The association between objectively measured neighborhood features and walking in middle-aged adults

Purpose: To explore the role of the neighborhood environment in supporting walking Design: Cross sectional study of 10,286 residents of 200 neighborhoods. Participants were selected using a stratified two-stage cluster design. Data were collected by mail survey (68.5% response rate). Setting: The Brisbane City Local Government Area, Australia, 2007. Subjects: Brisbane residents aged 40 to 65 years. Measures Environmental: street connectivity, residential density, hilliness, tree coverage, bikeways, and street lights within a one kilometer circular buffer from each resident’s home; and network distance to nearest river or coast, public transport, shop, and park. Walking: minutes in the previous week categorized as < 30 minutes, ≥ 30 < 90 minutes, ≥ 90 < 150 minutes, ≥ 150 < 300 minutes, and ≥ 300 minutes. Analysis: The association between each neighborhood characteristic and walking was examined using multilevel multinomial logistic regression and the model parameters were estimated using Markov chain Monte Carlo simulation. Results: After adjustment for individual factors, the likelihood of walking for more than 300 minutes (relative to <30 minutes) was highest in areas with the most connectivity (OR=1.93, 99% CI 1.32-2.80), the greatest residential density (OR=1.47, 99% CI 1.02-2.12), the least tree coverage (OR=1.69, 99% CI 1.13-2.51), the most bikeways (OR=1.60, 99% CI 1.16-2.21), and the most street lights (OR=1.50, 99% CI 1.07-2.11). The likelihood of walking for more than 300 minutes was also higher among those who lived closest to a river or the coast (OR=2.06, 99% CI 1.41-3.02). Conclusion: The likelihood of meeting (and exceeding) physical activity recommendations on the basis of walking was higher in neighborhoods with greater street connectivity and residential density, more street lights and bikeways, closer proximity to waterways, and less tree coverage. Interventions targeting these neighborhood characteristics may lead to improved environmental quality as well as lower rates of overweight and obesity and associated chromic disease.

The implementation of performance based planning in Queensland under the integrated planning act 1997 : an evaluation of perceptions and planning schemes

Performance based planning is a form of planning regulation that is not well understood and the theoretical advantages of this type of planning are rarely achieved in practice. Normatively, this type of regulation relies on performance standards that are quantifiable and technically based which are designed to manage the effects of development, where performance standards provide certainty in respect of the level of performance and the means of achievement is flexible. Few empirical studies have attempted to examine how performance based planning has been conceptualised and implemented in practice. Existing literature is predominately anecdotal and consultant based (Baker et al. 2006) and has not sought to quantitatively examine how land use has been managed or determine how context influences implementation. The Integrated Planning Act 1997 (IPA) operated as Queensland’s principal planning legislation between March 1998 and December 2009. The IPA prevented Local Governments from prohibiting development or use and the term zone was absent from the legislation. While the IPA did not use the term performance based planning, the system is widely considered to be performance based in practice (e.g. Baker et al. 2006; Steele 2009a, 2009b). However, the degree to which the IPA and the planning system in Queensland is performance based is debated (e.g. Yearbury 1998; England 2004). Four research questions guided the research framework using Queensland as the case study. The questions sought to: determine if there is a common understanding of performance based planning; identify how performance based planning was expressed under the IPA; understand how performance based planning was implemented in plans; and explore the experiences of participants in the planning system. The research developed a performance adoption spectrum. The spectrum describes how performance based planning is implemented, ranging between pure and hybrid interpretations. An ex-post evaluation of seventeen IPA plans sought to determine plan performativity within the conceptual spectrum. Land use was examined from the procedural dimension of performance (Assessment Tables) and the substantive dimension of performance (Codes). A documentary analysis and forty one interviews supplemented the research. The analytical framework considered how context influenced performance based planning, including whether: the location of the local government affected land use management techniques; temporal variation in implementation exists; plan-making guidelines affected implementation; different perceptions of the concept exist; this type of planning applies to a range of spatial scales. Outcomes were viewed as the medium for determining the acceptability of development in Queensland, a significant departure from pure approaches found in the United States. Interviews highlighted the absence of plan-making direction in the IPA, which contributed to the confusion about the intended direction of the planning system and the myth that the IPA would guarantee a performance based system. A hybridised form of performance based planning evolved in Queensland which was dependent on prescriptive land use zones and specification of land use type, with some local governments going to extreme lengths to discourage certain activities in a predetermined manner. Context had varying degrees of influence on plan-making methods. Decision-making was found to be inconsistent and the system created a range of unforeseen consequences including difficulties associated with land valuation, increased development speculation, and the role of planners in court was found to be less critical than in the previous planning system.

