Programs and Communities

While the definition of sustainability remains open for all to contribute to and participate in, there do seem to be some notions it has come to embody that should not be neglected as the definition coalesces. Among these are the ethical and social dimensions of sustainability. Whether or not it is appropriate, required, or even desirable, concepts like social equity, human rights, ethical sharing of commons, etc. have increasingly come under the umbrella of the sustainability discourse. Even if “sustainability” as a bare word doesn’t imply those things, the concept of sustainable development certainly has taken on those dimensions. That sustainability might be redefined or re-scoped to be a purely environmental or a rigidly scientific endeavor, is not an immediate concern of this paper, though if that were to occur (whether for the sake of simplicity or pragmatics), it should be done explicitly so the ethical sub-discourse can be maintained (indeed, sustained) by some other movement.

This paper proposes a mechanism by which such a migration in terms can be prevented. First, in reviewing the work of Denis Goulet, it shows the solid basis for including an ethical aspect in the sustainability discourse. Second, it points out that Karl-Henrik Robèrt’s highly-lauded and broadly-employed sustainability framework, The Natural Step, is deficient in this area. This deficiency provides the impetus for, finally, proposing a mechanism by which The Natural Step can be extended to include the important social and ethical dimensions of sustainability. This mechanism is based on the capabilities approaches that, in many respects, evolved out of Goulet’s early work. Augmented accordingly, TNS can continue to be used without fear of overlooking the social and ethical aspects of the sustainability discourse.

This research on the early metal ages of the Wadi el-Hasa focuses on settlement systems and attempts to explain how social, economic and political adjustments helped tribal groups survive under natural (i.e., climatic) and anthropogenic (i.e., land degradation, erosion) stress factors. The shifting of subsistence base from agropastoral to pastoral is reflected in site and population densities, diversity of site types, levels of internal complexity, and levels of social organization via the presence of large settlements, like villages, which acted as economic and administrative centers emerge as risk reduction mechanisms.

The cycles of abandonment and resettlement are evaluated within the concept of social reorganization and such changes are assessed as parts of economic revitalization attempts. The social changes that emerge from such shifts are evaluated from the perspective of the scale-free networks modeled and tested through statistical methods, such as ANOVA, for spatial and temporal patterns, while patterns of land use and the impacts of changing climate and anthropogenic activities are evaluated with GIS.

Following the dimorphic society and heterarchic social organization concepts, the discussion emphasizes that tribal groups adjust population density, range and intensity of activities in marginal landscapes, like the Hasa, in order to prevent environmental degradation. These patterns may change once these marginal landscapes are integrated to more complex social organizations. Although this takes place in the Hasa during the Iron Age, the research results imply that environmental degradation did not take place possibly due to the continuation of extensive subsistence patterns, along with the emergence of the long-distance caravan trade as a major economic incentive.

Children often present to the emergency department (ED) for treatment of abuse-related injuries. ED healthcare providers (HCPs) do not consistently screen children for physical abuse, which may allow abuse to go undetected and increases the risk for re-injury and death. ED HCPs frequently cite lack of knowledge or confidence in screening for and detecting child physical abuse.

The purpose of this evidence-based quality improvement project was to implement a comprehensive screening program that included ED HCP education on child physical abuse, a systematic screening protocol, and use of the validated Escape Instrument. After a 20-minute educational session, there was a significant increase in ED HCP knowledge and confidence scores for child physical abuse screening and recognition (p < .001). There was no difference in diagnostic coding of child physical abuse by ED HCPs when evaluating a 30-day period before and after implementation of the screening protocol.

In a follow-up survey, the Escape Instrument and educational session were the most reported screening facilitators, while transition to a new electronic health system was the most reported barrier. The results of this project support comprehensive ED screening programs as a method of improving HCP knowledge and confidence in screening for and recognizing child physical abuse. Future research should focus on the impact of screening on the diagnosis and treatment of child physical abuse. Efforts should also be made to standardize child abuse screening programs throughout all EDs, with the potential for spread to other settings.