"Becoming a Values-Driven Self-Care User”: Development of a Grounded Theory Model and Group Intervention for Health Students

Self-care is generally understood as a multi-dimensional construct that involves using self-selected strategies in order to achieve a balance between personal and professional life, and to support and promote mental/emotional, physical, spiritual, and professional functioning (Jordan, 2010; Lee & Miller, 2013). Self-care is imperative for health students, as they are at a greater risk for burnout and given their collective responsibility for caring for others (Cecil et al., 2014; Duarte et al., 2016; Salyers et al., 2015). However, there is insufficient focus on self-care in training programs and students’ uptake of self-care is low (Bettney, 2017; El-Ghoroury et al., 2012; Furr & Brown-Rice, 2017). My dissertation aimed to understand this gap between knowledge and action by theorizing how health students who are in undergraduate and graduate programs naturalistically create and maintain self-care, and then by developing a theory-based intervention. In Study 1, I used grounded theory methodology to develop a theory delineating the process of a successful self-care user from the perspective of health students (N = 17). My grounded theory, Becoming a Values-Driven Self-Care User, comprised four phases that participants moved through iteratively: 1) Having a Wake-Up Call, 2) Building Skills, 3) Gaining Confidence, and 4) Building an Identity. In addition, my grounded theory explained why some students were unsuccessful at developing self-care practices and this helped to address the barriers of self-care reported by students. My theory showed that self-care skills are solidified into students’ identities in the context of a values disconnect along with practice and support. This is the first comprehensive theory to explain how health students develop effective self-care habits, and it informs the development of self-care interventions for this population. In Study 2, I used my grounded theory model, as well as previous theoretical work, to develop and evaluate a group self-care intervention, Values-Based Self-Care (VBSC), which comprised of six, 90-minute weekly sessions. I randomly assigned a heterogenous sample of health students (N = 61) into an intervention (VBSC) or waitlist control group. Pre- and post-group data was collected before and after the intervention/wait period and then analyzed for group differences. I also examined within-person changes before and after the intervention using the total sample. My hypotheses were partially supported. There were significant within-person pre-post intervention changes in self-care, emotional distress, valued living, and self-esteem. However, when comparing the intervention and waitlist control groups, meaningful differences were only found for self-care, valued living, and depression. My dissertation shows that values are essential for building and maintaining self-care. In addition, consolidating self-care behaviours into health students’ identities requires support, time, and practice. My dissertation encourages new avenues for future researchers to develop tailored self-care interventions that afford students with social support and feedback, which are necessary for skill mastery. My findings also have implications for how we operationalize self-care and measure it within research studies

An assessment of biomass supply chain : a DEA application

Renewable energy generation reduces carbon emissions and responds to the targets for renewable energy sources of most EU countries; it also enhances infrastructure resilience and creates flexibility of the energy matrix. However, the availability of biomass may drastically differ from country to country within the EU. In most cases, the most challenged countries to achieve high targets for sustainability are not those with a sufficiently large supply of biomass. Because of this, it is necessary to design new biomass supply chain networks and improve the existing networks. This paper aims to assess the efficiency of biomass alternative pathways of the supply network from South America to Europe. In this particular work, three scenarios of biomass using two transportation systems were investigated, i.e., transportation of wood logs, pellets and torrefied biomass in the country of origin by truck and train transportation. Efficiency was measured using a data envelopment analysis (DEA) model derived from CCR. The results present the most efficient supply chain alternatives and highlight the feasibility of establishing closer cooperation between Brazil and countries in Europe for green energy generation. This information can assist in the process of planning and decision-making to determine the practicability of the implementation of torrefaction facilities using the most efficient logistical pathway

The efficiency and productivity of G20 countries in Circular Economy (CE) practices for the implementation of the Millennium Sustainable Development Goals (SDGs)