Models of collective cell behaviour with crowding effects : comparing lattice-based and lattice-free approaches

Individual-based models describing the migration and proliferation of a population of cells frequently restrict the cells to a predefined lattice. An implicit assumption of this type of lattice based model is that a proliferative population will always eventually fill the lattice. Here we develop a new lattice-free individual-based model that incorporates cell-to-cell crowding effects. We also derive approximate mean-field descriptions for the lattice-free model in two special cases motivated by commonly used experimental setups. Lattice-free simulation results are compared to these mean-field descriptions and to a corresponding lattice-based model. Data from a proliferation experiment is used to estimate the parameters for the new model, including the cell proliferation rate, showing that the model fits the data well. An important aspect of the lattice-free model is that the confluent cell density is not predefined, as with lattice-based models, but an emergent model property. As a consequence of the more realistic, irregular configuration of cells in the lattice-free model, the population growth rate is much slower at high cell densities and the population cannot reach the same confluent density as an equivalent lattice-based model.

Spatio-temporal patterns of Barmah Forest virus disease in Queensland, Australia

Background Barmah Forest virus (BFV) disease is a common and wide-spread mosquito-borne disease in Australia. This study investigated the spatio-temporal patterns of BFV disease in Queensland, Australia using geographical information system (GIS) tools and geostatistical analysis. Methods/Principal Findings We calculated the incidence rates and standardised incidence rates of BFV disease. Moran's I statistic was used to assess the spatial autocorrelation of BFV incidences. Spatial dynamics of BFV disease was examined using semi-variogram analysis. Interpolation techniques were applied to visualise and display the spatial distribution of BFV disease in statistical local areas (SLAs) throughout Queensland. Mapping of BFV disease by SLAs reveals the presence of substantial spatio-temporal variation over time. Statistically significant differences in BFV incidence rates were identified among age groups (χ2 = 7587, df = 7327,p<0.01). There was a significant positive spatial autocorrelation of BFV incidence for all four periods, with the Moran's I statistic ranging from 0.1506 to 0.2901 (p<0.01). Semi-variogram analysis and smoothed maps created from interpolation techniques indicate that the pattern of spatial autocorrelation was not homogeneous across the state. Conclusions/Significance This is the first study to examine spatial and temporal variation in the incidence rates of BFV disease across Queensland using GIS and geostatistics. The BFV transmission varied with age and gender, which may be due to exposure rates or behavioural risk factors. There are differences in the spatio-temporal patterns of BFV disease which may be related to local socio-ecological and environmental factors. These research findings may have implications in the BFV disease control and prevention programs in Queensland.

Safety leaders’ perceptions of safety culture in a large Australasian construction organisation

