Seeing is believing
Presenting evidence using information graphics
!

Dr Will Stahl-Timmins
Associate Research Fellow: Vis...
Information graphics - visual presentation of E&HH data
Evaluation - investigating the effects of visual presentation
Commo...
Information graphics - visual presentation of E&HH data
Evaluation - investigating the effects of visual presentation
Commo...
1996

?

0yr

1

2

0

baseline
MMSE
10

20 30

1998 (A)

N = 473

Rogers et al.
1998 (B)

N = 468

N = 818

Greenberg
et ...
Information graphics - visual presentation of E&HH data
Evaluation - investigating the effects of visual presentation
Commo...
GOfER (Graphical Overview 

for Evidence Reviews
Mean task time
(% of total task time)

Error Bars: 95% CI

20%

15%

two-sample t(69) = 4.4

p < 0.001


10%

5%

0%

Repo...
task accuracy
!

COGS:

74.3%


report:

46.4%

!
!
!

c2 (1, N = 63) = 5.12, p = 0.024
1996

?

0yr

1

2

0

baseline
MMSE
10

20 30

1998 (A)

N = 473

Rogers et al.
1998 (B)

N = 468

N = 818

Greenberg
et ...
Title

Gender
M

Able Baker et al.

Ages

Sites

Features

Outcomes

Design

F

500mg N=22

2010

N=50
M

F

Dogg's Hamlet...
FLOODS AND STORMS

AIR QUALITY AND DISEASE
Weather at all time scales determines the development, transport, dispersion an...
157

129

CONTROL A

TEXT A

160

GRAPHIC A

RISK GROUP A:
STORMS & FLOODS

179

CONTROL B

142

166

TEXT B
RISK GROUP B:...
Approval
View Time
8 mins

6
5
4

3 mins
KEY

3
157 157 129 129 160 160
149
177

MEAN & 95% CI

SIG. (P < 0.05)
N.S. (P > ...
View Time
8 mins

6 mins*

3 3 mins
mins
KEY

157 157 129 129 160 160
149
177

MEAN & 95% CI

SIG. (P < 0.05)
N.S. (P > 0....
Memory
100%

80%

60%
0%

KEY
MEAN & 95% CI
SIG. (P < 0.05)
N.S. (P > 0.05)

159
157

130
129

CONTROL A
CONTROL A

TEXT A...
Risk perception (severity)
7

28

1
14
KEY
MEAN & 95% CI
SIG. (P < 0.05)
N.S. (P > 0.05)

158
157

129
129

CONTROL A
CONT...
50%
Age
group:
control
text
graphic

68-77

58-67

48-57

38-47

28-37

18-27

68-77

58-67

48-57

38-47

28-37

18-27

6...
Information graphics - visual presentation of E&HH data
Evaluation - investigating the effects of visual presentation
Commo...
Volume
1996

?

0yr

1

2

0

baseline
MMSE
10

20 30

1998 (A)

N = 473

Rogers et al.
1998 (B)

N = 468

N = 818

Greenberg
et ...
Time
9415027430914103495740913798571
0938475109345721039247851930475
1039485739085741039751039487548
30948571390471054710513249...
9415027430914103495740913798571
0938475109345721039247851930475
1039485739085741039751039487548
30948571390471054710513249...
FLOODS AND STORMS

AIR QUALITY AND DISEASE
Weather at all time scales determines the development, transport, dispersion an...
Multiple dimensions

1
Multiple dimensions

1

2
Multiple dimensions

1

2

3
Multiple dimensions

1

2

3

N...
Gapminder - Hans Rosling
Japan

GAPMINDER WORLD 2012

Israel

Mapping the Wealth and Health of Nations

Spain
South Korea
...
Charles Joseph Minard
Information graphics - visual presentation of E&HH data
Evaluation - investigating the effects of visual presentation
Commo...
!

w.stahl-timmins@exeter.ac.uk
!

www.ecehh.org
!

blog.willstahl.com
!

Twitter: @will_s_t

EUROPEAN UNION
Investing in ...
Seeing is Believing
Seeing is Believing
Seeing is Believing
Seeing is Believing
Seeing is Believing
Seeing is Believing
Seeing is Believing
Seeing is Believing
Seeing is Believing
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Seeing is Believing
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Presenting evidence using information graphics

