Evaluating Public Participation in Canadian Municipal Climate Change Adaptation Plans

This research employs a qualitative content analysis to evaluate public participation in municipal climate adaptation plans in Canada. I conducted quantitative scoring and qualitative coding based on the assessment framework adapted from Uittenbroek et al. (2019). The framework highlights three dimensions of public participation: (a) Who participates, (b) When, and (c) How. This study highlights four key findings. First, the majority of plans do not engage with a wide range of community stakeholders, suggesting that the complete representation of community interests is not being included. Second, participation is occurring throughout the planning process in half of the plans, demonstrating a need to increase the number of opportunities for participation. Third, plans were inconsistent in clearly articulating whether participation influenced decision-making in plan development. Finally, plans are inconsistent in their application of the quantity and variety of participation mechanisms. These findings offer insight into public participation in Canadian municipal adaptation planning

Romantic Interest Selection From an Imago Relationship Therapy Perspective

Imago Relationship Therapy (IRT) is a model of couples therapy that is not empirically validated (Jakubowski et al., 2004). IRT proposes that individuals select Romantic Interests (Interests) that are similar to their Childhood Caregivers (Caregivers) in an effort to heal childhood wounding (Hendrix, 1988). The current study sought to evaluate the IRT proposition of romantic interest selection by evaluating patterns in romantic interest selection, particularly the relationship between Caregiver and Interest personality characteristics, adult attachment dimensions, gender, and geographical location of origin. In addition, the study considers similarities in participant narratives of positive and negative experiences with Caregivers and Interests. Participants completed three Big Five Inventories (one for Caregiver, one of Interest, one for the Self), the Experiences in Close Relationships-Revised, four open-ended qualitative questions, and a demographics questionnaire. The study used mixed methods of cross-sectional correlations and quantitative inferential statistics. Caregiver and Interest Agreeableness, Openness, and Neuroticism were significantly correlated, however, Extraversion and Conscientiousness were not. These findings somewhat support the proposition that individuals select Interests that are similar to their Caregivers, but not completely. Insecure attachment was related to Caregiver Neuroticism. No gender differences were found. Only participants from rural areas demonstrated correlations in personality characteristics for Caregivers and Interests. A series of co-occurrence analyses failed to reveal overlapping emotional and behavioral themes within participants’ narratives. These findings are unsupportive of IRT. The current study suggests that explaining the process of romantic interest selection requires integration of multiple theories, including but not limited to IRT

User Interfaces for Patient-Centered Communication of Health Status and Care Progress

The recent trend toward patients participating in their own healthcare has opened up numerous opportunities for computing research. This dissertation focuses on how technology can foster this participation, through user interfaces to effectively communicate personal health status and care progress to hospital patients. I first characterize the design space for electronic information communication to patients through field studies conducted in multiple hospital settings. These studies utilize a combination of survey instruments, and low- and high-fidelity prototypes, including a document-editing prototype through which users can view and manage clinical data to automatically associate it with progress notes. The prototype, activeNotes, includes the first known techniques supporting clinical information requests directly within a document editor. A usage study with ICU physicians at New York-Presbyterian Hospital (NYP) substantiated our design and revealed how electronic information related to patient status and care progress is derived from a typical Electronic Health Record system. Insights gained from this study informed following studies to understand how to design abstracted, plain-language views suitable for patients. We gauged both patient and physician responses to information display prototypes deployed in patient rooms for a formative study exploring their design. Following my reports on this study, I discuss the design, development and pilot evaluations of a prototype Personal Health Record application providing live, abstracted clinical information for patients at NYP. The portal, evaluated by cardiothoracic surgery patients, is the first of its kind to allow patients to capture and monitor live data related to their care. Patient use of the portal influenced the subsequent design of tools to support users in making sense of online medication information. These tools, designed with nurses and pharmacists and evaluated by cardiothoracic surgery patients at NYP, were developed using topic modeling approaches and text analysis techniques. Embodied in a prototype called Remedy, they enable rapid filtering and comparison of medication-related search results, based on a number of website features and content topics. I conclude by discussing how findings from this series of studies can help shape the ongoing design and development of patient-centered technology

The Pricing Impact of Decreasing Competitiveness of the Health Insurance Market

The Affordable Care Act created the national insurance exchanges of qualified health plans to encourage a higher insured rate, larger risk pools, and lower prices for quality health coverage. Consolidation of insurers can have opposing effects. The insurers’ risk pools will grow, allowing insurers to better hedge for risk. However, consolidation decreases the prevalence of competition in the market, and past research shows that insurer consolidation decreases market competition and increases prices. I examine how the number of plans offered in a set market, pricing components, and county health variables impact the monthly premium pricing of plans sold on the individual market as well as how effective the exchanges are at keeping insurance prices low. Based on my findings, I conclude that the top three influential variables on premium price are the presence of a maximum out of pocket, the rate of excess drinking, and the unemployment rate. I also conclude that more plans in a market are associated with lower premium prices

