Material Flows Accounting: A Biophysical Approach to Macroeconomic Sustainability

The increasing dimension of socio-environmental problems make sustainability a macroeconomic issue and new methodological instruments are needed. In this paper, Material Flows Accounting is presented as a new statistical approach for an evaluation of macroeconomic sustainability. Based on the pre-analytic vision that economies are an open system embedded in the environment, it provides an overview in tonnes of annual material inputs and outputs of an economy. It quantifies the physical dimension of societies and analyses the “size” of the human economy in the geo-biosphere. As it provides information about efficiency and material requirements, it is a very important method for analysing whether a nation is moving towards sustainability or away from it. Used in many official statistics, it will become one of the most powerful tools in describing sustainability at the macroeconomic level. In this paper, after the presentation of the Material Flows Accounting approach, an Italian case study is considered.     

Measurement of the sexual health and wellbeing of women who have undergone female genital mutilation/Cutting: A scoping review

Objective: We conducted a scoping review to identify and assess instruments used to measure sexual health and wellbeing in women who have undergone female genital mutilation/cutting (FGM/C). Method: We retrieved and assessed 10 validated instruments using an 18-item checklist derived from the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) checklist. Results: All instruments were developed and initially validated among literate, predominantly Caucasian participants in North America and Europe. Only 1 validation study was conducted among women living with FGM/C. Conclusion: Most instruments only measured sexual functioning. Findings underscore the need to validate instruments appropriate for use among FGM/C survivors.     

Biomechanical overload in multiple tasks with weekly and annual cycle: practical experiences in the field of cleaning and packaging of fruit

The OCRA method is the reference method chosen in ISO (ISO 11228-3) and CEN (EN 1005-5) standards regarding risk assessment and management of upper limbs repetitive movements and exertions. The method consists of two specific tools (OCRA index and OCRA checklist). In this paper special attention will be devoted to the procedures for the analysis of multiple repetitive tasks.When computing the OCRA index (checklist score) considering the presence of more than one repetitive task, a "traditional" procedure has been previously proposed. This approach, whose results could be defined as "time weighted average", seems to be appropriate when considering rotations among tasks that are performed almost once every hour. On the contrary, when rotation among repetitive tasks is less frequent the "time weighted average" approach could result into an underestimation of the exposure level. For those scenarios an alternative approach is based on a concept that the most stressful task is the minimum starting point. A peculiar procedure allows to exactly estimate the resulting index within this range of minimum to maximum values. It is possible to apply this approach also for job rotation with weekly or monthly or annual cycle typical of agriculture, supermarket, cleaning sectors. This paper shows criteria and results in two working situation: cleaning (weekly cycle) and packaging of fruit (annual cycle).     

Evaluating Public Charity Websites

In this study, we explore nonprofit website development by applying two different types of website assessment tools to US charity websites. One instrument is theoretically based in nonprofit tendencies; the other is a commercial automated service. The results of these evaluation tools are further analyzed to determine whether the instruments are sufficiently independent for evaluation of nonprofit websites. The results illuminate differences in the assessment tools, finding them to be complementary. Each method offers different insights into website development deficiencies and avenues for improvement.     

Policy instruments for reducing toxic releases. The effectiveness of state information and enforcement actions

This article analyzes the extent to which different policy instruments explain toxic reductions among the states. Data from the Toxics Release Inventory (TRI) and other sources are used to assess the effect of various policy instruments, while holding economic factors constant. State TRI information programs, enforcement action, and direct regulation all matter in reducing toxic releases. Interestingly, the informational tool seems to matter more than both authoritative tools. The findings also support the idea that the interaction of policy instruments as well as the match between policy tools and policy context may account for a portion of the results.     

Improving wheelchair prescription: an analysis of user needs and existing tools

Wheelchair users experience many situations that affect the stability and associated performance of their wheelchair. Stability is affected by user characteristics and abilities, environmental features and conditions, and wheelchair modification and accessories. Wheelchair prescribers need effective tools and methods to provide quantitative evaluation and prediction of the behavior of the user-wheelchair system in a variety of static and dynamic situations. Such information is very important to guide efficient management of associated risks and adjust chairs accordingly. This project involves a user-centered approach for design and evaluation of a load cell based wheelchair stability assessment system (Wheel-SAS). Here, the current methods for assessing stability are described, and their shortcomings explained. The user-centered design approach being applied to the development of the associated Wheel-SAS hardware and software is described. Future work including semi-structured interviews and an online survey with wheelchair prescribers and associated healthcare professionals for deriving user requirements and a design specification for a load cell system for measuring dynamic wheelchair stability are detailed.     

