Vehicle trips presently account for approximately 50% of San Francisco’s greenhouse gas emissions (San Francisco County Transportation Authority, 2008). City and county officials have developed aggressive strategies for the future of passenger transportation in the metropolitan area, and are determined to move away from a “business as usual” future. This project starts with current-state source data from a life-cycle comparison of urban transportation systems (Chester, Horvath, & Madanat, 2010), and carries the inventoried emissions and energy usage through by way of published future scenarios for San Francisco.

From the extrapolated calculations of future emissions/energy, the implied mix of transportation modes can be backed out of the numbers. Five scenarios are evaluated, from “business as usual” through very ambitious “healthy environment” goals. The results show that when planners and policymakers craft specific goals or strategies for a location or government, those targets, even if met, are unlikely to result in the intended physical outcomes. City and state governments would be wise to support broad strategy goals (like 20% GHG reduction) with prioritized specifics that can inform real projects leading to the goals (for instance, add 5 miles of bike path per year through 2020, or remove 5 parking garages and replace them with transit depots). While these results should not be used as predictions or forecasts, they can inform the crafters of future transportation policy as an opportunity for improvement or a cautionary tale.

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.

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.

This LCA used data from a previous LCA done by Chester and Horvath (2012) on the proposed California High Speed Rail, and furthered the LCA to look into potential changes that can be made to the proposed CAHSR to be more resilient to climate change. This LCA focused on the energy, cost, and GHG emissions associated with raising the track, adding fly ash to the concrete mixture in place of a percentage of cement, and running the HSR on solar electricity rather than the current electricity mix. Data was collected from a variety of sources including other LCAs, research studies, feasibility studies, and project information from companies, agencies, and researchers in order to determine what the cost, energy requirements, and associated GHG emissions would be for each of these changes. This data was then used to calculate results of cost, energy, and GHG emissions for the three different changes. The results show that the greatest source of cost is the raised track (Design/Construction Phase), and the greatest source of GHG emissions is the concrete (also Design/Construction Phase).

The ultimate goal of this LCA is to give Arizona State University specific advice on possible changes in lighting systems that will reduce environmental impacts and support ASU’s sustainability efforts. The aim is to assess the potential for a decrease in specific environmental impacts (CO2 emissions and energy use) and economic impact (cost) from changing to a different type of lighting in a prototypical classroom in Wrigley Hall. The scope of this assessment is to analyze the impacts of T8 lamps lasting 50,000 hours. Thus, a functional unit was defined as 50,000 hours of use, maintaining roughly 825 lumens. To put this in perspective, 50,000 hours is equivalent to 8 hours of use per day, 365 days per year, for approximately 17.1 years.