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  1. 1. Seeing is believing Presenting evidence using information graphics ! Dr Will Stahl-Timmins Associate Research Fellow: Visualisation EUROPEAN UNION Investing in Your Future European Regional Development Fund 2007-13 EUROPEAN UNION Investing in Your Future European Regional Development Fund 2007-13
  2. 2. Information graphics - visual presentation of E&HH data Evaluation - investigating the effects of visual presentation Common evidence presentation issues - examples
  3. 3. Information graphics - visual presentation of E&HH data Evaluation - investigating the effects of visual presentation Common evidence presentation issues - examples
  4. 4. 1996 ? 0yr 1 2 0 baseline MMSE 10 20 30 1998 (A) N = 473 Rogers et al. 1998 (B) N = 468 N = 818 Greenberg et al. 2000 N = 60 2000 N = 268 Mohs et al. 2001 N = 431 Placebo N = 217 0yr 1 2 0 10 20 30 F F M Donepezil 10mg N = 214 F M Placebo N = 129 F F M Donepezil 5mg N = 134 Homma et al. F M Donepezil 5mg (D) group 1 (p-D-p-p) N=30 group 2 (p-p-D-p) N=30 Placebo (p) F F M M Placebo N = 274 F M Donepezil 10mg N = 273 F F M M Placebo N = 153 Donepezil 5mg N = 271 F M Donepezil 10mg N = 158 F F M M Placebo N = 162 Donepezil 5mg N = 157 F F F F M Donepezil 10mg N = 157 Burns et al. 1999 55 75 95 M M Donepezil 5mg N = 154 Rogers et al. ages M M M M Donepezil 1mg N = 42 Donepezil 3mg N = 40 Donepezil 5mg N = 39 Placebo N = 40 N = 161 sex F study quality Rand Char Blind Analy ADAS-cog MMSE SIB other ADCS-ADL DAD PDS other NPI other CIBIC GDS CDR ADCS-CGIC QoL Rogers & design, size & follow-up 1mg 3mg 5mg 5mg Rand Char Blind Analy 10 mg 5mg Rand Char Blind Analy 10 mg 5mg Rand Char Blind Analy 10mg Rand Char Blind Analy Rand Char Blind Analy Rand Char Blind Analy 55 75 95 ADAS-cog MMSE SIB other ADCS-ADL DAD PDS other NPI other CIBIC GDS CDR ADCS-CGIC QoL author location no. of centres outcome measures used cog func be glo cog func be glo
  5. 5. Information graphics - visual presentation of E&HH data Evaluation - investigating the effects of visual presentation Common evidence presentation issues - examples
  6. 6. GOfER (Graphical Overview for Evidence Reviews
  7. 7. Mean task time (% of total task time) Error Bars: 95% CI 20% 15% two-sample t(69) = 4.4 p < 0.001 10% 5% 0% Report COGS
  8. 8. task accuracy ! COGS: 74.3% report: 46.4% ! ! ! c2 (1, N = 63) = 5.12, p = 0.024
  9. 9. 1996 ? 0yr 1 2 0 baseline MMSE 10 20 30 1998 (A) N = 473 Rogers et al. 1998 (B) N = 468 N = 818 Greenberg et al. 2000 N = 60 2000 N = 268 Mohs et al. 2001 N = 431 Placebo N = 217 0yr 1 2 0 10 20 30 F F M Donepezil 10mg N = 214 F M Placebo N = 129 F F M Donepezil 5mg N = 134 Homma et al. F M Donepezil 5mg (D) group 1 (p-D-p-p) N=30 group 2 (p-p-D-p) N=30 Placebo (p) F F M M Placebo N = 274 F M Donepezil 10mg N = 273 F F M M Placebo N = 153 Donepezil 5mg N = 271 F M Donepezil 10mg N = 158 F F M M Placebo N = 162 Donepezil 5mg N = 157 F F F F M Donepezil 10mg N = 157 Burns et al. 1999 55 75 95 M M Donepezil 5mg N = 154 Rogers et al. ages M M M M Donepezil 1mg N = 42 Donepezil 3mg N = 40 Donepezil 5mg N = 39 Placebo N = 40 N = 161 sex F study quality Rand Char Blind Analy ADAS-cog MMSE SIB other ADCS-ADL DAD PDS other NPI other CIBIC GDS CDR ADCS-CGIC QoL Rogers & design, size & follow-up 1mg 3mg 5mg 5mg Rand Char Blind Analy 10 mg 5mg Rand Char Blind Analy 10 mg 5mg Rand Char Blind Analy 10mg Rand Char Blind Analy Rand Char Blind Analy Rand Char Blind Analy 55 75 95 ADAS-cog MMSE SIB other ADCS-ADL DAD PDS other NPI other CIBIC GDS CDR ADCS-CGIC QoL author location no. of centres outcome measures used cog func be glo cog func be glo
  10. 10. Title Gender M Able Baker et al. Ages Sites Features Outcomes Design F 500mg N=22 2010 N=50 M F Dogg's Hamlet 2009 M F Echo Bazaar 2006 M F Control N=28 N=150 ? N=25
  11. 11. FLOODS AND STORMS AIR QUALITY AND DISEASE Weather at all time scales determines the development, transport, dispersion and deposition of air pollutants, with the passage of fronts, cyclonic and anticyclonic systems and their associated air masses being of particular importance. This information graphic shows some of the causes and health impacts of air pollution, and shows how both the amount of air pollution, and our exposure to it, may increase in the future. Floods are low-probability, high-impact events that can overwhelm physical infrastructure, human resilience and social organisation. Floods are the most frequent natural weather disaster. This information graphic shows some of the causes and health impacts of floods, and shows how the number and severity of floods may increase in the future. CLIMATE CHANGE CLIMATE CHANGE URBANISATION The majority of climate scientists agree that human activity is causing temperatures to rise around the world. As these higher temperatures free water that is usually frozen at the poles, sea levels are rising. Increased temeratures also lead to more evaporation of water from seas and lakes. This can lead to increased rainfall and greater numbers of storms, cyclones and extreme weather events. The number of people living in cities is growing, particularly in low income countries. The majority of climate scientists agree that human activity is causing temperatures to rise around the world. These higher temperatures can affect weather systems, causing extremely high or extremely low winds. Rising temperatures also affect the amount of water in the atmosphere. 