Os desequilíbrios ambientais decorrentes do atual modelo socioeconômico, que promove a exploração e degradação de recursos naturais, abre portas para novos paradigmas condizentes com o desenvolvimento sustentável. Nesse contexto, surgiu o conceito de Economia Circular (EC), que consiste em um ciclo contínuo de desenvolvimento positivo que preserva e valoriza o capital natural. Além disso, as práticas da EC em seu nível macro - podem impactar diretamente o progresso dos Objetivos de Desenvolvimento Sustentável do Milênio (ODS). Diante desse cenário, o objetivo geral deste trabalho consiste em mensurar a eficiência e produtividade dos países do G20 - Argentina, Austrália, Brasil, Canadá, China, França, Alemanha, Índia, Indonésia, Itália, Japão, Coreia do Sul, Rússia, Estados Unidos, México, Arábia Saudita, África do Sul, Turquia, Reino Unido - em práticas da Economia Circular para o progresso na realização de Objetivos de Desenvolvimento Sustentável do Milênio (ODS). Baseado em Schroeder et al. (2019), foram elaborados quatro modelos de eficiência e produtividade, em que variáveis relacionadas à EC são identificadas como fator causal de variáveis representativas dos ODS selecionados. Aplicou-se a Análise Envoltória de Dados (DEA) modelo Slack-Based Measure (SBM) para mensurar a eficiência e o Malmquist Productivity Index (MPI) para determinar a produtividade. Os resultados sugerem que os países do G20, quando considerados conjuntamente, apresentaram perda de eficiência e de produtividade. Uma possível explicação para tal observação é que os recursos naturais têm sido consumidos em maior intensidade enquanto as melhorias tecnológicas necessárias para aumento da produtividade ainda não demonstraram ser suficientes para compensar a pressão de demanda. Para o modelo referente ao 6° ODS (Água Potável e Saneamento), os países eficientes, no período de 2010 a 2019, foram Alemanha, Austrália, Reino Unido, África do Sul, Arábia Saudita, Brasil e Índia. Aqueles com os maiores escores de produtividade foram Alemanha, Canadá, França e Reino. A queda da eficiência e produtividade observada para todos os países pode ser devido à demanda por água potável e saneamento em maior escala que a proporcionada pela adoção de novas tecnologias. Referente ao modelo do 7° ODS (Energia Limpa e Acessível), os países eficientes no período de 2010 a 2019 foram: Coreia do Sul, África do Sul, Argentina, Brasil e Índia. Aqueles com os maiores escores de produtividade foram África do Sul, Índia e Indonésia. As perdas da eficiência e produtividade podem ser explicadas pela pressão por energia e eletricidade em um ritmo mais acelerado do que o desenvolvimento de tecnologias de energia renovável ou para outras formas de energia limpa acessível. Em relação ao 12° ODS Estados Unidos. Nesse modelo, os países mostraram uma redução na eficiência, porém ganhos de produtividade relacionados com o desenvolvimento de tecnologias. Por fim, para o 15° ODS (Vida Terrestre), os países eficientes no período de 2016 a 2019, foram: Alemanha, Coreia do Sul, França, Itália, Reino Unido, África do Sul, Argentina, Brasil, Indonésia e Turquia. Aqueles com os maiores escores de produtividade foram Alemanha, Coreia do Sul, Estados Unidos, Itália, Japão, Reino Unido, Argentina e China. O decréscimo da eficiência e produtividade indica que os recursos relacionados com a Vida Terrestre podem estar sendo consumidos de uma maneira mais acentuada que a capacidade e implementação de tecnologias para mantê-los. Os países considerados eficientes podem servir de benchmarkings para os demais em identificar práticas da EC que podem contribuir para a realização dos ODS, além de subsidiar políticas governamentais e estratégias da agenda ambiental a nível mundial.Environmental imbalances resulting from the current socioeconomic model, which promotes