This paper reports safety leaders’ perceptions of safety culture in one of Australasia’s largest construction organisations. A modified Delphi method was used including two rounds of data collection. The first round involved 41 semi-structured interviews with safety leaders within the organisation. The second round involved an online quantitative perception survey, with the same sample, aimed at confirming the key themes identified in the interviews. Participants included Senior Executives, Corporate Managers, Project Managers, Safety Managers and Site Supervisors. Interview data was analysed using qualitative thematic analysis, and the survey data was analysed using descriptive statistics. Leaders’ definitions and descriptions of safety culture were primarily action-oriented and some confusion was evident due to the sometimes implicit nature of culture in organisations. Leadership was identified as a key factor for positive safety culture in the organisation, and there was an emphasis on leaders demonstrating commitment to safety, and being visible to the project-based workforce. Barriers to safety culture improvement were also identified, including the subcontractor management issues, pace of change, and reporting requirements. The survey data provided a quantitative confirmation of the interview themes, with some minor discrepancies. The findings highlight that safety culture is a complex construct, which is difficult to define, even for experts in the organisation. Findings on the key factors indicated consistency with the current literature; however the perceptions of barriers to safety culture offer a new understanding in to how safety culture operates in practice.

The geostationary orbit : a critical legal geography of space’s most valuable real estate

This chapter attends to the legal and political geographies of one of Earth's most important, valuable, and pressured spaces: the geostationary orbit. Since the first, NASA, satellite entered it in 1964, this small, defined band of Outer Space, 35,786km from the Earth's surface, and only 30km wide, has become a highly charged legal and geopolitical environment, yet it remains a space which is curiously unheard of outside of specialist circles. For the thousands of satellites which now underpin the Earth's communication, media, and data industries and flows, the geostationary orbit is the prime position in Space. The geostationary orbit only has the physical capacity to hold approximately 1500 satellites; in 1997 there were approximately 1000. It is no overstatement to assert that media, communication, and data industries would not be what they are today if it was not for the geostationary orbit. This chapter provides a critical legal geography of the geostationary orbit, charting the topography of the debates and struggles to define and manage this highly-important space. Drawing on key legal documents such as the Outer Space Treaty and the Moon Treaty, the chapter addresses fundamental questions about the legal geography of the orbit, questions which are of growing importance as the orbit’s available satellite spaces diminish and the orbit comes under increasing pressure. Who owns the geostationary orbit? Who, and whose rules, govern what may or may not (literally) take place within it? Who decides which satellites can occupy the orbit? Is the geostationary orbit the sovereign property of the equatorial states it supertends, as these states argued in the 1970s? Or is it a part of the res communis, or common property of humanity, which currently legally characterises Outer Space? As challenges to the existing legal spatiality of the orbit from launch states, companies, and potential launch states, it is particularly critical that the current spatiality of the orbit is understood and considered. One of the busiest areas of Outer Space’s spatiality is international territorial law. Mentions of Space law tend to evoke incredulity and ‘little green men’ jokes, but as Space becomes busier and busier, international Space law is growing in complexity and importance. The chapter draws on two key fields of research: cultural geography, and critical legal geography. The chapter is framed by the cultural geographical concept of ‘spatiality’, a term which signals the multiple and dynamic nature of geographical space. As spatial theorists such as Henri Lefebvre assert, a space is never simply physical; rather, any space is always a jostling composite of material, imagined, and practiced geographies (Lefebvre 1991). The ways in which a culture perceives, represents, and legislates that space are as constitutive of its identity--its spatiality--as the physical topography of the ground itself. The second field in which this chapter is situated—critical legal geography—derives from cultural geography’s focus on the cultural construction of spatiality. In his Law, Space and the Geographies of Power (1994), Nicholas Blomley asserts that analyses of territorial law largely neglect the spatial dimension of their investigations; rather than seeing the law as a force that produces specific kinds of spaces, they tend to position space as a neutral, universally-legible entity which is neatly governed by the equally neutral 'external variable' of territorial law (28). 'In the hegemonic conception of the law,' Pue similarly argues, 'the entire world is transmuted into one vast isotropic surface' (1990: 568) on which law simply acts. But as the emerging field of critical legal geography demonstrates, law is not a neutral organiser of space, but is instead a powerful cultural technology of spatial production. Or as Delaney states, legal debates are “episodes in the social production of space” (2001, p. 494). International territorial law, in other words, makes space, and does not simply govern it. Drawing on these tenets of the field of critical legal geography, as well as on Lefebvrian concept of multipartite spatiality, this chapter does two things. First, it extends the field of critical legal geography into Space, a domain with which the field has yet to substantially engage. Second, it demonstrates that the legal spatiality of the geostationary orbit is both complex and contested, and argues that it is crucial that we understand this dynamic legal space on which the Earth’s communications systems rely.