1900 1950 2005 POLLUTION SOURCES GLOBAL TRENDS Investigating the use of information graphics to explain the effects of climate change on health, compared to textual presentation. FLOODS AND STORMS There is increasing evidence of the importance of mental disorders as an impact of disasters. Prolonged impairment resulting from common mental disorders (anxiety and depression) may be considerable. Studies in both low- and high-income countries indicate that the mental-health aspect of flood-related impacts has been insufficiently investigated. A systematic review of post-traumatic stress disorder in high income countries found a small but significant effect following disasters. There is also evidence of medium- to long-term impacts on behavioural disorders in young children. Vulnerability to weather disasters depends on the attributes of the person at risk (including where they live, age, income, education and disability) and on broader social and environmental factors (level of disaster preparedness, health sector responses and environmental degradation). Poorer communities, particularly slum dwellers, are more likely to live in flood-prone areas. In the USA, lower-income groups were most affected by Hurricane Katrina, and low-income schools had twice the risk of being flooded compared with the reference group. High-density populations in low-lying coastal regions experience a high health burden from weather disasters, such as settlements along the North Sea coast in north-west Europe, the Seychelles, parts of Micronesia, the Gulf Coast of the USA and Mexico, the Nile Delta, the Gulf of Guinea, and the Bay of Bengal. Environmentally degraded areas are particularly vulnerable to tropical cyclones and coastal flooding under current climate conditions. Future vulnerability to climate change EVAPORATION Drowning by storm surge is the major killer in coastal storms. Global warming and changes in land use (like urbanisation) affect how much water is carried in the air. THE NILE DELTA FLOODS SOUTH ASIA MICRONESIA THE GULF COAST LATIN AMERICA HEALTH IMPACTS SURFACE RUN-OFF LOCAL TOPOGRAPHY Urbanisation can affect how much excess water can be absorbed into the ground. Sometimes, the shape of the land can make areas vulnerable to flooding. Those living in Low lying places (especially those with high density) In the USA, lower-income groups were most affected by Hurricane Katrina in 2005. BAY OF BENGAL (particularly at risk from storm GULF OF GUINEA SEYCHELLES surges) Those with limited ability to escape Such as children, the infirm, or those living in sub-standard housing. INFECTIOUS DISEASES Deaths recorded in disaster databases are from drowning and severe injuries. VENEZUELA 1999 30,000 DEAD MOZAMBIQUE 2000/2001 1,813 DEAD CHINA 2003 130m AFFECTED Improved warnings have decreased mortality from floods and storm surges in the last 30 years; however, the impact of weather disasters in terms of social and health effects is still considerable and is unequally distributed, particularly affecting women. TOXIC CONTAMINATION From storage or from chemicals already in the environment: Oil FOREST FIRES As well as producing greenhouse gasses such as carbon dioxide, that lead to global warming, the burning of fossil fuels for energy releases small particles into the air, called particulate matter (PM). The amount of air pollution breathed in by people depends on: — Wind / circulation of air — Topography — Housing characteristics — Activity patterns In urban areas, transport vehicles are the key sources of nitrogen oxides and volatile organic compounds (VOCs) that lead to ground-level ozone. Burning fossil fuels for transport also releases other gasses and particles. Naturally-occuring forest fires mean that toxic gaseous and particulate air pollutants are released into the atmosphere. ALLERGIC RHINITIS Hazardous waste The number of forest fires is affected by: — Raised temperatures — Atmospheric moisture PARTICULATE MATTER (PM) OTHER TOXIC GASSES Many different kinds of combustion, both artificial and natural, can cause particles of solid matter can become suspended in the air. PM is known to affect morbidity and mortality. Ozone is a secondary pollutant formed through photochemical reactions involving nitrogen oxides and volatile organic compounds (VOCs) in the presence of bright sunshine with high temperatures. As well as ozone, other toxic gasses such as carbon monoxide can have effects on human health. PNEUMONIA Insufficiently investigated, but may include: Post-traumatic stress Behavioural disorders in children Anxiety? Pesticides Heavy metals PM generation is affected by: — Raised temperatures — Atmospheric moisture OZONE Severe allergies can limit quality of life. MENTAL HEALTH Particularly in places with poor sanitation: Diarrhoeal diseases Cholera Cryptosporidiosis Typhoid fever URBAN TRANSPORT Ozone generation is affected by: — Bright sunlight — Raised temperatures — Low winds — Atmospheric moisture One-quarter of the world’s population resides within 100 km distance and 100 m elevation of the coastline. VULNERABLE PEOPLE Poorer communities DEATH & INJURY COPD ASTHMA Particularly affects children. Chronic obstructive pulmonary disease. Can affect quality of life, and is increasingly common, particularly in children. OTHER DISEASE Other Cardiovascular and respiratory diseases are also caused by air pollution. BURNS & SMOKE INHALATION forest fires can have direct effects on health. MORTALITY AND MORBIDITY Depression? OZONE