the exploitation and degradation of natural resources, opens doors to new paradigms consistent with sustainable development. In this context, the concept of Circular Economy (CE) emerged, which consists of a continuous cycle of positive development that preserves and values natural capital. Furthermore, CE practices at its macro level can directly impact the progress of the Millennium Sustainable Development Goals (SDGs). Given this scenario, the general objective of this work is to measure the efficiency and productivity of the G20 countries - Argentina, Australia, Brazil, Canada, China, France, Germany, India, Indonesia, Italy, Japan, South Korea, Russia, United States United States, Mexico, Saudi Arabia, South Africa, Turkey, United Kingdom - in Circular Economy practices for progress in achieving the Millennium Sustainable Development Goals (SDGs). Based on Schroeder et al. (2019), four models of efficiency and productivity were developed, in which EC-related variables are identified as a causal factor of variables representative of the selected SDGs. Data Envelopment Analysis (DEA) Slack- Based Measure (SBM) model was applied to measure efficiency and the Malmquist Productivity Index (MPI) to determine productivity. The results suggest that the G20 countries, when considered together, showed a loss of efficiency and productivity. A possible explanation for this observation is that natural resources have been consumed more intensively while the technological improvements needed to increase productivity have not yet proven to be sufficient to compensate for the demand pressure. For the model referring to the 6th SDG (Clean Water and Sanitation), the efficient countries, in the period from 2010 to 2019, were Germany, Australia, United Kingdom, South Africa, Saudi Arabia, Brazil and India. Those with the highest productivity scores were Germany, Canada, France and the United Kingdom. The drop in efficiency and productivity observed for all countries may be due to the demand for potable water and sanitation on a larger scale than that provided by the adoption of new technologies. Referring to the model of the 7th SDG (Affordable and Clean Energy), the efficient countries in the period from 2010 to 2019 were: South Korea, South Africa, Argentina, Brazil and India. Those with the highest productivity scores were South Africa, India and Indonesia. The efficiency and productivity losses can be explained by the pressure for energy and electricity at a faster pace than the development of renewable energy technologies or for other forms of affordable clean energy. Regarding the 12th SDG (Responsible Consumption and Production), the efficient countries in the period 2017 and 2019 were Australia, Canada, Italy, Argentina and Brazil. Countries with the highest productivity scores were: Germany, United Kingdom, France, Italy, Japan, South Korea and the United States. In this model, countries showed a reduction in efficiency, but productivity gains related to the development of technologies. Finally, for the 15th SDG (Life on Land), the efficient countries in the period from 2016 to 2019 were: Germany, South Korea, France, Italy, United Kingdom, South Africa, Argentina, Brazil, Indonesia and Turkey. Those with the highest productivity scores were Germany, South Korea, United States, Italy, Japan, United Kingdom, Argentina and China. The decrease in efficiency and productivity indicates that resources related to terrestrial life may be being consumed in a more accentuated way than the capacity and implementation of technologies to maintain them. Countries considered efficient can serve as benchmarkings for others in identifying CE practices that can contribute to the achievement of the SDGs, in addition to subsidizing government policies and strategies of the environmental agenda worldwide

