Traditionally, environmental related work is not commonly practised by the Swedish small and medium enterprises (SME). This can be attributed to the non-inclusive Swedish sustainability reporting legislation, which is primarily targeted at the large corporations, but also due to shortage of resources, demands, prioritization and competences in the SME. The study is aimed to simulate the SME’s interest and confidence in taking the first step in incorporating sustainability into their business strategies by means of environmental inventory. Through the development of an easy-to-use inventory model in MS Excel and automatically generated inventory reports, the study provides the SME with a tool to account for lifecycle greenhouse gas (GHG) emissions and water resource utilization. The availability of Snacksbolaget, a wholesaling actor, as a case study company refines the research scope to put focus on the wholesale and retail trading sector. Carrying out in two phases, the study begins with developing a generic theoretical model to portray typical GHG emissions and water resource utilization in the wholesale and retail trading sector, which is followed by applying the theoretical model to Snacksbolaget as a case study. The application involves system boundary definitions in the company and product levels, data collections, calculations, inventory model building and verification by Snacksbolaget. The usability of the inventory model is verified by Snacksbolaget and the company is satisfied with the information the overarching inventory reports provided. The inventory results based on Snacksbolaget’s data demonstrate that Scope 3, indirect GHG emissions, contributes to the majority of the company’s overall emissions. Within Scope 3, the largest contributions are originated from purchased products cradle-to-gate stages and their upstream transportation, while sensitivity analysis proves that the energy production mix applied to the manufacturing of product and the modes of goods transport could play a vital role in GHG reduction. Correspondingly, indirect water use in electricity generation, particularly in the product manufacturing stage, is shown to be the largest water input and output source of the studied products. Recommendations to Snacksbolaget are provided in the report, aiming at potentially minimizing indirect GHG emitted and water withdrawn or discharged by the products and services they purchase. To reach a larger SME audience, it is recommended to further develop the current customized spreadsheet model into sector specific inventory models. The interest and uptake of the models will likely increase if they are well developed and maintained by expertise independent of the SME and made readily available to the use of the SME. / Jämfört med de större företagen är det i Sverige inte lika vanligt att små och medelstora företag (SME) jobbar med miljöfrågor. Detta beror delvis på att hållberhetsredovisningskraven inte gäller SME, men också på grund av att SME saknar resurser, tid, pengar, kompetens samt att kunderna inte alltid ställer krav kring att driva de frågorna. Genom att utveckla modeller kring hur man beräknar och redovisar växthusgasutsläpp (GHG) och vattenanvändning för ett företag är tanken att examensarbetet ska underlätta SME:s miljöarbete och locka flera SME till att adressera de miljörelaterade utmaningarna. Examensarbetet är uppdelat i två sektioner. Först tas en teoretisk modell fram med inriktning mot parti- och detaljhandelssektorn, där avgränsningarna är dragna i enlighet med GHG protokollstandarden och redovisningsprinciper för vattenanvändning. Modellen implementeras sedan som verktyg i MS Excel, med inbyggda beräknings- och rapporteringsfunktioner. Verifiering av modellen görs genom tillämpning av verktyget på Snacksbolaget, ett fallstudieföretag som har en grossistverksamhet inom hotell, restaurang och cateringbranschen. Inventeringsresultatet visar att Scope 3 GHG-utsläppen är störst i Snacksbolagets totala utsläppsprofil 2019, vilken är ganska typisk för partihandeln. Av Scope 3 utsläppen är materialutvinning och produkttillverkningsfaserna av de köpta produkterna det som bidrar till största delen, samtidigt som utsläppen från transport-kategorier sådan som Scope 1, Scope 3.4 och Scope 3.9 också är signifikanta. Inventeringen av vattenanvändning visar att produkttillverkningsfasen kräver den högsta vattenvolymen, där en relativ stor del är indirekt vatten som användas i elproduktionen. Inventeringsresultatet och känslighetsanalysen visar de potentiella åtgärder företaget kan implementera för att påverka storleken av Scope 3 emissionen och indirekta vattenanvändningen. Företaget rekommenderas att överväga sina produktval genom att utvärdera miljöprestationen genom att analysera flera miljöparametrar / miljödimensioner. Dessutom bör de inskaffa den underliggande produktinformation från leverantörerna för att säkerställa att man tar hänsyn till en korrekt produktlivscykel och validera de miljöfördelar som framhävs av leverantören. Det är också viktigt att välja produkter där materialet utvinns i, och produktens tillverkning sker i, länder eller regioner som utnyttjar förnybar energi och samtidigt inte är drabbat av vattenbrist. Företaget kan även motivera leverantören att frakta varorna med gröna transportalternativ. Sist men inte minst kan företaget uppmuntra till mindre konsumtion genom att erbjuda tjänster som uthyrning och återanvändning av produkter. Vidareutveckling av modellen inom parti- och detaljhandelssektorn kommer att kräva ytterligare data, tid och kompentens. Medan utvidgning av modellen för att omfatta andra affärssektor kan uppnås genom att utveckla separata modeller med likande tillvägagångssätt som beskrivs för den nuvarande modellen. Datakvaliteten kan förbättras under tiden genom regelbunden underhållning och uppdatering. För att kunna locka till sig fler små och medelstora företag, bör anpassande modeller utvecklas och underhålls av externa miljöexperter och göras tillgängliga för användning av SME.

