Intersection crashes account for over one-third of all crashes in the U.S., and 39% of these result in injury or death. As part of a larger effort to develop and evaluate in-vehicle countermeasures to reduce the number of intersection-related crashes, haptic warnings and a combined haptic/auditory warning were explored and compared to combined visual/auditory warnings. The first phase of this study determined which haptic brake pulse warning candidate most often resulted in the driver successfully stopping for an intersection. Five brake pulse warnings were tested (varied with respect to jerk, duration, and the number of pulses). Participants receiving the haptic warnings were 38 times more likely to stop at the intersection than those receiving no warning and 7.6 times more likely to stop than those receiving a combined visual/auditory tone warning. The 600ms-3 pulses condition was advanced to the second phase because it provided the longest warning and had a more favorable subjective rating; it was then combined with an auditory verbal warning (urgent "STOP"). This phase determined whether the added verbal warning resulted in differences from the haptic warning alone. Although the warning was activated 7.62 m (25 ft) closer to the intersection in the second phase than in the first phase, there were no significant differences for the reaction times and distance to stop bar. Participants receiving the haptic plus auditory verbal warning were also 1.5 times more likely to stop than those who received the haptic warning alone. Overall, this study shows that haptic warnings show promise for warning drivers of impending intersection violations. Guidelines for haptic intersection warnings were developed, including a recommendation that haptic warnings be combined with auditory verbal warnings for increased warning effectiveness. / Master of Science

Failure to recognize and respond to early signs of deterioration in hospitalized patients can have significant implications associated with delays in treatment. This lack of recognition was the impetus for rapid response teams in the United States and the recommendation by the Institute of Healthcare Improvement for use of early warning scores. This project was designed to evaluate the pilot implementation of an early warning score on 2 units in a community hospital in the Northeast. The practice-focused question was used to explore how patient outcomes changed following implementation of an early warning score (EWS) compared to patient outcomes associated with a rapid response team alone. The translating evidence into practice model informed this project. Supporting evidence from existing hospital data was collected for rapid response, code blue, and mortality. Analysis using the chi-square test of homogeneity compared post-implementation with baseline data. The findings indicated the differences between the proportions were not statistically significant, indicating the metrics did not change appreciably following the implementation of the early warning score. While the evaluation analytics of this pilot did not demonstrate significant change in the outcome measures post-implementation, the results may be useful for the facility when performing a future evaluation of the EWS. It is possible that the results of the 2 units were not representative of the facility, and it is therefore recommended to repeat the evaluation using data from the entire facility for a longer period. Increasing the capacity for early recognition in decline has implications for social change through improvement in safety and quality of health care for all hospitalized patients.

The nation has placed a spotlight on improving graduation rates for all students. The current study analyzed retrospective, longitudinal student data from the fifth largest school district in Oregon to create an Early Warning Indicator System (EWS) to identify students on track to graduate and those who are not. This study creates an EWS system using the student demographics and the ABC’s of (a) attendance, (b) behavior, and (c) coursework to identify students who are on track and those who are not. I employed logistic regression model to build a prediction model using middle school data (N = 2,041) that examined predictors established in sixth through eighth grade with high school graduation. The dependent variable, four-year graduation was coded as graduate or non-graduate. The independent variables were (a) gender, (b) race, (c) ELL status, (d) SPED Status (e) attendance rate, (f) ODR’s, and (g) number of F’s in English Language Arts and Mathematics. Attendance rate was the strongest predictor of high school graduation. Overall the model predicted graduates with 89.7% accuracy and non-graduates with 33.6% accuracy with the total model predicting 69.5% of graduates and non-graduates.

