Economic Losses and Extreme Tornado Events

Research on tornado impacts has previously focused mainly on analyzing the deaths and injuries associated with tornadoes. While economic loss from multiple hazards is a well-researched field, little has been done to assess the economic losses sustained during tornado events. Additionally, the literature regarding the Enhanced Fujita scale’s comparability to the Fujita scale is limited. This research aims to add to the literature by statistically analyzing the two tornado scales, determining the movement of tornadoes over time using a cluster analysis, comparing the location of extreme tornadoes to those which produce extreme loss, and looking at the statistical relationship between extreme tornadoes and extreme loss. This study uses tornado data collected from the National Climatic Data Center to analyze tornadoes in the continental United States from 1990-2012. Tornadoes studied were limited to those that included a GPS location and any estimated property or crop damage, no matter how small. Loss estimates were adjusted for inflation using the Consumer Price Index and again using a county Gross Domestic Product method developed by Ash, Cutter, and Emrich (2013). The results of this thesis conclude that the Enhanced Fujita and Fujita scales are statistically different from one another for lower-rated (0-2) tornadoes, but not for higher-rated ones (3-5). Geographically, clusters of tornadoes have moved northward and eastward over time. This research also demonstrates that the location of extreme tornadoes is not always the same as the location of tornadoes producing extreme loss. Finally, this research shows that economic losses from F/EF5 tornadoes have a greater mean, range, and standard deviation than those from F/EF4 tornadoes. From a research perspective, this thesis demonstrates the importance of distinguishing between tornadoes rated on the Fujita and Enhanced Fujita scales, since they cannot be considered equivalent to one other. From a policy perspective, local mitigation plans would be improved by taking into account the historical movement of tornado clusters northward and eastward as identified here. Finally, this research has identified that it is not just the extreme tornadoes that deserve mitigation efforts, but also lower-rated tornadoes that are capable of producing millions of dollars in damage

School of Law_Law Student and Paralegal COVID Pro Bono Support Project Email

Email from Rachel Reeves, Director of Field Placement Programs and Adjunct Professor, University of Maine School of Law to students regarding a national law student pro bono support project

Respiratory Syncytial Virus in Young Children in England - Burden and Risk Factors for Severe Disease

Respiratory syncytial virus (RSV) is a major cause of respiratory infection in infants and young children. With potential vaccines on the horizon it is essential that RSV burden is accurately calculated by age and risk group to identify optimal target populations. My PhD investigates the secondary care burden of RSV in children younger than five years in England using routinely collected national laboratory surveillance and hospital admissions data. First, I explore the use of the individual datasets to describe RSV epidemiology. Second, I use ecological time series modelling to estimate the number of weekly hospital admissions attributable to RSV. Third, I use probabilistically linked laboratory and hospital data to describe laboratory-confirmed RSV-associated hospital admissions in England for the first time, and to determine risk factors for severe RSV-associated disease. Finally, from the linked data I generate a predictive model for RSV-associated admissions in infants, and use this to estimate the national burden of RSV-associated admissions by patient and clinical characteristics. I estimate an annual average of 33,500 (95% CI: 30,400-38,500) RSV-associated admissions in children younger than five years in England. 82% (95% CI: 79-87%) of admissions for bronchiolitis in children younger than six months could be attributed to RSV. My results highlight the importance of young age (<3 months) and birth around the beginning of RSV season in the risk of RSV-associated admission, and the importance of young age, prematurity and comorbidities in the increasing severity of disease. This is the first study to use linked laboratory surveillance and hospital admissions data for RSV in England. I have produced detailed, recent estimates of RSV-associated admissions in infants and young children using multiple methods, and highlight the strengths and limitations of using routinely collected data for RSV research. My results provide essential baseline epidemiological data required for vaccine impact studies

Changes in inpatients' experiences of hospital care in England over a 12-year period: a secondary analysis of national survey data