Examining the link between program implementation and behavior outcomes in the lifestyle education for activity program (LEAP)

Lifestyle Education for Activity Program (LEAP) was a comprehensive, school-based intervention designed to promote physical activity in high school girls. The intervention focused on changes in instructional practices and the school environment to affect personal, social, and environmental factors related to physical activity. Multiple process evaluation tools and an organizational assessment tool were developed to monitor program implementation from a framework called the LEAP essential elements, which characterized complete and acceptable intervention delivery; secular trends were also monitored. Using process data, LEAP intervention schools were categorized into low- and high-implementing groups and compared with control schools on nine essential elements assessed at the organizational level. The Wilcoxon scores test revealed that low- and high-implementing intervention, and control schools differed significantly on two of nine administrator-reported organizational-level components: having a physical activity team and having a faculty-staff health promotion program. A mixed-model analysis of covariance indicated that, compared to control schools, a greater percentage of girls in high-implementing schools reported engaging in vigorous physical activity. Process evaluation can be used to understand the relationship between level of implementation and successful program outcome.     

Measurement Issues in Human Behaviour Theory

Abstract

This paper provides a brief introduction to the use of standardized measurement scales in behavioural theory, discusses some of the limitations of the domain sampling model of measurement for behavioural scientists and practitioners, and identifies central measurement issues in behavioural theory that are germane to all measurement tools. The ever popular and useful behavioural checklist is used to introduce the domain sampling model of measurement and to describe how it can be treated as a standardized measurement tool.     

Perceived contra observed physical work load in Swedish dentists

In an earlier questionnaire study, dentists reported high experienced physical work load in their profession, but low to moderate complaints from their musculoskeletal system. The correlation between reported physical work load and pain from the musculoskeletal system was weak. This discrepancy could not be satisfactorily explained. Therefore, a second study was undertaken, in which the same 27 dentists who reported musculoskeletal problems were video recorded during one hour of clinical work, and the records were later analyzed using PEO (Portable Ergonomic Observation). PEO is a frequency analysis method which allows observation of work in real time using a portable computer or video recordings. PEO can be adjusted for registration of single or multiple work operations. Output data are presented as frequency, duration, and sequence of the various work operations. The aim of the present study was to investigate if there was a relation between observed work load recorded with PEO, and subjectively estimated work load and musculoskeletal complaints recorded with a questionnaire based on Visual Analogue Scales. Sitting and standing postures, and head, trunk and arm movements were analyzed. The PEO observations showed that dentists generally perform their clinical work in a sitting position, with the head bent forward almost half of the time. Only weak to moderate correlations (r =0.0-0.6) were found between observed physical work load and subjective estimations of experienced physical work load and musculoskeletal complaints. These findings support the results in our previous study, but they do not explain the large difference between the observed low work load and the subjectively experienced high work load. The study will be followed up by EMG measurements and free interviews, where both muscular load and psychosocial factors will be evaluated.     

Assessment and management of hospitalized suicidal patients

Suicide in inpatient psychiatric settings is a critical problem. A comprehensive literature review was performed to determine risk factors for inpatient suicide, instruments for assessing suicide, and treatment of hospitalized suicidal patients. Findings suggested that root causes of inpatient suicide were factors related to the treatment environment, failure to assess patient behavioral characteristics, and staff reliance on no-suicide contracts. Recommendations include assessing suicide risk regularly throughout hospitalization, including on admission, during changes in a patient's mental or physical status, after a change in observation level, and before discharge. Orientation and inservice education for all staff and additional research on the psychometric properties of available suicide assessment instruments are also essential.     

A Review of Alcoholism Screening Instruments and Their Appropriateness for Women

Abstract

The purpose of this paper is to review empirical data on currently used alcoholism screening instruments. It is the contention of this article that current established instruments have incorporated items significantly more characteristic of males' alcoholism or late stage problem drinking of women. They omit areas more germane to women's life course experiences, such as reproductive health issues and exposure to physical and sexual abuse. Indicators more appropriate for detecting problem drinking in women are proposed.     