The Pricing Impact of the Decreasing Competitiveness of the Health Insurance Market

The Affordable Care Act created the national insurance exchanges of qualified health plans to encourage a higher insured rate, larger risk pools, and lower prices for quality health coverage. Consolidation of insurers can have opposing effects. The insurers’ risk pools will grow, allowing insurers to better hedge for risk. However, consolidation decreases the prevalence of competition in the market, and past research shows that insurer consolidation decreases market competition and increases prices. I examine how the number of plans offered in a set market, pricing components, and county health variables impact the monthly premium pricing of plans sold on the individual market as well as how effective the exchanges are at keeping insurance prices low. Based on my findings, I conclude that the top three influential variables on premium price are the presence of a maximum out of pocket, the rate of excess drinking, and the unemployment rate. I also conclude that more plans in a market are associated with lower premium prices

INTERNET OF WATER: Sharing and Integrating Water Data for Sustainability. A Report from the Aspen Institute Dialogue Series on Water Data

The Aspen Institute Dialogue Series on Sharing and Integrating Water Data for Sustainability was convened to address one of the country's most pressing challenges: how to improve our water data infrastructure to enable us to more sustainably manage our water resources.To address this challenge, this Dialogue Series, hosted by the Aspen Institute Energy and Environment Program in partnership with the Nicholas Institute for Environmental Policy Solutions and the Redstone Strategy Group, aimed to formulate a national water data and information policy framework for sharing, integrating, and disseminating public data to characterize and forecast the quantity, quality, and uses of water across the United States. Participants included experts and representatives from the federal, state, and local government agencies, the private sector, academia and non-governmental organizations.This document represents the group's findings as developed over the course of three scoping sessions and two roundtable dialogues convened in 2016-2017. Here we provide a summary of the major findings, shared principles and action-oriented recommendations toward creating a national water data and information policy framework for sharing and integrating open water data. The intended audience for this report is threefold:Policymakers for whom this document can inform their thinking and strategic approaches;The community of practitioners focused on water data and management issues and their implications for water sustainability and innovation; andFunders who will support the implementation process and initiatives put forth in this report

Spatiotemporal analysis of socioeconomic exposure to assess flood policy effectiveness

After nearly a century of flood policies in the U.S., losses have continued to increase. This thesis examined the potential increase in losses related to the 100-yr floodplain, which is the minimum standard for implementing policies. Despite this core role, as much as 1.5 vertical meters of uncertainty exists when delineating the boundray. However, no uncertainty is provided on flood maps, which could result in increased socioeconomic exposure adjacent to the boundary when a larger flood occurs. This thesis quantified the effectiveness of mitigation from 1990 to 2000 for five North Carolina counties by examining changes in exposure inside and adjacent to the 100-yr floodplain. Findings indicated mitigation efforts have been effective inside the 100-yr floodplain; however, there was a significant increase in exposure adjacent to this floodplain. Stream scale analyses indicated mitigation effectiveness was influenced by stream size, distance from the stream, and location in urban versus rural areas

Walkability in Suburbia

Master of Landscape ArchitectureDepartment of Landscape Architecture/Regional and Community PlanningHyung Jin KimWalkability is a challenge for most suburban metropolitan areas. Specifically, the Kansas City suburban cities of Overland Park, Olathe, Leawood, and South KCMO have sprawled and disconnected urban patterns and a low average walkability score of 37 out of 100 (Walk Score, 2013, https://www.redfin.com/how-walk-score-works/). The Indian Creek Trail, an existing recreational trail that extends throughout the southern Kansas City neighborhoods, has the potential to improve walkability. It connects major destinations, including residential communities, businesses, and commercial districts throughout the suburban neighborhoods. Many studies have analyzed suburban sprawl and walkability, but few studies have identified the possibility of enhancing existing trail systems to provide for greater mobility, connectivity, and activity. The study examines the feasibility of reusing an existing trail system to act as a catalyst to promote walkability in the Kansas City suburbs. The goal of the project to create a paradigm shift in the way people think about transport and development. The purpose is to identify how centering walkable strategies around an active transportation network can promote walkability in sprawled suburban areas. The question: How can focusing improvement around existing trail infrastructure enhance walkability in suburban areas? has guided the project and helped define strategies for improvement. This project identifies the Indian Creek Trail’s current and potential uses from an in depth community and spatial analysis. Surveys, interviews, and observations were conducted within 13 major destination areas along the Indian Creek Trail. The results were then analyzed to create an evidence‐based design framework that will address walkable concerns. The project results showed there were three primary causes for walkable limitations along the trail network: current transportation trends, suburban development patterns, and social perceptions. Understanding these important aspects of walkability helped identify a framework for improvement. The findings from the analysis determined the site restrictions and prospects of creating a walkable environment along the Indian Creek Trail. The results identified primary locations of needed intervention and revealed major opportunities for connection. The design then applied walkable components based on analysis findings to create nodes of complete communities. Design decisions were tailored to amend community needs and alter traditional transport perceptions. The objective of the designs was to address specific walkable limitations to create reasonable solutions in suburban areas. The project identifies 5 primary components of walkability that can be used to create a walkable plan. Future studies would revolve around implementing the designs and analyzing the effectiveness to create a model that can be applied to enhance walkability for other suburban areas. Ultimately, the results could establish how improved walkability can promote multi‐modal transportation opportunities where population, density, diversity, and funding do not allow for typical transportation or development enhancements