<p>Antibiotic use is generally regarded as the major driver for resistance. Many studies reporting an association between antibiotic use and the emergence of resistance have been published. However, most studies have significant limitations such as single center data with comparably low number of cases, using retrospective designs with limited data availability, ecological studies with lack of assessing the individual level and risk for ecological fallacy, and inappropriate selection of controls in case-control studies.</p> <p>A cohort study in adult patients hospitalized in 15 participating acute care hospital sites in Ontario, Canada, was conducted from April 1 2005 to June 30 2006. Antibiotic use on the unit level in defined daily doses (DDD) was only available for 3 sites. In order to assess antibiotic use on both the individual as well as on the unit level as a risk factor for resistance, days of therapy (DOT) could be calculated. However, it was unclear whether this approach would results in similar findings as when using DDD. Thus, the impact of using either DDD or DOT on the risk estimates for resistance was assessed for three antimicrobial-bacteria combinations, i.e. fluoroquinolone use and fluoroquinolone resistance in enterobacteriaceae an in <em>Pseudomonas aeruginosa</em>, and the use of betalactams and resistance to third generation cephalosporins in enterobacteriaceae.</p> <p>The risk estimates for resistance were very similar for all three antimicrobial-bacteria combinations on acute care units, there were some discrepancies on the unit level on intensive care units, and discrepancies on both levels for step down and rehabilitation units.</p> <p>In conclusion, the approach to use DOT instead of DDD to measure antibiotic utilization revealed similar results. However, the lack of comprehensive information on patient transfers when calculating DOT may bias the findings on units with frequent patient transfers such as intensive care units and step down and rehabilitation units.</p> / Master of Science (MSc)

<p><strong>Abstract</strong></p> <p>Health care practice environments are central to the safety and quality of patient care. Hospitals often develop and implement a professional practice model (PPM) to improve practice environments. In the United States, magnet hospital designation is a driving force in PPM implementation. In Ontario, Canada, despite the lack of magnet hospital designation, many hospitals have implemented PPMs. There appear to be differences in how PPMs are implemented in Ontario.</p> <p>This phenomenographic study examined professional practice experts’ conceptions of PPM implementation and use in Ontario acute care hospitals. The findings indicate that PPM implementation is a dynamic and emergent phenomenon that occurs in cyclical phases of growth and reduced activity.</p> <p>Seven categories of PPM use are described (a) creating alignment/consistency, (b) supporting evidence-based practice, (c) enabling interprofessional practice, (d) enhancing professional accountability, (e) enabling patient-centred care, (f) creating/ strengthening linkages, and (g) strategic positioning of professional practice. Categories exhibited hierarchical relationships, with more foundational uses providing support for higher level uses.</p> <p>Three structural themes are identified (a) model design/structure, (b) professional practice leadership, and (c) organizational support. These themes work individually and synergistically, within and across the categories to influence use and potential impact of the PPM. Progressively fuller and more complex use of the PPM appears to occur under increasingly intense influence of the structural themes.</p> <p>The analysis provides unique information about relationships within and among categories of PPM use. This provides insight regarding how organizations might maximize return on investment with PPM implementation. Seven recommendations are identified.</p> / Master of Science (MSc)

<p>The purposes of this study are to compare the differences in research utilization among rural and urban nurses working in acute care hospitals and to examine the individual and contextual factors that may be associated with the differences. A quantitative research designed was used to compare the responses of 220 nurses (109 rural and 111 urban) working in a Local Health Integrated Network in South West Ontario, Canada. Data were collected using a modified version of Estabrooks’ (1997) self-report, mail-in, Research Utilization Survey. Results from the data analysis are discussed. Rural and urban nurses reported similar conceptual, instrumental, and persuasive research utilization (RU), with conceptual RU being the most commonly used form. However, rural nurses reported using overall RU significantly less than their urban counterparts did.</p> <p>Rural nurses reported having less access to organizational champions and resources, such as library research journals and computers, than nurses in urban practice had. An analysis of the association between the individual and contextual variables and overall RU indicates that approximately 26% of variance in nurses’ overall RU scores can be predicted from the variance in scores of the following variables: (a) positive RU attitude, (b) organizational relationships supportive of RU, (c) level of competence, and (d) location of nurses. The findings support a multi-dimensional conceptualization of RU and the merits of exploring individual factors as well as organizational and environmental context in future research, theory development, and implementation of strategies to promote RU among nurses.</p> / Doctor of Philosophy (PhD)

