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Robèrt Forgot Goulet: Augmenting TNS with the Capabilities Approach to Support the Social Dimensions of Sustainability

Description

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

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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Implementation of Adolescent Depression Care Guidelines into the Electronic Health Record at a Rural Pediatric Primary Care Clinic

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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,

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.

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2020-05-01

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Enhanced Primary Care Electronic Medical Record Education to Improve the Use of Patient Portals

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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

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.

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2020-05-01

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Screening for Posttraumatic Stress Disorder in Behavioral Health

Description

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

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.

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2020-05-06

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Being Proactive in Geriatric Advance Care Planning

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

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.

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2020-04-30

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Blockchain: An Assessment of its Potential and Challenges in Addressing Sustainability Issues

Description

Blockchain, the technology behind the worldwide-known cryptocurrency Bitcoin, offers a new set of potential advantages and opportunities that various industries and institutions could use to enhance their processes. Although most research and development on blockchain has focused on applications for

Blockchain, the technology behind the worldwide-known cryptocurrency Bitcoin, offers a new set of potential advantages and opportunities that various industries and institutions could use to enhance their processes. Although most research and development on blockchain has focused on applications for cryptocurrencies and the finance industry, relatively few analyses and assessments have been conducted on how it could provide tools to address social and environmental issues. This research, using interviews, literature review and examples of blockchain applications, explores how this technology can be employed to address sustainability issues under the framework of three UN Sustainable Development Goals: 2. Zero Hunger, 7. Affordable and Clean Energy, and 14. Life Below Water. The analysis shows that blockchain has the potential to support solutions to sustainability problems that need efficient traceability, trust, a unique ID, transparency, or a highly secure payment system. However, the technology should not be mistaken for a panacea for addressing sustainability issues in its current state because it is not yet mature and has not been sufficiently tested. Expansion of blockchain as an effective tool for helping solve sustainability challenges will require a greater understanding of the governance of blockchain, its scalability and its potential unintended consequences for the technology to become properly integrated into the decision-making progress.

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2019-04-17

Biochar Briquettes: Alternative to Firewood and Charcoal Fuel

Description

Domestic energy is an important component of our day to day lives and is something we cannot live without. Imagine how life would be without a means to cook our food, to warm our house, life would be unbearable. As

Domestic energy is an important component of our day to day lives and is something we cannot live without. Imagine how life would be without a means to cook our food, to warm our house, life would be unbearable. As we enjoy these comforts rarely do we stop to think what the opportunity cost is. For those using renewable sources, it is not a big issue, but for those who rely on wood fuel, they have to strike a delicate balance between need for fuel and the need to conserve the greatest support systems of their livelihoods, the forests. The main source of energy for households in many developing countries is biomass, mainly from forests and woodlands. The continued use of firewood and charcoal fuel puts a strain on forests, resulting in adverse effects on the environment such as prolonged droughts, loss of biodiversity, dwindling water resources, changing weather patterns among other sustainability challenges. An alternative to firewood to charcoal lies in biochar briquettes. This paper discusses the role of biochar briquettes in mitigating climate change and serves as a step by step guide on how biochar briquettes may be produced.

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2018

The Sustainability Fair: Building a Grassroots Movement Around Community

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People everywhere should be doing everything they can to be more sustainable so that climate change can begin to be mitigated. We are already feeling the negative effects of climate change, and they are thoroughly documented. Despite this people are

People everywhere should be doing everything they can to be more sustainable so that climate change can begin to be mitigated. We are already feeling the negative effects of climate change, and they are thoroughly documented. Despite this people are not changing to be more sustainable fast enough. Many either reject the idea of climate change, do not know what they could do, or are unaware of how climate change affects them. Sustainability also impacts more than just climate change. Living more sustainably can have positive impacts economically as well as positive impacts on human health. In a world that is so connected and with such a wealth of information, we can no longer afford to have communities in the dark. Leaders need to rise on a community level to make a difference. Leadership is an aspect of an organization or a project that can elevate it to new heights. A leader is not everything, but the difference a good leader makes is universal. In this paper I will teach you about organizing a sustainability fair that educates and engages marginalized communities that typically are not included in the conversation on how to save our world.

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2018-11-10

Moving Sustainability Forward: A Game-based Approach For Building Confidence In Municipal Administration

Description

Cities with a car-oriented mobility system are significant consumers of energy and require drastic transformations in their structure and function to minimize their harmful impacts on environment and people and to achieve sustainability goals. To promote such sustainable transformations, municipal

Cities with a car-oriented mobility system are significant consumers of energy and require drastic transformations in their structure and function to minimize their harmful impacts on environment and people and to achieve sustainability goals. To promote such sustainable transformations, municipal administrators need to act as change-agents. Because municipal governments are often not agile organizations, they tend toward incrementalism even in the pursuit of transformational goals. Therefore, there is a need in municipal governments to build individual transformative capacity so that municipal administrators can design, test, and implement plans, projects, and policies that are capable of transforming cities toward sustainability. This research presents a game-based workshop, “Stadt-liche Ziele” (AudaCity), that uses a backcasting approach to make municipal administrators build a sustainability strategy. I conducted a pilot study to test the effects of the game on municipal administrators’ confidence in their own ability and power to implement sustainability actions, a key determinant of transformative capacity. Five municipal administrators from Lüneburg, Germany, working on mobility issues, participated in a three-hour-workshop playing the game. Interviews and questionnaires were used before and after the workshop and participants’ contributions during the event were recorded to explore collective changes in confidence. Results indicate that the game increased participant confidence by rewarding collective success, breaking down an ambitious goal into achievable tasks, and acknowledging how administrators’ current actions already contribute to the goal.

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2018-06-28

Community Values Mapping for Apache Junction, AZ

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The City of Apache Junction is located in an environmentally and culturally rich location on the eastern edge of the Phoenix Metropolitan area. This suburb is expected to grow in the future with undeveloped land zoned for development. Despite its

The City of Apache Junction is located in an environmentally and culturally rich location on the eastern edge of the Phoenix Metropolitan area. This suburb is expected to grow in the future with undeveloped land zoned for development. Despite its uniqueness, the city is challenged by a negative reputation in the region. To help improve the city's image and promote development, the City of Apache Junction has partnered with Arizona State University's Project Cities program. Through this partnership both parties work to work toward sustainable development of Apache Junction. This Culminating Experience project is one of several initiatives working for and with the city to help improve quality of life for residents. The project asks, how can we measure, identify, and promote locations of high community value in Apache Junction to attract new residents and create more development opportunities? A Public Participation GIS methodology was used to survey residents about their favorite locations in Apache Junction, participants were asked to mark their favorite locations on a paper map with stickers. Each sticker had a different color and corresponded with different values. The values were: recreational, cultural, spiritual, aesthetic, and special place values. All survey responses were transferred from physical maps to online geographic survey website Maptionnaire. Running statistical and geospatial analysis, survey found 6 locations in Apache Junction with highest density values. Findings from this project will be delivered to city of Apache Junction for integration into the Positively Apache Junction rebranding campaign and future urban development decisions.

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2018-04-27