Warning Fatigue or Cry-Wolf effect is a taken-for-granted phenomenon that can result from being ‘over-warned’. The terms are used to describe situations where individuals who are exposed to recurring warning messages about a disaster which then does not eventuate become cynical, apathetic and ‘tired’ of hearing warnings. They may become desensitised to the risk thereby endangering themselves even more. The assumption by practitioners (emergency managers and governmental policy-makers for example) that warning fatigue is a problem presents emergency agencies with a conundrum: they want to avoid the accusation of panicking the public but worry they may run the risk of under-preparing them at the same time. As a result, they may be tempted to err on the side of caution, delay issuing a warning and downplay the possible severity of a potential disaster. Examination of the literature, and an analysis of presentations and news stories have shown that policy-makers, emergency managers, academics and the public use the term ‘cry wolf’ or ‘warning fatigue’ in everyday life. They regard it as conventional wisdom and believe it can influence risk perception and warning response. Nonetheless it has been presumptively assigned by some disaster theorists to the category of a myth. A limited warning fatigue literature has examined the phenomenon in the context of rapid-onset disasters and has concluded that risk perception is not affected by warning fatigue. However, it also suggests there is a direct relationship between warning time, preparedness and response. This allows for the possibility that warning fatigue may not be a myth, but a function of the type of disaster, the frequency of warnings and warning lead-time. This thesis makes a distinction between rapid-onset and prolonged lead-time disasters and hypothesises that prolonged lead-time disasters are responded to in very differently ways than rapid-onset ones. Australian bushfires provide the context in which this research was conducted because bushfires are repeatedly warned about yet rarely (once every ten or twenty years) result in a major disaster. Using social constructionist and social representation theoretical frameworks, and integrating psychosocial and sociological perspectives, this thesis examines the role that warning fatigue plays in the risk perceptions, warning responses and decision-making processes of people living in bushfire-prone areas of Australia. Utilisation of a mixed methods design, a substantive literature review and two rounds of semi-structured interviews resulted in a conceptualisation of a bushfire warning fatigue measure (BWFM). Application of the measure among at-risk Australian communities validated the measure. Through empirical statistical analysis, this standardised instrument was revised (BWFM-R) and used to measure the change in warning fatigue levels over a fire season (November 2011-April 2012). Analysis showed that warning fatigue appears to be multi-faceted comprising five aspects: Trust and credibility, over-warning, false alarms, scepticism and helplessness. It was also found that warning fatigue responses are contextual and interconnected with ‘unofficial’ warnings (such as media stories). The direction of the change and analysis of the qualitative component of the survey implied that unofficial bushfire rhetoric from the media during the winter months may produce a warning fatigue effect, so that when the official warnings were issued at the beginning of the bushfire season, the public were already ‘tired’ of the message. Trust and credibility, over-warning, false alarms, scepticism and helplessness are not new factors in public warning response to disaster communication, but this research demonstrates that they can combine in a unique way to produce ‘warning fatigue’. It proposes that if emergency and disaster agencies differentiate between rapid-onset and prolonged lead-time disasters, understand the complexities of warning fatigue and design their warnings accordingly, then disaster risk communication will become more effective, increasing public engagement and improving disaster response.

The devastating southeast Asian tsunami of December 26, 2004 has brought home the destructive consequences of coastal hazards in an absence of effective warning systems. Since the 1946 tsunami that destroyed much of Hilo, Hawai'i, a network of pole mounted sirens has been used to provide an early public alert of future tsunamis. However, studies in the 1960s showed that understanding of the meaning of siren soundings was very low and that ambiguity in understanding had contributed to fatalities in the 1960 tsunami that again destroyed much of Hilo. The Hawaiian public has since been exposed to monthly tests of the sirens for more than 25 years and descriptions of the system have been widely published in telephone books for at least 45 years. However, currently there remains some uncertainty in the level of public understanding of the sirens and their implications for behavioral response. Here, we show from recent surveys of Hawai'i residents that awareness of the siren tests and test frequency is high, but these factors do not equate with increased understanding of the meaning of the siren, which remains disturbingly low (13%). Furthermore, the length of time people have lived in Hawai'i is not correlated systematically with understanding of the meaning of the sirens. An additional issue is that warning times for tsunamis gene rated locally in Hawai'i will be of the order of minutes to tens of minutes and limit the immediate utility of the sirens. Natural warning signs of such tsunamis may provide the earliest warning to residents. Analysis of a survey subgroup from Hilo suggests that awareness of natural signs is only moderate, and a majority may expect notification via alerts provided by official sources. We conclude that a major change is needed in tsunami education, even in Hawai'i, to increase public understanding of, and effective response to, both future official alerts and natural warning signs of future tsunamis.

