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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

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.

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Interdependent systems providing water and energy services are necessary for agriculture. Climate change and increased resource demands are expected to cause frequent and severe strains on these systems. Arizona is especially vulnerable to such strains due to its hot and arid climate. However, its climate enables year-round agricultural production, allowing

Interdependent systems providing water and energy services are necessary for agriculture. Climate change and increased resource demands are expected to cause frequent and severe strains on these systems. Arizona is especially vulnerable to such strains due to its hot and arid climate. However, its climate enables year-round agricultural production, allowing Arizona to supply most of the country's winter lettuce and vegetables. In addition to Phoenix and Tucson, cities including El Paso, Las Vegas, Los Angeles, and San Diego rely on Arizona for several types of agricultural products such as animal feed and livestock, meaning that disruptions to Arizona's agriculture also disrupt food supply chains to at least six major cities.

Arizona's predominately irrigated agriculture relies on water imported through an energy intensive process from water-stressed regions. Most irrigation in Arizona is electricity powered, so failures in energy or water systems can cascade to the food system, creating a food-energy-water (FEW) nexus of vulnerability. We construct a dynamic simulation model of the FEW nexus in Arizona to assess the potential impacts of increasing temperatures and disruptions to energy and water supplies on crop irrigation requirements, on-farm energy use, and yield.

We use this model to identify critical points of intersection between energy, water, and agricultural systems and quantify expected increases in resource use and yield loss. Our model is based on threshold temperatures of crops, USDA and US Geological Survey data, Arizona crop budgets, and region-specific literature. We predict that temperature increase above the baseline could decrease yields by up to 12.2% per 1 °C for major Arizona crops and require increased irrigation of about 2.6% per 1 °C. Response to drought varies widely based on crop and phenophase, so we estimate irrigation interruption effects through scenario analysis. We provide an overview of potential adaptation measures farmers can take, and barriers to implementation.

ContributorsBerardy, Andrew (Author) / Chester, Mikhail Vin (Author)
Created2017-02-28
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Background: Healthcare providers are encouraged to prepare their practice to effectively manage the care of mild to moderate adolescent depression. Cost-effective screening, diagnostic, and newly developed pediatric primary care depression management guidelines have been established. To integrate guidelines into practice, primary care providers (PCPs) must document effectively to ensure a

Background: Healthcare providers are encouraged to prepare their practice to effectively manage the care of mild to moderate adolescent depression. Cost-effective screening, diagnostic, and newly developed pediatric primary care depression management guidelines have been established. To integrate guidelines into practice, primary care providers (PCPs) must document effectively to ensure a complete treatment plan is in place in the patient’s electronic health record (EHR).

Intervention: Elements from a flowsheet were implemented into the EHR to promote thorough assessment and documentation of care delivered to adolescents with depression.

Methods: An initial chart review was completed on patients diagnosed with depression. An updated depression template was implemented within the EHR for six weeks. A follow-up chart review was completed post-intervention to determine if documentation of elements from the adolescent depression guidelines improved after the EHR update. Pre-intervention and post- intervention surveys were delivered to PCP’s to understand their perspective on adolescent depression management.

Outcomes: The chart review revealed that baseline PHQ-9 screenings were documented in 91% (n=43) of the charts reviewed in the pre-intervention timeframe. Only 78% (n=7) of the charts reviewed during post-intervention included PHQ-9 screenings. Early intervention treatment options documented in the pre-intervention timeframe included education 100% (n=47), medication prescriptions 53% (n=25), and psychotherapy referrals 18% (n=18). During post- intervention, education 100% (n=9), medication prescriptions 78% (7), and psychotherapy referrals 22% (n=7) were documented by the PCPs.

Recommendation: The quality improvement project focused heavily on documentation completed over a one year pre-intervention timeframe compared to a six-week post-intervention timeframe. Further evaluation and chart review over the next year will provide a more adequate comparison of documentation within primary care practice.

ContributorsMomberg, Heather (Author) / Jacobson, Diana (Thesis advisor)
Created2020-05-01
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Background: Health information technology (HIT) refers to the electronic health care systems organizations used to store, share and analyze healthcare information. A central component of the HIT infrastructure is an electronic health record (EMR) and although HIT has been shown to increase enthusiasm for patient care, decrease healthcare costs and

Background: Health information technology (HIT) refers to the electronic health care systems organizations used to store, share and analyze healthcare information. A central component of the HIT infrastructure is an electronic health record (EMR) and although HIT has been shown to increase enthusiasm for patient care, decrease healthcare costs and improve patient outcomes overall utilization in the United States (US) remains low.