MODELS FUTURE CHANGES CASE STUDY 1: BANGLADESH CASE STUDY 2: USA If human activity continues to warm global temperatures, countries like Bangladesh are likely to see more flooding. Studies in industrialised countries indicate that densely populated urban areas are at risk from sea-level rise. ASSUMPTIONS Global temperature rise Global Sea level rise Increase in monsoon rains Increase in monsoon discharge into rivers NEW ORLEANS (USA) 2°c 4°c 30cm 100cm 18% 33% 5% 10% LIKELY EFFECTS People affected 4.8% 57% Flooding depth 30–90cm 90–180cm 1.5–3m below sea level now Mid-range estimate of 48 cm sea level rise by 2100 plus subsidence 2.5–4m below This would mean that sea level by 2100 a storm surge from a Category 3 hurricane (estimated at 3 to 4 m without waves) could be 6 to 7 m above areas that were heavily populated in 2004. PM MODELS Future emissions are, of course, uncertain, and depend on assumptions of population growth, economic development, regulatory actions and energy use. Changes in concentrations of ground-level ozone driven by scenarios of future emissions and/or weather patterns have been projected for Europe and North America: FUTURE CHANGES The risk of infectious disease following flooding in high income countries is generally low, although increases in respiratory and diarrhoeal diseases have been reported after floods. An important exception was the impact of Hurricanes Katrina and Rita in the USA in 2005, where contamination of water supplies with faecal bacteria led to many cases of diarrhoeal illness and some deaths. Flooding may lead to contamination of waters with dangerous chemicals, heavy metals or other hazardous substances, from storage or from chemicals already in the environment (e.g., pesticides). Chemical contamination following Hurricane Katrina in the USA included oil spills from refineries and storage tanks, pesticides, metals and hazardous waste. Concentrations of most contaminants were within acceptable short-term levels, except for lead and volatile organic compounds (VOCs) in some areas. There are also health risks associated with long-term contamination of soil and sediment; however, there is little published evidence demonstrating a causal effect of chemical contamination on the pattern of morbidity and mortality following flooding events. Increases in population density and accelerating industrial development in areas subject to natural disasters increase the probability of future disasters and the potential for mass human exposure to hazardous materials released during disasters. STORMS Extreme rainfall can overwhelm rivers and lakes, causing them to flood. THE NORTH SEA COAST Major storm and flood disasters have occurred in the last two decades. In 2003, 130 million people were affected by floods in China. In 1999, 30,000 died from storms followed by floods and landslides in Venezuela. In 2000/2001, 1,813 died in floods in Mozambique. Improved structural and non-structural measures, particularly improved warnings, have decreased mortality from floods and storm surges in the last 30 years; however, the impact of weather disasters in terms of social and health effects is still considerable and is unequally distributed, particularly affecting women. Flood health impacts range from deaths, injuries, infectious diseases and toxic contamination, to mental health problems. Populations with poor sanitation infrastructure and high burdens of infectious disease often experience increased rates of diarrhoeal diseases after flood events. Increases in cholera, cryptosporidiosis and typhoid fever have been reported in low- and middle-income countries. Flood related increases in diarrhoeal disease have also been reported in India, Brazil and Bangladesh. The floods in Mozambique in 2001 were estimated to have caused over 8,000 additional cases and 447 deaths from diarrhoeal disease in the following months. RAINFALL Coastal regions are more vulnerable to flooding as sea levels rise. VULNERABLE PLACES Floods are low-probability, high-impact events that can overwhelm physical infrastructure, human resilience and social organisation. Floods are the most frequent natural weather disaster. Floods result from the interaction of rainfall, surface runoff, evaporation, wind, sea level and local topography. In inland areas, flood regimes vary substantially depending on catchment size, topography and climate. Water management practices, urbanisation, intensified land use and forestry can substantially alter the risks of floods. Windstorms are often associated with floods. In terms of deaths and populations affected, floods and tropical cyclones have the greatest impact in South Asia and Latin America. Deaths recorded in disaster databases are from drowning and severe injuries. Deaths from unsafe or unhealthy conditions following the extreme event are also a health consequence, but such information is rarely included in disaster statistics. Drowning by storm surge is the major killer in coastal storms where there are large numbers of deaths. An assessment of surges in the past 100 years found that major events were confined to a limited number of regions, with many events occurring in the Bay of Bengal, particularly Bangladesh. SEA LEVEL ENERGY PRODUCTION AIR POLLUTION (AP) FLOOD CAUSES = 100m people in towns or cities These changes may affect air pollution in two main ways. First, it may mean that the atmospheric conditions are right for more air pollution to form. Secondly, it