STREAMFLOW TRENDS AND DROUGHT IN THE SOUTH ATLANTIC, U.S.: IMPLICATIONS FOR WATER MANAGEMENT AND WATER TRANSFERS

The South Atlantic has recently experienced region-wide droughts. There is concern that water scarcity may become more common or prevalent due to a warming climate. Problems associated with water scarcity are compounded by under-developed water allocation policy in the historically water abundant South Atlantic. This dissertation examined the potential causes of water scarcity related to changes in average streamflow from 1934-2005, 1934-1969 (Mid-20th Century) and 1970-2005 (Late-20th Century). Second, the contribution of climate versus anthropogenic drivers of change in mean annual streamflow in the Late 20th Century was evaluated using Budyko curves. Third, hydrologic drought was characterized in the South Atlantic and changes in drought characteristics were assessed over multiple time periods. Fourth, water interconnections, which form an important component of water infrastructure and water management, were assessed for the potential to transfer water from a drought free to a drought stricken area. Results showed that streamflow abruptly shifted from a drier regime in the Mid-20th Century to a wetter regime in the Late-20th Century with trends of significantly decreasing streamflow since 1970. Climate contributed to increased streamflow during the Late-20th Century throughout the South Atlantic; whereas human factors varied between basins and either amplified or decreased the climate change effect on streamflow. Human impacts were equivalent to or exceeded climate impacts in some basins. Seventy-one percent of drought events were shorter than 6 months with a recurrence interval of 6 years. Less than 7% of droughts were longer than one year, yet these longer duration droughts resulted in region-wide water scarcity. There were few significant temporal trends in drought characteristics over the studied time periods. The short interconnection distances (median=11.6 km) rarely extended beyond the spatial extent of multi-year droughts; interconnected water systems were simultaneously in drought 98±3% of the time from 2000-2008. Water managers face many challenges with a steadily growing demand and fluctuating long-term and short-term water supply needs that can be partially met through interconnections. Decision-making will benefit from monitoring changes in climate, human activities, and streamflow, as well as continually assessing the ability of current water infrastructure to perform under normal and adverse conditions.Doctor of Philosoph

Examining the Relationship between Health-Related Need and the Receipt of Care by Participants Experiencing Homelessness and Mental Illness

Background People experiencing homelessness and mental illness face multiple barriers to care. The goal of this study was to examine the association between health service use and indicators of need among individuals experiencing homelessness and mental illness in Vancouver, Canada. We hypothesized that those with more severe mental illness would access greater levels of primary and specialist health services than those with less severe mental illness. Methods Participants met criteria for homelessness and current mental disorder using standardized criteria (n = 497). Interviews assessed current health status and involvement with a variety of health services including specialist, general practice, and emergency services. The 80th percentile was used to differentiate ‘low health service use’ and ‘high health service use’. Using multivariate logistic regression analysis, we analyzed associations between predisposing, enabling and need-related factors with levels of primary and specialist health service use. Results Twenty-one percent of participants had high primary care use, and 12% had high use of specialist services. Factors significantly (p ≤ 0.05) associated with high primary care use were: multiple physical illnesses [AOR 2.74 (1.12, 6.70]; poor general health [AOR 1.68 (1.01, 2.81)]; having a regular family physician [AOR 2.27 (1.27, 4.07)]; and negative social relationships [AOR 1.74 (1.01, 2.99)]. Conversely, having a more severe mental disorder (e.g. psychotic disorder) was significantly associated with lower odds of high service use [AOR 0.59 (0.35, 0.97)]. For specialist care, recent history of psychiatric hospitalization [AOR 2.53 (1.35, 4.75)] and major depressive episode [AOR 1.98 (1.11, 3.56)] were associated with high use, while having a blood borne infectious disease (i.e., HIV, HCV, HBV) was associated with lower odds of high service use. Conclusions Contrary to our hypotheses, we found that individuals with greater assessed need, including more severe mental disorders, and blood-borne infectious diseases had significantly lower odds of being high health service users than those with lower assessed needs. Our findings reveal an important gap between levels of need and service involvement for individuals who are both homeless and mentally ill and have implications for health service reform in relation to the unmet and complex needs of a marginalized sub-population. (Trial registration: ISRCTN57595077 and ISRCTN66721740)