Lane change or "Side" Crash Avoidance Systems (SCAS) technologies are becoming available to help alleviate the lane change crash problem. They detect lane change crash hazards and warn the driver of the presence of such hazards. This thesis examines driver lane change behavior and evaluates the potential effectiveness of five warning onset rules for lane change or "side" crash avoidance system (SCAS) technologies. The ideal SCAS should warn the driver only when two conditions are met: (1) positive indication of lane change intent and (2) positive detection of a proximal vehicle in the adjacent lane of concern. Together, these two conditions create a crash hazard. The development of SCAS technologies depends largely on an understanding of driver behavior and performance during lane change maneuvers. By quantifying lane change behavior, real world crash hazard scenarios can be simulated. This provides an opportunity to evaluate potential warning onset rules or algorithms of driver intent to change lanes. Five warning onset rules for SCAS were evaluated: turn-signal onset (TSO), minimum separation (MS), line crossing (LC), time-to-line crossing (TLC), and tolerance limit (TL). The effectiveness of each rule was measured by the maximum response time available (tavailable) to avoid a crash for a particular lane change crash scenario, and by the crash outcome, crashed or crash avoided, of a particular lane change crash scenario. / Master of Science

A new stochastic rainfall field model is described which employs the Turning Bands Method (TBM) to transform a unidimensional Gaussian process, generated by the fractional differencing process along a line, into a multidimensional space-time Gaussian process with a specified space-time correlation structure. Transformations are applied to give the rainfall process a non-Gaussian and non-stationary structure. A correction factor is introduced into the model to take account of the effect of topography on rainfall. The model has been applied to the small upland Wye catchment in mid Wales (area 10.55 km2) and shown to reproduce satisfactorily the statistics and correlation structure of observed hourly point rainfall. As an extension to the rainfall field model, a new technique of conditional simulation has been used to generate the rainfall fields. The conditionally simulated rainfall fields reproduce exactly the observed point rainfalls at measurement points and likely realizations of rainfall fields between points. Rainfall fields generated by the above mentioned rainfall field model and the conditional simulation technique are fed directly into the Systeme Hydrologique European (SHE) model and the sensitivity of runoff prediction errors to (i) level of space-time correlation (ii) sampling of rainfall with different schemes in space and (iii) antecedent conditions are explored. It is found that in case of Wye catchment the errors deriving from sampling procedure used are generally small when rainfall fields were based on observed correlation structure. Sensitivity of errors to different correlation levels give the impression that errors increase with a decrease in correlation level. Further it is noticed that this trend of errors is more pronounced in `dry' catchment conditions as compared to `wet' catchment conditions. Overall the results for the small Wye catchment illustrate that the catchment acts as a smoother of the spatially distributed rainfall input at this spatial scale and for the rainfall regime in question. However, the results imply that for the typical raingauge densities encountered for larger catchments, significant errors may occur.

Purpose: The aim of this project was to evaluate data from a survey sent to nurses in regards to the current practices and workflow of the Early Warning System (EWS) currently in use at Banner Health. Methods: A descriptive cross-sectional design was used to collect feedback from Registered Nurses. The survey was open between February and March of 2016. Likert style and open-ended questions demonstrate evidence supporting the following study questions: 1) What are the barriers to documentation that triggers the EWS? 2) To what extent is the EWS useful and usable? 3) What were the features of the EWS implementation? Results: Findings demonstrated three barriers associated with EWS protocol compliance to include increased workload (78%), previous negative responses from providers (62%), and alert fatigue (48%). Provider responsiveness to notification of the Early Warning Score was shown to be effective "most of the time" and "about half of the time" at 71%, with 12% indicating "sometimes" and "never". Deployment of the Rapid Response Team (RRT) when indicated by EWS algorithm showed only 9 (14%) of nurses always call the RRT, 7 (11%) call about half the time, and 16% indicated they never use the RRT. "Real time" charting occurred 50-75% or less than 50% of the time for 96% of respondents. Open ended questions support recommendations for future practice to include: implementation of a pop up alert for easy recognition of changes in EWS, tailoring parameters based on individual patient characteristics, automatic direct paging to medical providers, and elimination of the level of consciousness parameter. A validated usability survey provided data with a mean response rate (n=58). Nurses (84%) agree the EWS is useful and usable. Ease of use, efficiency, and comfort with EWS software showed 90% agree. System interface responses demonstrate 23% dislike using the interface, and 21% felt the system interface was unpleasant.Conclusions: Findings demonstrate EWS system usability and usefulness. Recommendations for improvement include implementation of a "pop up" alert for easy recognition of changes in the Early Warning Score and/or automatic direct paging to medical providers and nursing will increase effective use. Barriers to EWS protocol documentation include increased workload, previous negative response from providers, and alert fatigue. "Real time" documentation of physiological parameters is essential to successful triggering of an Early Warning Score.

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