may change the patterns of air flow, meaning that more people are exposed to this pollution. Evidence for the health impacts of particulate matter is stronger than that for ozone. However, there are few models of the impact of climate change on pollutants other than ozone. These tend to emphasise the role of local abatement strategies in determining the future levels of, primarily, particulate matter, and tend to project the probability of air-quality standards being exceeded instead of absolute concentrations; the results vary by region. REFERENCE AREA assumed changes by 2050s TEMP. INCREASE EMISSIONS EFFECTS Knowlton New York et al., 2004 area, USA 1.6 – 3.2°C medium increase 4.5% more deaths Bell et al., 2007 1.6 – 3.2°C medium increase 0.6% more deaths 0.9 – 2.4°C no increase ozone + other AP - 50 cities, East USA Anderson England et al., 2001 & Wales (all models assume population constant at year 2000 level) There are no projections for cities in low- or middleincome countries, despite the heavier pollution burdens in these populations. Because transboundary transport of pollutants plays a significant role in determining local to regional air quality, changing patterns of atmospheric circulation at the hemispheric to global level are likely to be just as important as regional patterns for future local air quality.
  12. 12. 157 129 CONTROL A TEXT A 160 GRAPHIC A RISK GROUP A: STORMS & FLOODS 179 CONTROL B 142 166 TEXT B RISK GROUP B: AIR QUALITY GRAPHIC B
  13. 13. Approval View Time 8 mins 6 5 4 3 mins KEY 3 157 157 129 129 160 160 149 177 MEAN & 95% CI SIG. (P < 0.05) N.S. (P > 0.05) TEXT A GRAPHIC A RISK GROUP A: STORMS & FLOODS 179 179 142 142 166 166 163 185 TEXT B GRAPHIC B RISK GROUP B: AIR QUALITY
  14. 14. View Time 8 mins 6 mins* 3 3 mins mins KEY 157 157 129 129 160 160 149 177 MEAN & 95% CI SIG. (P < 0.05) N.S. (P > 0.05) TEXT A GRAPHIC A RISK GROUP A: STORMS & FLOODS 179 179 142 142 166 166 163 185 TEXT B GRAPHIC B RISK GROUP B: AIR QUALITY
  15. 15. Memory 100% 80% 60% 0% KEY MEAN & 95% CI SIG. (P < 0.05) N.S. (P > 0.05) 159 157 130 129 CONTROL A CONTROL A TEXT A TEXT A 164 160 GRAPHIC A GRAPHIC A RISK GROUP A: RISK GROUP A: STORMS & FLOODS STORMS & FLOODS 179 179 142 142 CONTROL B TEXT B CONTROL B TEXT B 166 166 RISK GROUP B: RISK QUALITY AIR GROUP B: AIR QUALITY GRAPHIC B GRAPHIC B
  16. 16. Risk perception (severity) 7 28 1 14 KEY MEAN & 95% CI SIG. (P < 0.05) N.S. (P > 0.05) 158 157 129 129 CONTROL A CONTROL A TEXT A TEXT A 160 160 GRAPHIC A GRAPHIC A RISK GROUP A: RISK GROUP A: STORMS & FLOODS STORMS & FLOODS 176 179 142 142 CONTROL B TEXT B CONTROL B TEXT B 161 166 RISK GROUP B: RISK QUALITY AIR GROUP B: AIR QUALITY GRAPHIC B GRAPHIC B
  17. 17. 50% Age group: control text graphic 68-77 58-67 48-57 38-47 28-37 18-27 68-77 58-67 48-57 38-47 28-37 18-27 68-77 58-67 48-57 38-47 28-37 18-27 Mean knowledge Error Bars: 95% CI 80% 70% 60%
  18. 18. Information graphics - visual presentation of E&HH data Evaluation - investigating the effects of visual presentation Common evidence presentation issues - examples
  19. 19. Volume
  20. 20. 1996 ? 0yr 1 2 0 baseline MMSE 10 20 30 1998 (A) N = 473 Rogers et al. 1998 (B) N = 468 N = 818 Greenberg et al. 2000 N = 60 2000 N = 268 Mohs et al. 2001 N = 431 Placebo N = 217 0yr 1 2 0 10 20 30 F F M Donepezil 10mg N = 214 F M Placebo N = 129 F F M Donepezil 5mg N = 134 Homma et al. F M Donepezil 5mg (D) group 1 (p-D-p-p) N=30 group 2 (p-p-D-p) N=30 Placebo (p) F F M M Placebo N = 274 F M Donepezil 10mg N = 273 F F M M Placebo N = 153 Donepezil 5mg N = 271 F M Donepezil 10mg N = 158 F F M M Placebo N = 162 Donepezil 5mg N = 157 F F F F M Donepezil 10mg N = 157 Burns et al. 1999 55 75 95 M M Donepezil 5mg N = 154 Rogers et al. ages M M M M Donepezil 1mg N = 42 Donepezil 3mg N = 40 Donepezil 5mg N = 39 Placebo N = 40 N = 161 sex F study quality Rand Char Blind Analy ADAS-cog MMSE SIB other ADCS-ADL DAD PDS other NPI other CIBIC GDS CDR ADCS-CGIC QoL Rogers & design, size & follow-up 1mg 3mg 5mg 5mg Rand Char Blind Analy 10 mg 5mg Rand Char Blind Analy 10 mg 5mg Rand Char Blind Analy 10mg Rand Char Blind Analy Rand Char Blind Analy Rand Char Blind Analy 55 75 95 ADAS-cog MMSE SIB other ADCS-ADL DAD PDS other NPI other CIBIC GDS CDR ADCS-CGIC QoL author location no. of centres outcome measures used cog func be glo cog func be glo
  21. 21. Time
  22. 22. 9415027430914103495740913798571 0938475109345721039247851930475 1039485739085741039751039487548 3094857139047105471051324957104 0194562770139569134056710934567 5709690413765906309167591038467
  23. 23. 9415027430914103495740913798571 0938475109345721039247851930475 1039485739085741039751039487548 3094857139047105471051324957104 0194562770139569134056710934567 5709690413765906309167591038467