Objectives Adult inpatient surveys generate approximately 70,000 responses per year about patients’ experiences of National Health Service hospital care in England. We examine historical data to assess change between 2002 and 2013 and consider the factors that may have stimulated any change. Methods: Archived national data from National Health Service Inpatient Surveys between 2002 and 2013 (comprising 840,077 patient responders) were obtained. Questions were selected for inter-year analysis if they had been replicated for at least seven years. The percentage of responses in the most positive category was compared for each question’s earliest and most recent year. The statistical significance of differences was tested using chi-square. Also, since such large sample sizes mean that even 1% differences are statistically significant, effect sizes were used to assess the practical significance of those differences. Results: There were statistically significant (p  0.1) and one ‘small’ decline, but differences were not meaningful for 42 questions. The greatest improvements were for patients receiving copies of doctors’ letters; single sex ward areas; clinicians’ hand washing; ward cleanliness and planned admission waiting times. The greatest decline was that fewer responders said their call bells were usually answered within 2 min. Conclusions: More aspects of care have improved than have deteriorated. This study highlights the need for a consistent repeated survey programme to detect changes over the long term, since year-to-year changes tend to be small. The greatest improvements are in areas that can be influenced by organisation-wide interventions and many are associated with top–down government policies, targets or media campaigns. Patients’ evaluations of many aspects of their interactions with clinicians are unchanged or have declined. Further research could test whether ward-specific facilitated communication of survey results to clinicians could drive improvements in clinician–patient interactions

'Set up to fail'? How welfare conditionality undermines citizenship for vulnerable groups

Underpinned by the assumption that unemployed persons are passive recipients of social security, recent welfare reforms have increased benefit conditionality in the UK and introduced harsher penalties for failure to meet these conditions. Yet, conditionality may result in vulnerable groups disproportionately experiencing disentitlement from benefits, one of the rights of social citizenship, because they are, in some cases, less able to meet these conditions. Rising sanctions, then, may be the product of a disconnection between welfare conditionality and the capabilities of vulnerable claimants. To test this hypothesis, we evaluate whether sanctions are higher in areas where there are more vulnerable Jobseeker's Allowance claimants, namely, lone parents, ethnic minorities and those with disabilities. We find that sanction rates are higher in local authorities where more claimants are lone parents or live with a disability, and that this relationship has strengthened since the welfare reforms were introduced under the Conservative-led coalition. Failure to meet conditions of benefit receipt may disproportionately affect vulnerable groups

The growing disconnect between food prices and wages in Europe: cross-national analysis of food deprivation and welfare regimes in twenty-one EU countries, 2004–2012

Food insecurity has been rising across Europe following the Great Recession, but to varying degrees across countries and over time. The reasons for this increase are not well understood, nor are what factors might protect people’s access to food. Here we test the hypothesis that an emerging gap between food prices and wages can explain increases in reported inability to afford protein-rich foods and whether welfare regimes can mitigate its impact. We collected data in twenty-one countries from 2004 to 2012 using two databases: (i) on food prices and deprivation related to food (denoted by reported inability to afford to eat meat, chicken, fish or a vegetarian equivalent every second day) from EuroStat 2015 edition; and (ii) on wages from the Organisation for Economic Co-operation and Development 2015 edition. After adjusting for macroeconomic factors, we found that each 1 % rise in the price of food over and above wages was associated with greater self-reported food deprivation (β=0·060, 95 % CI 0·030, 0·090), particularly among impoverished groups. However, this association also varied across welfare regimes. In Eastern European welfare regimes, a 1 % rise in the price of food over wages was associated with a 0·076 percentage point rise in food deprivation (95 % CI 0·047, 0·105) while in Social Democratic welfare regimes we found no clear association (P=0·864). Rising prices of food coupled with stagnating wages are a major factor driving food deprivation, especially in deprived groups; however, our evidence indicates that more generous welfare systems can mitigate this impact

Facilitated patient experience feedback can improve nursing care: a pilot study for a phase III cluster randomised controlled trial

BACKGROUND: England’s extensive NHS patient survey programme has not fulfilled NHS white paper promises of improvements in patients’ experiences. Impediments to the surveys’ impact may include: surveys not being specific to departments, so staff claim “that doesn’t happen here”; clinicians not knowing how to improve; insufficient understanding of survey methods; delays in communicating survey results; and over-emphasis on data collection per se, rather than using results to improve care. METHODS: Over two years, patient surveys were conducted at four-monthly intervals in 18 wards in two NHS Trusts in England. Wards were randomly allocated to Basic Feedback (ward-level patient survey results including patients’ written comments sent to nurses by letter); Feedback Plus (in addition to letters, ward meetings to discuss results and plan improvements) or Control (no active feedback of survey results). Patient survey responses to survey questions about nursing care were used to compute wards’ average Nursing Care Scores at each survey interval. RESULTS: 4,236 (47%) of the patients surveyed returned questionnaires. Nursing Care Scores improved more for Feedback Plus than Basic Feedback or Control (difference between Control and Feedback Plus = 8.28 ± 7.2 (p = 0.02)). Feedback Plus meetings were effective in engaging nurses, correcting methodological misunderstandings and challenging “excuses”. Patients’ written comments stimulated interest. CONCLUSION: Merely informing nurses of patient survey results in writing does not stimulate improvements, even if results are disaggregated by ward. The addition of ward meetings had a significant impact. Effective patient feedback can be achieved with: validated patient experience surveys; ward-specific results; information that includes a combination of numerical data and patients’ comments; and facilitated ward meetings. This study provides preliminary evidence that facilitated patient feedback can improve patients’ experiences such that a full trial is justified