Methods: At an urban primary care pediatric office located in the southwestern US, an educational quality improvement project for healthcare practice providers and front office staff was conducted to increase the utilization of the existing EMR-linked patient portal. The healthcare providers were asked to complete a pre- and post- survey evaluation of their knowledge and usage of the patient portal. Provider and patient portal data usage was collected over a five-month period, September 2019 to January 2020.

Results: Data was analyzed using the Intellectus Statistics softwareTM. Significant results were found at the conclusion of the project in the number of active patient portal users, web-enabled, portal logins, labs published/viewed, messages sent, appointment reminders and Santovia utilization. At the end of the project no significance was found with messages received by the healthcare providers or staff through the patient portal. Survey results found significant differences between pre- and post- portal usage. No significance was found on providers’ knowledge on how to web-enable patients. Providers’ also demonstrated no significant change in their perceptions of the benefit in utilizing the portal in patient care after the educational intervention. Survey results allowed for additional analysis of commonly utilized portal functionalities, disease or health topics utilized in Santovia, and suggestions on how to make the use of the patient portal easier for providers.

Implications for Health Care Providers: This quality improvement project found that implementation an EMR-linked patient portal requires a comprehensive practice approach with structured education sessions. Including all employees can improve patient portal utilization. This educational project resulted in significant increases in most portal functionalities within 5 months. Further practice change evaluations are needed to evaluate how to improve patient portal utilization with a larger group of participants in a variety of outpatient settings.
ContributorsProsev, Brittany (Author) / Jacobson, Diana (Thesis advisor)
Created2020-05-01
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Background: Non-Veteran Affair (VA) mental health care facilities are admitting increased numbers of military affiliated members due to recent changes, allowing veterans to outsource healthcare at civilian treatment centers. The VA reports less than 9 million veterans enrolled in VA services, leaving over 50% seeking treatment from civilian providers. Given

Background: Non-Veteran Affair (VA) mental health care facilities are admitting increased numbers of military affiliated members due to recent changes, allowing veterans to outsource healthcare at civilian treatment centers. The VA reports less than 9 million veterans enrolled in VA services, leaving over 50% seeking treatment from civilian providers. Given the high prevalence of Posttraumatic Stress Disorder (PTSD) in the military population, it is imperative to implement a valid and reliable screening tool at primary care facilities to ensure timely and accurate diagnosis and treatment.

Method: This project aimed to provide an evidence-based education for intake nurses to understand prevalence of PTSD and to use a screening tool Primary Care PTSD for DSM-5 (PC-PTSD-5) in a non-VA behavioral health facility.

Setting: The project site was a civilian behavioral health facility located in West Phoenix Metropolitan area. The behavioral health facility serves mental health and substance abuse needs. Project implementation focused on the intake department.

Measures: Sociodemographic data, PTSD diagnosis criteria, prevalence and PC-PTDSD-5 screening tool knowledge collected from pre and posttest evaluation. Patients’ charts for those admitted 6-week before and 6-week after the education to calculate numbers of screening tools completed by nurses at intake assessment.

Data analysis: Descriptive statistics was used to describe the sample and key measures; the Wilcoxon Signed Rank Test was used to examine differences between pre-test and post-test scores. Cohen’s effect size was used to estimate clinical significance.

Results: A total of 23 intake nurses (87.0% female, 65.2% 20-39 years old, 52.2% Caucasian, 95.6% reported having 0-10 years of experience, 56.5% completed Associate’s degree) received the education. For PTSD-related knowledge, the pre-test score (Mdn = 6.00) was significantly lower than the post-test score (Mdn = 10.00; Z= -4.23, p < .001), suggesting an increase of PTSD knowledge among nurses after the education. Regarding the diagnosis, the percentage of patients who were diagnosed with PTSD increased from (0.02% to 20% after the education).