Spatial inequalities in colorectal and breast cancer survival : premature deaths and associated factors

This study examines the influence of cancer stage, distance to treatment facilities and area disadvantage on breast and colorectal cancer spatial survival inequalities. We also estimate the number of premature deaths after adjusting for cancer stage to quantify the impact of spatial survival inequalities. Population-based descriptive study of residents aged <90 years in Queensland, Australia diagnosed with primary invasive breast (25,202 females) or colorectal (14,690 males, 11,700 females) cancers during 1996-2007. Bayesian hierarchical models explored relative survival inequalities across 478 regions. Cancer stage and disadvantage explained the spatial inequalities in breast cancer survival, however spatial inequalities in colorectal cancer survival persisted after adjustment. Of the 6,019 colorectal cancer deaths within 5 years of diagnosis, 470 (8%) were associated with spatial inequalities in non-diagnostic factors, i.e. factors beyond cancer stage at diagnosis. For breast cancers, of 2,412 deaths, 170 (7%) were related to spatial inequalities in non-diagnostic factors. Quantifying premature deaths can increase incentive for action to reduce these spatial inequalities.

The use of computerised simulators for training of transthoracic and transoesophageal echocardiography. The future of echocardiographic training?

Echocardiography is the commonest form of non-invasive cardiac imaging and is fundamental to patient management. However, due to its methodology, it is also operator dependent. There are well defined pathways in training and ongoing accreditation to achieve and maintain competency. To satisfy these requirements, significant time has to be dedicated to scanning patients, often in the time pressured clinical environment. Alternative, computer based training methods are being considered to augment echocardiographic training. Numerous advances in technology have resulted in the development of interactive programmes and simulators to teach trainees the skills to perform particular procedures, including transthoracic and transoesophageal echocardiography. 82 sonographers and TOE proceduralists utilised an echocardiographic simulator and assessed its utility using defined criteria. 40 trainee sonographers assessed the simulator and were taught how to obtain an apical 2 chamber (A2C) view and image the superior vena cava (SVC). 100% and 88% found the simulator useful in obtaining the SVC or A2C view respectively. All users found it easy to use and the majority found it helped with image acquisition and interpretation. 42 attendees of a TOE training day utilising the simulator assessed the simulator with 100% finding it easy to use, as well as the augmented reality graphics benefiting image acquisition. 90% felt that it was realistic. This study revealed that both trainee sonographers and TOE proceduralists found the simulation process was realistic, helped in image acquisition and improved assessment of spatial relationships. Echocardiographic simulators may play an important role in the future training of echocardiographic skills.

Analysis of Cone-Beam CT using prior information

Treatment plans for conformal radiotherapy are based on an initial CT scan. The aim is to deliver the prescribed dose to the tumour, while minimising exposure to nearby organs. Recent advances make it possible to also obtain a Cone-Beam CT (CBCT) scan, once the patient has been positioned for treatment. A statistical model will be developed to compare these CBCT scans with the initial CT scan. Changes in the size, shape and position of the tumour and organs will be detected and quantified. Some progress has already been made in segmentation of prostate CBCT scans [1],[2],[3]. However, none of the existing approaches have taken full advantage of the prior information that is available. The planning CT scan is expertly annotated with contours of the tumour and nearby sensitive objects. This data is specific to the individual patient and can be viewed as a snapshot of spatial information at a point in time. There is an abundance of studies in the radiotherapy literature that describe the amount of variation in the relevant organs between treatments. The findings from these studies can form a basis for estimating the degree of uncertainty. All of this information can be incorporated as an informative prior into a Bayesian statistical model. This model will be developed using scans of CT phantoms, which are objects with known geometry. Thus, the accuracy of the model can be evaluated objectively. This will also enable comparison between alternative models.