Family policy and food insecurity: an observational analysis in 142 countries

Background: Levels of child malnutrition and hunger across the world have decreased substantially over the past century, and this has had an important role in reducing mortality and improving health. However, progress has stalled. We examined whether family policies (eg, cash transfers from governments that aim to support households with children) are associated with reduced food insecurity. Methods: In this observational analysis, we used a dataset of individual-level data that captured experience-based measures of food insecurity and sociodemographic characteristics collected by the Gallup World Poll in 142 countries for 2014–17. We then combined this dataset with indicators of the type and generosity of family policies in these countries, taken from the University of California, Los Angeles’ World Policy Analysis Center. We used multilevel regression models to examine the association between the presence of family policies for households with children and the probability of reporting moderate or severe food insecurity or severe food insecurity (moderate or severe food insecurity was defined as a “yes” response to at least four of eight questions on the Gallup Food Insecurity Experience Scale, and severe food insecurity was defined as a “yes” response to at least seven questions). We controlled for multiple covariates, including individual-level measures of social position and country-level measures, such as gross domestic product. We further examined whether this association varied by household income level. Findings: Using data from 503 713 households, we found that, on average, moderate or severe food insecurity is 4·09 percentage points (95% CI 3·50–4·68) higher in households with at least one child younger than 15 years than in households with no children and severe food insecurity is 2·20 percentage points (1·76–2·63) higher. However, the additional risk of food insecurity among households with children is lower in countries that provide financial support (either means-tested or universal) for families than for countries with little or no financial assistance. These policies not only reduce food insecurity on average, but they also reduce inequalities in food insecurity by benefiting the poorest households most. Interpretation: In some countries, family policies have been cut back in the past decade and such retrenchment might expose low-income households to increased risk of food insecurity. By increasing investment in family policies, progress towards Sustainable Development Goal 2, zero hunger, might be accelerated and, in turn, improve health for all. Funding: Wellcome Trust

The rise of hunger among low-income households: an analysis of the risks of food insecurity between 2004 and 2016 in a population-based study of UK adults

Background: Rising food bank use in the past decade in the UK raises questions about whether food insecurity has increased. Using the 2016 Food and You survey, we describe the magnitude and severity of the problem, examine characteristics associated with severity of food insecurity, and examine how vulnerability has changed among low-income households by comparing 2016 data to the 2004 Low Income Diet and Nutrition Survey. Methods: The Food and You survey is a representative survey of adults living in England, Wales, and Northern Ireland (n=3118). Generalised ordered logistic regression models were used to examine how socioeconomic characteristics related to severity of food insecurity. Coarsened exact matching was used to match respondents to respondents in the 2004 survey. Logistic regression models were used to examine if food insecurity rose between survey years. Results: 20.7% (95% CI 18.7% to 22.8%) of adults experienced food insecurity in 2016, and 2.72% (95% CI 2.07% to 3.58%) were severely food insecure. Younger age, non-white ethnicity, low education, disability, unemployment, and low income were all associated with food insecurity, but only the latter three characteristics were associated with severe food insecurity. Controlling for socioeconomic variables, the probability of low-income adults being food insecure rose from 27.7% (95% CI 24.8% to 30.6 %) in 2004 to 45.8% (95% CI 41.6% to 49.9%) in 2016. The rise was most pronounced for people with disabilities. Conclusions: Food insecurity affects economically deprived groups in the UK, but unemployment, disability and low income are characteristics specifically associated with severe food insecurity. Vulnerability to food insecurity has worsened among low-income adults since 2004, particularly among those with disabilities