Discussion: An evidence-based education aimed at enhancing intake nurses’ knowledge, confidence and skills implementing a brief and no-cost PTSD screening tool showed positive results, including an increase of PTSD diagnosis. The implementation of this screening tool in a civilian primary mental health care facility was feasible and helped patients connect to PTSD treatment in a timely fashion. Continued use of paper version of screening tool will be maintained at facility as an intermediary solution until final approval through parent company is received to implement into electronic medical records.
ContributorsCowart, Amanda (Author) / Chen, Angela (Thesis advisor)
Created2020-05-06
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Description

Disease burden is higher in the United States than in comparable countries. The Patient Self Determination Act of 1990 requires healthcare facilities to provide Advance Care Planning (ACP) information to all Medicare patients. The healthcare staffs’ (n=7) commitment to 3-days of ACP training increase ACP rates in the primary care

Disease burden is higher in the United States than in comparable countries. The Patient Self Determination Act of 1990 requires healthcare facilities to provide Advance Care Planning (ACP) information to all Medicare patients. The healthcare staffs’ (n=7) commitment to 3-days of ACP training increase ACP rates in the primary care setting. The Medicare Incentive Program is the platform for this initiative. This quantitative project used a valid and reliable pre and posttest design that consisted of 27 items on a Likert-scale. A 3.5-month chart audit (n=91) was conducted to assess the completion rate. Descriptive statistics was used to describe the demographic data.

The results of the two-tailed Wilcoxon signed rank test were significant based on an alpha value of 0.05, V = 0.00, z = -2.37, p = .018. There was a significant increase in the post-readiness to change average scores. A Mann Whitney test was used to analyze the statistically significant difference between the averages in two ACP types and electronic health record documentation (EHR). Staff did not always code (Mdn = 0.00) but they documented in the EHR (Mdn =1.00; 512.00, p = 0.003). ACP discussion was performed 63% of the time during Annual Wellness Visits (AWV), and there was a 49% increase in the EHR documentation. Trained staff are key stakeholders in guiding ACP conversations. They understand the barriers, impact, and consequences related to the lack of advance directives.

ContributorsBautista, Hija Mae (Author) / Johannah, Uriri-Glover (Thesis advisor)
Created2020-04-30
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Description

Global environmental change and sustainability science increasingly recognize the need to address the consequences of changes taking place in the structure and function of the biosphere. These changes raise questions such as: Who and what are vulnerable to the multiple environmental changes underway, and where? Research demonstrates that vulnerability is

Global environmental change and sustainability science increasingly recognize the need to address the consequences of changes taking place in the structure and function of the biosphere. These changes raise questions such as: Who and what are vulnerable to the multiple environmental changes underway, and where? Research demonstrates that vulnerability is registered not by exposure to hazards (perturbations and stresses) alone but also resides in the sensitivity and resilience of the system experiencing such hazards. This recognition requires revisions and enlargements in the basic design of vulnerability assessments, including the capacity to treat coupled human–environment systems and those linkages within and without the systems that affect their vulnerability. A vulnerability framework for the assessment of coupled human–environment systems is presented.

Research on global environmental change has significantly improved our understanding of the structure and function of the biosphere and the human impress on both (1). The emergence of “sustainability science” (2–4) builds toward an understanding of the human–environment condition with the dual objectives of meeting the needs of society while sustaining the life support systems of the planet. These objectives, in turn, require improved dialogue between science and decision making (5–8). The vulnerability of coupled human–environment systems is one of the central elements of this dialogue and sustainability research (6, 9–11). It directs attention to such questions as: Who and what are vulnerable to the multiple environmental and human changes underway, and where? How are these changes and their consequences attenuated or amplified by different human and environmental conditions? What can be done to reduce vulnerability to change? How may more resilient and adaptive communities and societies be built?

Answers to these and related questions require conceptual frameworks that account for the vulnerability of coupled human–environment systems with diverse and complex linkages. Various expert communities have made considerable progress in pointing the way toward the design of these frameworks (10, 11). These advances are briefly reviewed here and, drawing on them, we present a conceptual framework of vulnerability developed by the Research and Assessment Systems for Sustainability Program (http://sust.harvard.edu) that produced the set of works in this Special Feature of PNAS. The framework aims to make vulnerability analysis consistent with the concerns of sustainability and global environmental change science. The case study by Turner et al. (12) in this issue of PNAS illustrates how the framework informs vulnerability assessments.