In the U.S., criteria for a substance abuse or dependence diagnosis were met by approximately 22.2 million in 2008, while managed healthcare covered 176.3 million Americans. This study examined how risk for substance abuse disorders interacted with age, gender, and mental health and medical comorbidity status to affect behavioral health treatment utilization and cost. Individual impacts include risks to physical and psychological well-being. The disruptive behaviors of substance use disorders influence families through both social impairment and an inability to maintain role functions, leading to discord within couples and an increased risk of cognitive, emotional, and behavioral problems in offspring. Substance use disorders affect businesses through absenteeism, reduced productivity, and termination and new-hire costs. Local, state, and federal governments all attempt to minimize the impact of substance use disorders on communities, which significantly affects the workload and fiscal solvency of those governments through public welfare and law enforcement programs. Treatment of substance use disorders has been shown to effectively mitigate the immediate impacts on individuals, families, and businesses; yet, the impact on governments has not been explored, though they may be inferred to receive some benefit through the same mechanisms by which they are negatively influenced. The study sample consisted of 13,417 adult members of a managed behavioral healthcare company who went to at least one outpatient mental health session and reported a significant level of psychological distress on a self-report measure administered at that session. Substance use risk, age, gender, comorbidity status, treatment utilization, and treatment cost for a four-month period were examined, based on data from that assessment and claims data. Correlations initially ruled out any significant effect of psychological distress on the other predictor variables, indicated that Facility and Other treatment types were highly interrelated, and set the foundation for later multiple regressions. Factor analysis then determined that Facility and Other treatment types were part of a single factor for both treatment utilization and cost; so, these criterion variables were then combined. Multiple regressions then examined the relationships between multiple predictors on each criterion. Results indicated significant relationships for most analyses which was expected given the large sample size, so Cohen's d was used to discuss the relative strength of the effects. No relatively weak results were found between all of the predictor and criterion variables. Suggested causes for this pattern of outcomes included methodological flaws in operationalization or minimal relationship between the constructs of interest and the assessment questions aimed at evaluating those constructs. Future research is discussed in terms of improving methodological problems of the current study. / Counseling Psychology

Ethnic minority youth use mental health services less frequently than Caucasian youth, despite similar rates of psychopathology. Research has documented ethnic differences in (1) parents' beliefs about the seriousness, prognosis, and etiology of child symptoms and (2) preferences for help-seeking, which may partially explain disparities in treatment utilization; however, few studies have examined underlying cultural factors that may account for ethnic differences or parent's beliefs and preferences with regard to youth anxiety. This study examined parents' beliefs about separation anxiety disorder (SAD) and preferences for help-seeking among 117 Indian-American (IA; n = 39), Puerto Rican (PR; n = 39), and European-American (EA; n = 39) mothers. After reading four vignettes describing SAD symptoms, parents rated the seriousness, prognosis, and etiology of symptoms and the likelihood of help-seeking. Parents also completed measures of acculturation, independent/interdependent self-construal, and strength of religious faith. RM-MANCOVA (controlling for SES) revealed that PR mothers were more likely than EA mothers to endorse medical etiology and were more likely than IA mothers to seek help from a physician. Hierarchical multiple regression revealed that acculturation and strength of religious faith predicted parents' etiological beliefs and preferences for help-seeking, after accounting for variance associated with SES and child gender. Results highlight the importance of examining cultural constructs that may contribute to ethnic differences. Implications for future research and clinical practice are discussed. / Psychology

This dissertation is exploratory in design and employs an electronic survey and comparative case studies to examine the factors that shape the impact of a non-traditional data source that measures the market power of urban neighborhoods, the Social Compact Neighborhood Market DrillDown, on the policymaking process of local government officials concerned with neighborhood economic development. The four case studies are: Baltimore, MD, Louisville, KY, Detroit, MI, and Tampa, FL. The study examines the conditions that affect decision-making at the different stages of information use and considers instrumental, conceptual, and symbolic uses of information. The observation of seven variables (applicability to agenda of lead sponsor, congruence between findings and prior preferences, trust of information producer, availability of alternative information sources, information sustainability, costs of production, information as private sector "lure") provide the context for theory and hypotheses on information impact in which three factors are found to be significant (applicability to agenda to lead sponsor, information sustainability, and information as private sector "lure"). Overall, the study finds evidence that information use is inherently a political endeavor in which its use is dominated by the preferences of those who sponsor its production and use information toward initiatives that are important to them. / Political Science