Welfare-to-work and the experience of single mothers in Australia : where are the benefits?

In July 2006 ‘welfare-to-work’ policies were introduced for single parents in Australia. These policies require most single parents with school aged children to be employed or seeking employment of 15-25 hours per week in return for their income support payment. The changes represented a sharp increase in the obligations applying to single parents on income support. This paper is concerned with how the well-being of single mothers who are combining income support and paid employment is being influenced by these stepped up activity requirements. The paper draws on data from semi-structured interviews with 21 Brisbane single mothers. The analysis explores participants’ experiences in the new policy environment utilizing the theoretical framework of ‘relational autonomy’. Relational approaches to autonomy emphasize the importance of relations of dependency and interdependency to the development of autonomy and well-being. The findings indicate that in their dealings with the welfare bureaucracy participants experienced a lack of recognition of their identities as mothers, paid workers and competent decision makers. These experiences have negative consequences for self worth, relational autonomy and ultimately the well-being of single parent families.

A critical regionalist approach to housing design in Vietnam : socio-environmental organisation of living spaces in pre- and post-reform houses

Vietnam has a unique culture which is revealed in the way that people have built and designed their traditional housing. Vietnamese dwellings reflect occupants’ activities in their everyday lives, while adapting to tropical climatic conditions impacted by seasoning monsoons. It is said that these characteristics of Vietnamese dwellings have remained unchanged until the economic reform in 1986, when Vietnam experienced an accelerated development based on the market-oriented economy. New housing types, including modern shop-houses, detached houses, and apartments, have been designed in many places, especially satisfying dwellers’ new lifestyles in Vietnamese cities. The contemporary housing, which has been mostly designed by architects, has reflected rules of spatial organisation so that occupants’ social activities are carried out. However, contemporary housing spaces seem unsustainable in relation to socio-cultural values because they has been influenced by globalism that advocates the use of homogeneous spatial patterns, modern technologies, materials and construction methods. This study investigates the rules of spaces in Vietnamese houses that were built before and after the reform to define the socio-cultural implications in Vietnamese housing design. Firstly, it describes occupants’ views of their current dwellings in terms of indoor comfort conditions and social activities in spaces. Then, it examines the use of spaces in pre-reform Vietnamese housing through occupants’ activities and material applications. Finally, it discusses the organisation of spaces in both pre- and post-reform housing to understand how Vietnamese housing has been designed for occupants to live, act, work, and conduct traditional activities. Understanding spatial organisation is a way to identify characteristics of the lived spaces of the occupants created from the conceived space, which is designed by designers. The characteristics of the housing spaces will inform the designers the way to design future Vietnamese housing in response to cultural contexts. The study applied an abductive approach for the investigation of housing spaces. It used a conceptual framework in relation to Henri Lefebvre’s (1991) theory to understand space as the main factor constituting the language of design, and the principles of semiotics to examine spatial structure in housing as a language used in the everyday life. The study involved a door-knocking survey to 350 households in four regional cities of Vietnam for interpretation of occupancy conditions and levels of occupants’ comfort. A statistical analysis was applied to interpret the survey data. The study also required a process of data selection and collection of fourteen cases of housing in three main climatic regions of the country for analysing spatial organisation and housing characteristics. The study found that there has been a shift in the relationship of spaces from the pre- to post-reform Vietnamese housing. It also indentified that the space for guest welcoming and family activity has been the central space of the Vietnamese housing. Based on the relationships of the central space with the others, theoretical models were proposed for three types of contemporary Vietnamese housing. The models will be significant in adapting to Vietnamese conditions to achieve socioenvironmental characteristics for housing design because it was developed from the occupants’ requirements for their social activities. Another contribution of the study is the use of methodological concepts to understand the language of living spaces. Further work will be needed to test future Vietnamese housing designs from the applications of the models.