Macroeconomic policy tools to finance gender equality

Feminist economists and heterodox macroeconomists have contributed substantively to the body of research that explores the distributional effects of macro policies. This work explicitly addresses the livelihood problems created by neoliberalism and, in addition, it provides a pathway for identifying financing mechanisms. Building on earlier work by Seguino and Grown (2006), this article synthesizes and elaborates the major contributions of this body of gender and macro research and, from this, extrapolates macro‐level policies and tools that support gender equality. Among the tools identified is targeted government spending on physical and social infrastructure, the latter a relatively new conceptual tool that is discussed in detail. A key argument is that financing for gender equality that raises economy‐wide productivity can be self‐sustaining. As a result, both physical and social infrastructure spending have the ability to create fiscal space. This possibility offers a financing framework for gender equality expenditures. A contribution of this article is to critique mainstream monetary policies and identify alternative approaches that expand the toolkit to achieve gender equality goals.     

Auditing Nonphysician Providers' Visits through a Computer-Assisted System

Abstract

The Medical Department is using a computer-assisted system for auditing care provided by mid-level practitioners. Standards of care and corresponding checklist forms have been developed for six common ambulatory problem areas. These include: Respiratory complaints, headache, gastrointestinal disorders, urinary tract infections, male genitourinary problems, and minor trauma. The standards for the diagnostic process and treatment of each complaint were developed by a working group of physicians and mid-level practitioners. Providers complete a checklist form for each patient presenting with problems covered by the protocol. The checklist serves as the medical record for the visit. Checklist data is entered into a computer which audits the visit record against protocol standards. The computer identifies records containing discrepancies in the appropriateness of diagnosis, treatment plan, and physician consultation. The computer output is not the end of the audit process. It identifies encounter records which need further review. Because a discrepancy from the programmed standards does not necessarily reflect faulty medical judgement or care, these records are referred weekly to a physician-nurse audit team. The computerized system allows the auditors to focus their efforts on problems which may make a significant difference in patient care.

As a result, the Medical Department's audit process is both more comprehensive and more thorough than it was prior to the inception of this program. Since April 1, 1977, more than 15,000 encounters have been audited through this system.     

Using Yoga Interventions to Enhance Clinical Social Work Practices with Young Women with Cancer

It is widely published that physical, psychological, and social stressors adversely affect many individuals who are diagnosed with cancer, influencing their experience of treatment and perhaps, the quality of life after treatment is complete. No one is prepared for this battle, yet most patients are forced to make split-second decisions that are critical to their care. This case study highlights the mindfulness approach taken by one social worker to help a young woman during her journey with cancer. By guiding her through gentle yoga postures, yoga breathing, and meditation this patient learned how to take back some measure of control in her recovery, address her illness-related stress, and possibly enhance the quality of her life during treatment. As more clinicians combine conventional best practices with complementary healing therapies, they may provide tools any patient can use to instill hope and promote wellness during this most challenging time and beyond.     

Preliminary Validation of an Online DSM-Based Mental Health Referral Inventory

A brief online inventory was developed as a much needed corrective for the hundreds of unscientific tests that are used now by millions of people to self-diagnose mental health problems. The primary purpose of the new inventory is to refer people to mental health professionals for further evaluation when they are experiencing problems that might be diagnosable under DSM guidelines; it is not designed to diagnose, however. The inventory was found to be a valid and reliable measuring instrument based on analysis of data obtained from 3,403 subjects. The 54-item checklist looks for 18 common problems identified in the DSM-IV and takes from 5 to 10 min to complete. Test scores proved to be good predictors of a variety of self-reported criterion measures, including happiness, personal and professional success, history of hospitalization, history of therapy, current participation in therapy, employment, and level of education. Females were found to have slightly more mental health problems than males, but no differences in scores were found by race or ethnicity.     

A new ‘aging males’ symptoms' rating scale

Unlike in women, where instruments are available to measure the severity of symptoms, standardized instruments are lacking for aging males. However, a new ‘aging males’ symptoms' (AMS) rating scale has been developed in the present study, as well as reference values.