  24. 24. FLOODS AND STORMS AIR QUALITY AND DISEASE Weather at all time scales determines the development, transport, dispersion and deposition of air pollutants, with the passage of fronts, cyclonic and anticyclonic systems and their associated air masses being of particular importance. This information graphic shows some of the causes and health impacts of air pollution, and shows how both the amount of air pollution, and our exposure to it, may increase in the future. Floods are low-probability, high-impact events that can overwhelm physical infrastructure, human resilience and social organisation. Floods are the most frequent natural weather disaster. This information graphic shows some of the causes and health impacts of floods, and shows how the number and severity of floods may increase in the future. CLIMATE CHANGE CLIMATE CHANGE URBANISATION The majority of climate scientists agree that human activity is causing temperatures to rise around the world. As these higher temperatures free water that is usually frozen at the poles, sea levels are rising. Increased temeratures also lead to more evaporation of water from seas and lakes. This can lead to increased rainfall and greater numbers of storms, cyclones and extreme weather events. The number of people living in cities is growing, particularly in low income countries. The majority of climate scientists agree that human activity is causing temperatures to rise around the world. These higher temperatures can affect weather systems, causing extremely high or extremely low winds. Rising temperatures also affect the amount of water in the atmosphere. 1900 1950 2005 POLLUTION SOURCES GLOBAL TRENDS Investigating the use of information graphics to explain the effects of climate change on health, compared to textual presentation. FLOODS AND STORMS There is increasing evidence of the importance of mental disorders as an impact of disasters. Prolonged impairment resulting from common mental disorders (anxiety and depression) may be considerable. Studies in both low- and high-income countries indicate that the mental-health aspect of flood-related impacts has been insufficiently investigated. A systematic review of post-traumatic stress disorder in high income countries found a small but significant effect following disasters. There is also evidence of medium- to long-term impacts on behavioural disorders in young children. Vulnerability to weather disasters depends on the attributes of the person at risk (including where they live, age, income, education and disability) and on broader social and environmental factors (level of disaster preparedness, health sector responses and environmental degradation). Poorer communities, particularly slum dwellers, are more likely to live in flood-prone areas. In the USA, lower-income groups were most affected by Hurricane Katrina, and low-income schools had twice the risk of being flooded compared with the reference group. High-density populations in low-lying coastal regions experience a high health burden from weather disasters, such as settlements along the North Sea coast in north-west Europe, the Seychelles, parts of Micronesia, the Gulf Coast of the USA and Mexico, the Nile Delta, the Gulf of Guinea, and the Bay of Bengal. Environmentally degraded areas are particularly vulnerable to tropical cyclones and coastal flooding under current climate conditions. Future vulnerability to climate change EVAPORATION Drowning by storm surge is the major killer in coastal storms. Global warming and changes in land use (like urbanisation) affect how much water is carried in the air. THE NILE DELTA FLOODS SOUTH ASIA MICRONESIA THE GULF COAST LATIN AMERICA HEALTH IMPACTS SURFACE RUN-OFF LOCAL TOPOGRAPHY Urbanisation can affect how much excess water can be absorbed into the ground. Sometimes, the shape of the land can make areas vulnerable to flooding. Those living in Low lying places (especially those with high density) In the USA, lower-income groups were most affected by Hurricane Katrina in 2005. BAY OF BENGAL (particularly at risk from storm GULF OF GUINEA SEYCHELLES surges) Those with limited ability to escape Such as children, the infirm, or those living in sub-standard housing. INFECTIOUS DISEASES Deaths recorded in disaster databases are from drowning and severe injuries. VENEZUELA 1999 30,000 DEAD MOZAMBIQUE 2000/2001 1,813 DEAD CHINA 2003 130m AFFECTED Improved warnings have decreased mortality from floods and storm surges in the last 30 years; however, the impact of weather disasters in terms of social and health effects is still considerable and is unequally distributed, particularly affecting women. TOXIC CONTAMINATION From storage or from chemicals already in the environment: Oil FOREST FIRES As well as producing greenhouse gasses such as carbon dioxide, that lead to global warming, the burning of fossil fuels for energy releases small particles into the air, called particulate matter (PM). The amount of air pollution breathed in by people depends on: — Wind / circulation of air — Topography — Housing characteristics — Activity patterns In urban areas, transport vehicles are the key sources of nitrogen oxides and volatile organic compounds (VOCs) that lead to ground-level ozone. Burning fossil fuels for transport also releases other gasses and particles. Naturally-occuring forest fires mean that toxic gaseous and particulate air pollutants are released into the atmosphere. ALLERGIC RHINITIS Hazardous waste The number of forest fires is affected by: — Raised temperatures — Atmospheric moisture PARTICULATE MATTER (PM) OTHER TOXIC GASSES Many different kinds of combustion, both artificial and natural, can cause particles of solid matter can become suspended in the air. PM is known to affect morbidity and mortality. Ozone is a secondary pollutant formed through photochemical reactions involving nitrogen oxides and volatile organic compounds (VOCs) in the presence of bright sunshine with high temperatures. As well as ozone, other toxic gasses such as carbon monoxide can have effects on human health. PNEUMONIA Insufficiently investigated, but may include: Post-traumatic stress Behavioural disorders in