ContributorsTurner II, B. L. (Author) / Kasperson, Roger E. (Author) / Matson, Pamela A. (Author) / McCarthy, James J. (Author) / Corell, Robert W. (Author) / Christensen, Lindsey (Author) / Eckley, Noelle (Author) / Kasperson, Jeanne X. (Author) / Luers, Amy (Author) / Martello, Marybeth L. (Author) / Polsky, Colin (Author) / Pulsipher, Alexander (Author) / Schiller, Andrew (Author)
Created2003-03-07
Description

Interview with J.D. Hill, co-founder of Recycled City

J.D. Hill is the co-founder of Recycled City LLC a business devoted to building a revolving relationship within the local food economy by limiting food waste. His business provides materials to create compost out of waste materials for residential customers and business. J.D.’s

Interview with J.D. Hill, co-founder of Recycled City

J.D. Hill is the co-founder of Recycled City LLC a business devoted to building a revolving relationship within the local food economy by limiting food waste. His business provides materials to create compost out of waste materials for residential customers and business. J.D.’s goals with his business are to inspire the community to participate in their local food economy, promote activism, focus on building farm land, and encourage a green economy in the Valley area. He is an ASU grad with degrees from the School of Sustainability and the W.P. Carey School of Business. This knowledge has shaped his view toward the ability of green businesses to flourish in the Phoenix area.

ContributorsHill, J.D. (Interviewee)
Created2015-08-07
Description

Interview with Mr. Arnott Duncan, owner of Duncan Family Farms, Inc.

Arnott Duncan is the owner of Duncan Family Farms. Farming runs in Arnott’s veins. He is a third generation farmer who has developed a deep connect to his local economy. However, interacting with Arizona food systems is not his only

Interview with Mr. Arnott Duncan, owner of Duncan Family Farms, Inc.

Arnott Duncan is the owner of Duncan Family Farms. Farming runs in Arnott’s veins. He is a third generation farmer who has developed a deep connect to his local economy. However, interacting with Arizona food systems is not his only goal. Arnott also is actively engaged with educating the community about local produce. His farm provided U-Pick opportunities to the local community to provide people with in engaging experience toward food. The many years Arnott spent in the food industry has taught him that food, family, and community change the way we think but what we choose to do with that makes the difference in how we shape the world.

ContributorsDuncan, Arnott (Interviewee)
Created2015-08-07
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Description

Transitions towards sustainability are urgently needed to address the interconnected challenges of economic development, ecological integrity, and social justice, from local to global scales. Around the world, collaborative science-society initiatives are forming to conduct experiments in support of sustainability transitions. Such experiments, if carefully designed, provide significant learning opportunities for

Transitions towards sustainability are urgently needed to address the interconnected challenges of economic development, ecological integrity, and social justice, from local to global scales. Around the world, collaborative science-society initiatives are forming to conduct experiments in support of sustainability transitions. Such experiments, if carefully designed, provide significant learning opportunities for making progress on transition efforts. Yet, there is no broadly applicable evaluative scheme available to capture this critical information across a large number of cases, and to guide the design of transition experiments. To address this gap, the article develops such a scheme, in a tentative form, drawing on evaluative research and sustainability transitions scholarship, alongside insights from empirical cases. We critically discuss the scheme's key features of being generic, comprehensive, operational, and formative. Furthermore, we invite scholars and practitioners to apply, reflect and further develop the proposed tentative scheme – making evaluation and experiments objects of learning.

ContributorsLuederitz, Christopher (Author) / Schäpke, Niko (Author) / Wiek, Arnim (Author) / Lang, Daniel J. (Author) / Bergmann, Matthias (Author) / Bos, Joannette J (Author) / Burch, Sarah (Author) / Davies, Anna (Author) / Evans, James (Author) / König, Ariane (Author) / Farrelly, Megan A. (Author) / Forrest, Nigel (Author) / Frantzeskaki, Niki (Author) / Gibson, Robert B. (Author) / Kay, Braden (Author) / Loorbach, Derk (Author) / McCormick, Kes (Author) / Parodi, Oliver (Author) / Rauschmayer, Felix (Author) / Schneidewind, Uwe (Author) / Stauffacher, Michael (Author) / Stelzer, Franziska (Author) / Trencher, Gregory (Author) / Venjakob, Johannes (Author) / Vergragt, Philip J. (Author) / von Wehrden, Henrik (Author) / Westley, Frances R. (Author)
Created2016-09-03