The efficiency of Bolsa Família programme to advance the achievement of the millennium development goals: a data envelopment analysis of the Brazilian federative units

O enfrentamento da pobreza e a promoção do desenvolvimento humano são desafios muito persistentes e arraigados em nossa sociedade, cujas consequências afetam a vida de milhões de pessoas. Diante desse cenário, derivados das discussões da Cúpula do Milênio de 2000, realizada pela Organização das Nações Unidas (ONU), foram elaborados os Objetivos de Desenvolvimento do Milênio (ODM). Nesse percurso, um dos grandes esforços do Brasil para combater a pobreza e a desigualdade social, foi a implementação do Programa Bolsa Família (PBF) em 2003. Presente em todos os municípios brasileiros, o Bolsa Família é considerado o maior programa de transferência de renda com acompanhamento na área de saúde, educação e assistência social do mundo em desenvolvimento. Em, 2016, com um custo de 0,45% do Produto Interno Bruto (PIB), o programa, atendeu mais de 13,5 milhões de famílias, ou seja, mais de 46,5 milhões de brasileiros, que representaram aproximadamente 23% da população total do país. Devido sua relevância social, o objetivo desse trabalho foi mensurar a eficiência das Unidades Federativas brasileiras em converter investimentos no Programa Bolsa Família e PIB per capita, em avanços no cumprimento dos Objetivos de Desenvolvimento do Milênio, assim como identificar os determinantes da eficiência. Para isso, foram elaborados 6 modelos de eficiência, adequados ao contexto brasileiro, correspondentes aos propósitos dos seis primeiros Objetivos de Desenvolvimento do Milênio: 1) erradicar a extrema pobreza e fome, 2) atingir o ensino primário universal, 3) promover a igualdade entre os sexos e a autonomia das mulheres, 4) reduzir a mortalidade infantil, 5) melhorar a saúde materna, 6) combater HIV/AIDS, malária e outras doenças. Além disso, elaborou-se um modelo geral de eficiência para a avaliação do desenvolvimento humano. Aplicou-se a Análise Envoltória de Dados (DEA) – modelo Slack-Based Measure (SBM) com retornos variáveis de escala, orientado ao output, para o período de 2004-2009 a 2011-2014. As variáveis inputs utilizadas para todos os modelos foram as Transferências de Recursos do Governo Federal destinados ao Programa Bolsa Família e o PIB per capita. De forma geral, os resultados demonstraram que o Brasil avançou no cumprimento dos Objetivos de Desenvolvimento do Milênio. Os escores de eficiência foram elevados, evidenciando o desempenho satisfatório e a contribuição do Bolsa Família para a promoção do desenvolvimento humano no país. Por outro lado, identifica-se a necessidade de ampliação de investimentos destinados ao PBF, uma vez que se os níveis de eficiência estão elevados, existe pouca margem para expandir sua performance, sem alterar os inputs. Além disso, para promover o desenvolvimento humano é importante a combinação de políticas públicas a médio e longo prazo, além de ampliação de gastos sociais para construção de uma estrutura sólida que promova o desenvolvimento humano e melhora da qualidade de vida dos brasileiros.Confronting poverty and promoting human development are very persistent and deeply rooted challenges in our society, what consequences affect the lives of millions of people. In the face of this scenario, the Millennium Development Goals (MDGs) have been elaborated in the discussions of the 2000 Millennium Summit, held by the United Nations. Along these lines, one of Brazil\'s great efforts to combat poverty and social inequality was the implementation of the Bolsa Família Program (PBF) in 2003. Present in all Brazilian municipalities, Bolsa Família is considered the largest income transfer program with accompaniment in the area of health, education and social assistance of the developing world. In 2016, at a cost of 0.45% of the Gross Domestic Product (GDP), the program served more than 13.5 million families, or more than 46.5 million Brazilians, who accounted for approximately 23% of the country\'s total population. Due to its social relevance, the objective of this study was to measure the efficiency of the Brazilian Federative Units in converting investments in the Bolsa Família Program and GDP per capita, in advancing the achievement of the Millennium Development Goals, as well as identifying the determinants of efficiency. To this purpose, 6 efficiency models were developed, adapted to the Brazilian context, corresponding to the first six Millennium Development Goals: 1) eradicate extreme poverty and hunger, 2) achieve universal primary education, 3) promote equality between gender, and women\'s empowerment, (4) reducing child mortality, (5) improving maternal health, (6) combating HIV/AIDS, malaria and other diseases. In addition, a general efficiency model for the assessment of human development was developed. We applied the Data Envelopment Analysis (DEA) - Slack-Based Measure (SBM) model with variable returns of scale, oriented to the output, for the period from 2004-2009 to 2011-2014. The input variables used for all models were the Federal Government Resource Transfers destined to the Bolsa Família Program and the GDP per capita. Overall, the results demonstrated that Brazil has made progress in achieving the Millennium Development Goals. The efficiency scores were high, evidencing the satisfactory performance and the contribution of the Bolsa Família to the promotion of human development in the country. On the other hand, it is identified the need to increase investments destined to the PBF, since if the levels of efficiency are high, there is little scope to expand its performance, without changing the inputs. In addition, to promote human development, it is important to combine public policies in the medium and long term, as well as to increase social spending to build a solid structure that promotes human development and improves the quality of life of Brazilians

Mise en garde : les études de médecine peuvent mettre la santé mentale des apprenants à rude épreuve. Les étudiants en médecine doivent pouvoir faire le choix d’entamer et de poursuivre leur formation en connaissance de cause