children Anxiety? Pesticides Heavy metals PM generation is affected by: — Raised temperatures — Atmospheric moisture OZONE Severe allergies can limit quality of life. MENTAL HEALTH Particularly in places with poor sanitation: Diarrhoeal diseases Cholera Cryptosporidiosis Typhoid fever URBAN TRANSPORT Ozone generation is affected by: — Bright sunlight — Raised temperatures — Low winds — Atmospheric moisture One-quarter of the world’s population resides within 100 km distance and 100 m elevation of the coastline. VULNERABLE PEOPLE Poorer communities DEATH & INJURY COPD ASTHMA Particularly affects children. Chronic obstructive pulmonary disease. Can affect quality of life, and is increasingly common, particularly in children. OTHER DISEASE Other Cardiovascular and respiratory diseases are also caused by air pollution. BURNS & SMOKE INHALATION forest fires can have direct effects on health. MORTALITY AND MORBIDITY Depression? OZONE MODELS FUTURE CHANGES CASE STUDY 1: BANGLADESH CASE STUDY 2: USA If human activity continues to warm global temperatures, countries like Bangladesh are likely to see more flooding. Studies in industrialised countries indicate that densely populated urban areas are at risk from sea-level rise. ASSUMPTIONS Global temperature rise Global Sea level rise Increase in monsoon rains Increase in monsoon discharge into rivers NEW ORLEANS (USA) 2°c 4°c 30cm 100cm 18% 33% 5% 10% LIKELY EFFECTS People affected 4.8% 57% Flooding depth 30–90cm 90–180cm 1.5–3m below sea level now Mid-range estimate of 48 cm sea level rise by 2100 plus subsidence 2.5–4m below This would mean that sea level by 2100 a storm surge from a Category 3 hurricane (estimated at 3 to 4 m without waves) could be 6 to 7 m above areas that were heavily populated in 2004. PM MODELS Future emissions are, of course, uncertain, and depend on assumptions of population growth, economic development, regulatory actions and energy use. Changes in concentrations of ground-level ozone driven by scenarios of future emissions and/or weather patterns have been projected for Europe and North America: FUTURE CHANGES The risk of infectious disease following flooding in high income countries is generally low, although increases in respiratory and diarrhoeal diseases have been reported after floods. An important exception was the impact of Hurricanes Katrina and Rita in the USA in 2005, where contamination of water supplies with faecal bacteria led to many cases of diarrhoeal illness and some deaths. Flooding may lead to contamination of waters with dangerous chemicals, heavy metals or other hazardous substances, from storage or from chemicals already in the environment (e.g., pesticides). Chemical contamination following Hurricane Katrina in the USA included oil spills from refineries and storage tanks, pesticides, metals and hazardous waste. Concentrations of most contaminants were within acceptable short-term levels, except for lead and volatile organic compounds (VOCs) in some areas. There are also health risks associated with long-term contamination of soil and sediment; however, there is little published evidence demonstrating a causal effect of chemical contamination on the pattern of morbidity and mortality following flooding events. Increases in population density and accelerating industrial development in areas subject to natural disasters increase the probability of future disasters and the potential for mass human exposure to hazardous materials released during disasters. STORMS Extreme rainfall can overwhelm rivers and lakes, causing them to flood. THE NORTH SEA COAST Major storm and flood disasters have occurred in the last two decades. In 2003, 130 million people were affected by floods in China. In 1999, 30,000 died from storms followed by floods and landslides in Venezuela. In 2000/2001, 1,813 died in floods in Mozambique. Improved structural and non-structural measures, particularly improved warnings, have decreased mortality from floods and storm surges in the last 30 years; however, the impact of weather disasters in terms of social and health effects is still considerable and is unequally distributed, particularly affecting women. Flood health impacts range from deaths, injuries, infectious diseases and toxic contamination, to mental health problems. Populations with poor sanitation infrastructure and high burdens of infectious disease often experience increased rates of diarrhoeal diseases after flood events. Increases in cholera, cryptosporidiosis and typhoid fever have been reported in low- and middle-income countries. Flood related increases in diarrhoeal disease have also been reported in India, Brazil and Bangladesh. The floods in Mozambique in 2001 were estimated to have caused over 8,000 additional cases and 447 deaths from diarrhoeal disease in the following months. RAINFALL Coastal regions are more vulnerable to flooding as sea levels rise. VULNERABLE PLACES Floods are low-probability, high-impact events that can overwhelm physical infrastructure, human resilience and social organisation. Floods are the most frequent natural weather disaster. Floods result from the interaction of rainfall, surface runoff, evaporation, wind, sea level and local topography. In inland areas, flood regimes vary substantially depending on catchment size, topography and climate. Water management practices, urbanisation, intensified land use and forestry can substantially alter the risks of floods. Windstorms are often associated