This study evaluated clinical and cultural barriers to help seeking to identify which factor best predicted African American undergraduate student initial attitudes towards seeking professional psychological help (ATSPPH-short form). Predictor variables included anticipated utility, emotional openness, cultural mistrust, racial identity development, and stigma. Moderator variables controlled for prior counseling, gender and site. This study built upon prior research by evaluating clinical and cultural factors together and utilizing an information processing model to conceptualize data (Vogel et al., 2006). The focus on African American undergraduate students was based on retention problems for this population (American Council on Education, 2006) and underutilization of counseling by this population despite evidence of links between counseling & college persistence (Alford, 2000; Hamilton, 2006; Kearney, Draper & Barron, 2005; Trippi & Cheatham, 1991; & Wilson, Mason & Ewing, 1997). Sixty seven students from two Northeastern US colleges were surveyed. Direct correlation analysis found nine significant relationships with ATSPPH. Controlled for prior counseling use, anticipated benefit (r = .423, p=.001), Emotional Openness (r = .330, p=.010), and an Assimilationist Ideology of Racial Identity (r = .296, p=.022) were correlated with ATSPPH. Stepwise Multiple Regression found four significant predictors of attitudes, anticipated benefit (F=15.062, p&lt;.001), Private Regard subscale of Racial Identity Development (F=13.845, p&lt;.001), Prior Counseling (F=11.791, p&lt;.001), and Emotional Openness (F=10.485, p&lt;.001). Predictors appeared to match each level of the information processing model, suggesting a complex decision making process. Future research might repeat the model with greater or different populations. / Counseling Psychology

Background: Place of death is a commonly reported indicator for assessing palliative care quality, but does not provide details of healthcare service utilization at the end-of-life, such as acute care. In particular, early palliative care has shown to reduce acute care service use, but findings are mostly limited to cancer patients with few population-based data available. Objectives: The purpose of this research is to: 1) explore place of care trajectories in the last 2 weeks of life in a general population and among distinct illness cohorts, and 2) investigate whether early versus late palliative care affects acute care use and other publically-funded services in the last 2 weeks of life. Research Design: A retrospective population-based cohort study using linked administrative health data to examine all Ontario decedents between April 1st, 2010 and December 31st, 2012. Methods: Descriptive statistics were used to examine place of care trajectories and service utilization trends in the last 2 weeks of life. Multivariable logistic regression analyses were conducted to assess in the 2 weeks before death: 1) the odds of using an acute care setting (yes/no), and 2) the odds of time spent (≤1 week or >1week) in acute care settings among users. Results: Overall, 235,159 decedents were identified. About 32% had cancer, 31% had organ failure, and 29% had frailty. Overall, 29% of decedents used a hospital two weeks before death, but this increased to 61% on the day of death. Those with cancer were the largest users of palliative-acute hospital care, while those with organ failure were the largest users of acute- hospital care. Assessing palliative care timing, 27% were early palliative care recipients, 13% were late. About 45% of early recipients had a community-based palliative care initiation, 74% of late recipients had a hospital-based initiation. Late recipients were more likely to use acute care settings; this was further modified by disease: comparing late to early recipients, cancer decedents were nearly two times more likely to spend >1 week in acute care settings (OR=1.84, 95%CI:1.83-1.85), frailty decedents were three times more likely (OR=3.04, 95%CI:3.01-3.07), and organ failure decedents were four times more likely (OR=4.04, 95%CI:4.02-4.06). Conclusion: Place of care trajectories differ greatly by disease cohort. Exploring place of care trajectories can provide details not evident when reporting solely place of death. Furthermore, early palliative care was associated with reduced acute care service use in cancer and non-cancer patients. Late initiations were associated with greater acute care use, and had the largest effect on those with organ failure and frailty, suggesting potential opportunities for improvement in non- cancer populations. / Thesis / Master of Science (MSc)

This study was undertaken to present the aerial differentiation within Brant Township. To express these differences most clearly the Township has been studied on a regional basis. This includes a breakdown of the study area into small subdivisions and the relationships of the unit areas to each other to discover the structural and functional basis of the larger area. It must be remembered that regional geography is sterile without the concepts and principles from systematic geography. Therefore systematic geography has been employed for an understanding of the aerial differences in each kind of phenomena and the relationships between them. Throughout the study, emphasis has been placed on the basic land utilization pattern of the Township. The land utilization maps are the result of systematic observation on a field to field basis. The functional map of Walkerton in the back cover illustrates the land use contained within the town. This map also constitutes the results of field work. The study is divided into six chapters. The first chapter is a general introduction to the location, size and the physical geography are discussed. Chapter three is a detailed account of the historical development of the Township. The present day agriculture is dealt within Chapter four while non-agricultural land use, which includes on urban study, is discussed in chapter five. Chapter six, containing the summary and conclusion, completes the thesis. / Thesis / Bachelor of Arts (BA)