts of the conference are in this publication

Family Houses and Social Identity: Communicational Perspectives onThe Homes of Ridge County

This study provides an analysis of the communicative use of family homes within the daily life of a rural community. As an ethnography of communicative behavior, the nature and functions of the home as a medium of communication are explored within a specified social context so that the social and cultural influences which shape its use and interpretation may be examined. The study explores the structure of rules, roles, values, customs and beliefs which organize how homes are used, how they are evaluated, and how they come to assume meaning within this frame of reference. It was hypothesized that family homes, as media of social communication, function as artifacts of and instruments for the structure of social relations that prevail within the community that employs them. Research was directed, therefore, to examining the role of family homes in the expression of patterns of association and differentiation through which social identity and the community\u27s system of social status are negotiatated, marked and maintained. The study draws on fourteen months of fieldwork, during which family homes were investigated as complex, multi-modal systems of communicative activity. Patterns of household maintenance, rules and customs in the use of household and community space, comparisons of house size and layout, traditions in the acquisition and use of furnishings, and patterns in taste preferences are each examined as integrated aspects of this system of communication. In this way a structure of shared values, standards and traditions is described which is shown to regulate the conduct and interpretation of activity in this sphere at a variety of levels. While previous research has emphasized the home\u27s value as an index of social class, this study finds that households are, in this insular community, devoted centrally to the expression of a family\u27s social orientation and moral repute. Processes of status comparison are muted, while homes serve to mark and maintain interdependent networks of kinship and affiliation through which social life is ordered and personal identity is defined. Change and systematic deviations from these common standards are examined and an effort is made to discuss the generalizability of these findings to other socio-cultural settings