with floods. In terms of deaths and populations affected, floods and tropical cyclones have the greatest impact in South Asia and Latin America. Deaths recorded in disaster databases are from drowning and severe injuries. Deaths from unsafe or unhealthy conditions following the extreme event are also a health consequence, but such information is rarely included in disaster statistics. Drowning by storm surge is the major killer in coastal storms where there are large numbers of deaths. An assessment of surges in the past 100 years found that major events were confined to a limited number of regions, with many events occurring in the Bay of Bengal, particularly Bangladesh. SEA LEVEL ENERGY PRODUCTION AIR POLLUTION (AP) FLOOD CAUSES = 100m people in towns or cities These changes may affect air pollution in two main ways. First, it may mean that the atmospheric conditions are right for more air pollution to form. Secondly, it may change the patterns of air flow, meaning that more people are exposed to this pollution. Evidence for the health impacts of particulate matter is stronger than that for ozone. However, there are few models of the impact of climate change on pollutants other than ozone. These tend to emphasise the role of local abatement strategies in determining the future levels of, primarily, particulate matter, and tend to project the probability of air-quality standards being exceeded instead of absolute concentrations; the results vary by region. REFERENCE AREA assumed changes by 2050s TEMP. INCREASE EMISSIONS EFFECTS Knowlton New York et al., 2004 area, USA 1.6 – 3.2°C medium increase 4.5% more deaths Bell et al., 2007 1.6 – 3.2°C medium increase 0.6% more deaths 0.9 – 2.4°C no increase ozone + other AP - 50 cities, East USA Anderson England et al., 2001 & Wales (all models assume population constant at year 2000 level) There are no projections for cities in low- or middleincome countries, despite the heavier pollution burdens in these populations. Because transboundary transport of pollutants plays a significant role in determining local to regional air quality, changing patterns of atmospheric circulation at the hemispheric to global level are likely to be just as important as regional patterns for future local air quality.
  25. 25. Multiple dimensions 1
  26. 26. Multiple dimensions 1 2
  27. 27. Multiple dimensions 1 2 3
  28. 28. Multiple dimensions 1 2 3 N...
  29. 29. Gapminder - Hans Rosling Japan GAPMINDER WORLD 2012 Israel Mapping the Wealth and Health of Nations Spain South Korea life expectancy in years Rich Sick 70 Micronesia Bangladesh Life Expectancy of the World North Korea Nepal Tajikistan Ghana Kyrgyzstan Laos Philippines 55 Niger Malawi 50 Burundi Mozambique Dem. Rep. Congo Nigeria Cameroon Zambia Sierra Leone 1 000 Afghanistan Lesotho 2 000 Kuwait Colour by region Angola income per person 100 1000 millions 2011 data for all 193 UN Members and for Hong Kong, Kosovo, Palestine, Puerto Rico and Taiwan. Documentation and pdf version for print at: gapminder.org/downloads/world-pdf Botswana Equatorial Guinea Free to copy, share and remix, but attribute to Gapminder Foundation. If you want to see more data visit: www.gapminder.org Chad Central African Rep. Guinea-Bissau 500 South Africa Mali Qatar Brunei United Arab Emirates 3 or 10 less Uganda Guinea Somalia Zimbabwe Congo, Rep. Burkina Benin Faso Cote d'Ivoire Rwanda Luxembourg Size by population Gabon Namibia Mauritania Kenya Togo USA Taiwan Denmark Liechtenstein Kazakhstan Kiribati Timor-Leste Djibouti Liberia Singapore Turkmenistan South Sudan Senegal Tanzania Gambia Bhutan Sudan Ethiopia Russia Ukraine India Comoros 60 Ireland Nauru Tuvalu Papua New Guinea Haiti Indonesia Fiji Mongolia Bolivia Sao Tome and Principe Cambodia Eritrea Iraq Moldova Uzbekistan Yemen Myanmar Norway Sweden Canada China Pakistan 65 Australia Brazil Solomon Islands Madagascar Bosnia and H. Income per Person of the World Poor Puerto Rico Mexico Uruguay Barbados Czech Rep. Poland DominicaCroatia Belize Syria Grenada Serbia Vietnam Slovak Rep. Panama Ecuador Montenegro ArgentinaAntigua Bahamas &Barbuda St.Lucia Macedonia Bahrain Cape St. Kitts Sri Lanka Thailand Libya Palestine Estonia Venezuela Verde & Nevis Tunisia Armenia Seychelles Malaysia Hungary Nicaragua Peru Romania Mauritius Egypt Dom.R. Georgia Jordan Saudi Colombia Turkey Latvia Honduras Oman Iran Paraguay Samoa Jamaica Arabia Lebanon Algeria Lithuania Palau Bulgaria Morocco Tonga El Salvador St.Vincent and G. Vanuatu Guatemala Suriname Belarus Azerbaijan Guyana Trinidad and Tobago Kosovo Maldives Albania Iceland San Marino Hong Andorra Switzerland Kong France Netherlands New Zealand Austria Greece Cyprus UK Germany Chile Portugal Finland Belgium Malta Slovenia Cuba Costa Rica Healthy 75 Italy map layout by Paolo Fausone 80 Monaco Swaziland 5 000 Version 11 September 2012 10 000 20 000 in US Dollars (GDP/capita, PPP$ inflation adjusted, log scale) 50 000
  30. 30. Charles Joseph Minard
  31. 31. Information graphics - visual presentation of E&HH data Evaluation - investigating the effects of visual presentation Common evidence presentation issues - examples
  32. 32. ! w.stahl-timmins@exeter.ac.uk ! www.ecehh.org ! blog.willstahl.com ! Twitter: @will_s_t EUROPEAN UNION Investing in Your Future European Regional Development Fund 2007-13 EUROPEAN UNION Investing in Your Future European Regional Development Fund 2007-13

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