A total of 116 medically well-characterized males (aged over 40 years) were recruited to complete a questionnaire of symptoms, the prevalence of which commonly changes with increasing age. Factor analysis was used to establish the raw scale and to identify the dimensions of the scale. This raw scale was applied to a large representative population sample of 992 German males, to establish reference values for the severity of symptoms in males over 40 years.

Three dimensions of symptoms were identified in the patient group: a psychological, a somatovegetative and a sexual factor, that explained 51.6% of the total variance. Reference values of the three dimensions were defined to be used in daily practice. The severity of symptoms assessed using the AMS scale was found to be related to the clinically defined ‘male climacteric’ in the patient group.

The AMS scale is a new and valuable tool for assessing aging males' symptomsc and can be easily used in practice.     

Screening for depression and suicide: self-report instruments that work

Self-report instruments for depression and suicide risk can help busy clinicians identify adult clients who may be at risk for depressive disorders. These instruments provide a baseline measure of clients' behavioral status, reflect response to treatment, and improve clinical decision making. Such scales can also detect symptoms of depression regardless of whether they are reported or observed. Clinicians' recognition of depression is improved when self-report screening tools are used. When it is not feasible to conduct a thorough psychiatric evaluation, screening instruments can identify at-risk clients who need further evaluation.     

Evidence-based exposure criteria for work-related musculoskeletal disorders as a tool to assess physical job demands

Despite worldwide attention, musculoskeletal disorders (MSDs) remain a substantial concern at work. To support ergonomists to assess the work-related risk factors for MSDs, several instruments are available. Unfortunately, many of these instruments are not supported by evidence-based exposure criteria for particular MSDs. For effective prevention of MSDs, it is important to know to what extent work-related risk factors are present in the work situation. The Netherlands Center for Occupational Diseases (NCOD) develops evidence-based criteria documents for the assessment of work-related MSDs. The exposure criteria of these documents can be used on a group level to support ergonomists in their assessment of the physical job demands that are associated with work-related MSDs. At the moment the NCOD has exposure criteria for the assessment of 22 work-related MSDs, for instance on the work-relatedness of upper extremity disorders, non-specific low back pain or patellar tendinopathy. The use of these exposure criteria enables ergonomist to better assess the work-related risks of MSDs as a starting point for effective prevention.     

Development of a framework for classifying threat and neglect in childhood: A qualitative study

Quantification of childhood adversity has typically involved a cumulative risk approach in which total number of discrete adversities serves as an index of overall risk. However, this approach fails to account for the growing evidence of differential outcomes following exposure to childhood adversities. An alternative approach adopts a dimensional perspective, with growing evidence for distinct developmental impacts associated with exposure to threat (violence/abuse) and deprivation (neglect). This study developed a framework for the classification of these dimensions through a thematic analysis of health practitioners' views and accounts of different forms of childhood adversity. Ten health practitioners experienced in working with children with challenging behaviours and neurodevelopmental disorders participated in semi-structured interviews regarding definitions and examples of six categories of adversity: physical/emotional/sexual abuse, physical/emotional neglect, and domestic and family violence. The qualitative analysis identified 23 themes across the six categories of adversity, along with two overarching themes regarding ambiguity of classifying exposures and non-specific outcomes of exposures. Themes were integrated to provide a framework and checklist for classifying indicators of exposure to threat and deprivation. The findings offer a framework and checklist for the assessment of threat and deprivation that will allow for further testing of the dimensional risk model.     

Risk assessment in context

This article provides an overview of the context in which decisions about risk are made in child welfare including personal, task, and environmental factors that may contribute to uncertainty and less-than-optimal decision making, as well as some of the methodological challenges posed by the use of current risk assessment instruments. Actuarial, consensus-based, and clinical instruments are discussed and the more successful track record of actuarial decision-making in child welfare and related fields is highlighted. Methodological challenges to assessing risk are also presented including lack of reliability and validity of measures, definitional dilemmas, temporal issues such as changes in risk over time, absence of base rate data, predicting for individuals and sensitivity and specificity of measures. Implications for the design and implementation of risk assessment tools are considered in light of contextual influences and methodological limitations. Lastly, an overview of the contents of Part One of this special issue on risk assessment is provided.