(Re)visioning the centre : education reform and the “ideal” citizen of the future

Discourses of public education reform, like that exemplified within the Queensland Government’s future vision document, Queensland State Education-2010 (QSE-2010), position schooling as a panacea to pervasive social instability and a means to achieve a new consensus. However, in unravelling the many conflicting statements that conjoin to form education policy and inform related literature (Ball, 1993), it becomes clear that education reform discourse is polyvalent (Foucault, 1977). Alongside visionary statements that speak of public education as a vehicle for social justice are the (re)visionary or those reflecting neoliberal individualism and a conservative politics. In this paper, it is argued that the latter coagulate to form strategic discursive practices which work to (re)secure dominant relations of power. Further, discussion of the characteristics needed by the “ideal” future citizen of Queensland reflect efforts to ‘tame change through the making of the child’ (Popkewitz, 2004, p.201). The casualties of this (re)vision and the refusal to investigate the pathologies of “traditional” schooling are the children who, for whatever reason, do not conform to the norm of the desired school child as an “ideal” citizen-in-the-making and who become relegated to alternative educational settings.

Mobility of the creative class and city attractiveness : a case study of Chinese animation workers

Abstract: The paper investigates the geographical mobility of creative workers in China,focusing on the authors’ survey of workers in the animation industry. More specifically,the authors use the Reilly-Converse model and GIS tools to probe the locational choices of Chinese animation workers in Beijing and Shanghai by analyzing such factors of spatial attractiveness as home town, place of residence, and university from which the worker graduated. The paper compares the creative milieus in Beijing and Shanghai, and demonstrates that the “personal trajectory” of human capital is a key determinant of occupational location. The results of the authors’ survey highlight the limitations of Richard Florida’s 3T theory in the Chinese context.

Querying a building information model for construction-specific spatial information

The design and construction community has shown increasing interest in adopting building information models (BIMs). The richness of information provided by BIMs has the potential to streamline the design and construction processes by enabling enhanced communication, coordination, automation and analysis. However, there are many challenges in extracting construction-specific information out of BIMs. In most cases, construction practitioners have to manually identify the required information, which is inefficient and prone to error, particularly for complex, large-scale projects. This paper describes the process and methods we have formalized to partially automate the extraction and querying of construction-specific information from a BIM. We describe methods for analyzing a BIM to query for spatial information that is relevant for construction practitioners, and that is typically represented implicitly in a BIM. Our approach integrates ifcXML data and other spatial data to develop a richer model for construction users. We employ custom 2D topological XQuery predicates to answer a variety of spatial queries. The validation results demonstrate that this approach provides a richer representation of construction-specific information compared to existing BIM tools.

Estimating the effects of ambient temperature on mortality : methodological challenges and proposed solutions

The health impacts of exposure to ambient temperature have been drawing increasing attention from the environmental health research community, government, society, industries, and the public. Case-crossover and time series models are most commonly used to examine the effects of ambient temperature on mortality. However, some key methodological issues remain to be addressed. For example, few studies have used spatiotemporal models to assess the effects of spatial temperatures on mortality. Few studies have used a case-crossover design to examine the delayed (distributed lag) and non-linear relationship between temperature and mortality. Also, little evidence is available on the effects of temperature changes on mortality, and on differences in heat-related mortality over time. This thesis aimed to address the following research questions: 1. How to combine case-crossover design and distributed lag non-linear models? 2. Is there any significant difference in effect estimates between time series and spatiotemporal models? 3. How to assess the effects of temperature changes between neighbouring days on mortality? 4. Is there any change in temperature effects on mortality over time? To combine the case-crossover design and distributed lag non-linear model, datasets including deaths, and weather conditions (minimum temperature, mean temperature, maximum temperature, and relative humidity), and air pollution were acquired from Tianjin China, for the years 2005 to 2007. I demonstrated how to combine the case-crossover design with a distributed lag non-linear model. This allows the case-crossover design to estimate the non-linear and delayed effects of temperature whilst controlling for seasonality. There was consistent U-shaped relationship between temperature and mortality. Cold effects were delayed by 3 days, and persisted for 10 days. Hot effects were acute and lasted for three days, and were followed by mortality displacement for non-accidental, cardiopulmonary, and cardiovascular deaths. Mean temperature was a better predictor of mortality (based on model fit) than maximum or minimum temperature. It is still unclear whether spatiotemporal models using spatial temperature exposure produce better estimates of mortality risk compared with time series models that use a single site’s temperature or averaged temperature from a network of sites. Daily mortality data were obtained from 163 locations across Brisbane city, Australia from 2000 to 2004. Ordinary kriging was used to interpolate spatial temperatures across the city based on 19 monitoring sites. A spatiotemporal model was used to examine the impact of spatial temperature on mortality. A time series model was used to assess the effects of single site’s temperature, and averaged temperature from 3 monitoring sites on mortality. Squared Pearson scaled residuals were used to check the model fit. The results of this study show that even though spatiotemporal models gave a better model fit than time series models, spatiotemporal and time series models gave similar effect estimates. Time series analyses using temperature recorded from a single monitoring site or average temperature of multiple sites were equally good at estimating the association between temperature and mortality as compared with a spatiotemporal model. A time series Poisson regression model was used to estimate the association between temperature change and mortality in summer in Brisbane, Australia during 1996–2004 and Los Angeles, United States during 1987–2000. Temperature change was calculated by the current day's mean temperature minus the previous day's mean. In Brisbane, a drop of more than 3 �C in temperature between days was associated with relative risks (RRs) of 1.16 (95% confidence interval (CI): 1.02, 1.31) for non-external mortality (NEM), 1.19 (95% CI: 1.00, 1.41) for NEM in females, and 1.44 (95% CI: 1.10, 1.89) for NEM aged 65.74 years. An increase of more than 3 �C was associated with RRs of 1.35 (95% CI: 1.03, 1.77) for cardiovascular mortality and 1.67 (95% CI: 1.15, 2.43) for people aged < 65 years. In Los Angeles, only a drop of more than 3 �C was significantly associated with RRs of 1.13 (95% CI: 1.05, 1.22) for total NEM, 1.25 (95% CI: 1.13, 1.39) for cardiovascular mortality, and 1.25 (95% CI: 1.14, 1.39) for people aged . 75 years. In both cities, there were joint effects of temperature change and mean temperature on NEM. A change in temperature of more than 3 �C, whether positive or negative, has an adverse impact on mortality even after controlling for mean temperature. I examined the variation in the effects of high temperatures on elderly mortality (age . 75 years) by year, city and region for 83 large US cities between 1987 and 2000. High temperature days were defined as two or more consecutive days with temperatures above the 90th percentile for each city during each warm season (May 1 to September 30). The mortality risk for high temperatures was decomposed into: a "main effect" due to high temperatures using a distributed lag non-linear function, and an "added effect" due to consecutive high temperature days. I pooled yearly effects across regions and overall effects at both regional and national levels. The effects of high temperature (both main and added effects) on elderly mortality varied greatly by year, city and region. The years with higher heat-related mortality were often followed by those with relatively lower mortality. Understanding this variability in the effects of high temperatures is important for the development of heat-warning systems. In conclusion, this thesis makes contribution in several aspects. Case-crossover design was combined with distribute lag non-linear model to assess the effects of temperature on mortality in Tianjin. This makes the case-crossover design flexibly estimate the non-linear and delayed effects of temperature. Both extreme cold and high temperatures increased the risk of mortality in Tianjin. Time series model using single site’s temperature or averaged temperature from some sites can be used to examine the effects of temperature on mortality. Temperature change (no matter significant temperature drop or great temperature increase) increases the risk of mortality. The high temperature effect on mortality is highly variable from year to year.