For decades there has been ample evidence that training to become a physician and practicing medicine is hazardous to one’s health and wellness. In the face of the extremely high rates of suicide, substance abuse, depression and burnout in the medical student, resident, and physician populations, it would be dishonest to suggest medical education and practice is all gain and no pain. This article is directed to members of the medical education community and challenges stakeholders to view their teaching and training of medical students as an intervention requiring free and informed consent. We hope this exercise shifts the paradigm of educators and enables students to enter medical training from a free and informed position. Depuis des décennies, il existe amplement de preuves à l’effet que la formation t et la pratique de la médecine peuvent compromettre la santé et le bien-être de la personne. Face aux taux extrêmement élevés de suicide, de toxicomanie, de dépression et d’épuisement professionnel tant chez les étudiants, les résidents que les médecins, il serait faux de prétendre qu’on est ou qu’on devient médecin sans faire de sacrifice. Cet article s’adresse aux acteurs du milieu de l’éducation médicale pour les inciter à considérer la formation qu’ils donnent aux étudiants en tant qu’intervention nécessitant le consentement libre et éclairé de ces derniers. Nous espérons que cet exercice amènera les enseignants à changer de paradigme et les étudiants à entreprendre leur formation médicale de façon libre et informée

Warning: Medical education is hazardous to your mental health. Medical students should make an informed decision to begin and continue training

For decades there has been ample evidence that training to become a physician and practicing medicine is hazardous to one’s health and wellness. In the face of the extremely high rates of suicide, substance abuse, depression and burnout in the medical student, resident, and physician populations, it would be dishonest to suggest medical education and practice is all gain and no pain. This article is directed to members of the medical education community and challenges stakeholders to view their teaching and training of medical students as an intervention requiring free and informed consent. We hope this exercise shifts the paradigm of educators and enables students to enter medical training from a free and informed position.Depuis des décennies, il existe amplement de preuves à l’effet que la formation t et la pratique de la médecine peuvent compromettre la santé et le bien-être de la personne. Face aux taux extrêmement élevés de suicide, de toxicomanie, de dépression et d’épuisement professionnel tant chez les étudiants, les résidents que les médecins, il serait faux de prétendre qu’on est ou qu’on devient médecin sans faire de sacrifice. Cet article s’adresse aux acteurs du milieu de l’éducation médicale pour les inciter à considérer la formation qu’ils donnent aux étudiants en tant qu’intervention nécessitant le consentement libre et éclairé de ces derniers. Nous espérons que cet exercice amènera les enseignants à changer de paradigme et les étudiants à entreprendre leur formation médicale de façon libre et informée

Multi-criteria efficiency assessment of international biomass supply chain pathways using data envelopment analysis

Most European countries have committed to ambitious emissions reduction goals. Energy generation in particular is responsible for more than 30% of global emissions, where significant focus has been placed on renewable energy generation, including biomass. On the one hand, there are countries, like the UK, where the biomass stock is insufficient to meet the demand; on the other hand, there are countries, like Brazil, where the stock significantly exceeds the demand. To promote a natural symbiosis, it is necessary to take on the challenge of transporting biomass through long distances in an environmentally and economically efficient manner. This paper aims to assess the efficiency of alternative pathways of international biomass supply-chains. The alternatives involve different biomass origin regions, transportation modes, export ports and processing technologies, including torrefaction. Data Envelopment Analysis (DEA) has been used for the first time to assess the efficiency of the alternative biomass supply chain pathways in a Latin American context, considering multiple-criteria relating to economic and environmental performance simultaneously, such as the biomass delivered cost, the environmental impact and the fossil energy consumption. Additionally, a sensitivity analysis was performed to analyse the robustness of the results under uncertainty in parameter values. The DEA approach presented can assist the process of planning biomass sourcing and improve decision-making under multiple decision criteria. The results can support medium- and long-term strategic decisions for decision- and policy-makers

Economic Complexity and Human Development: DEA performance measurement in Asia and Latin America

Abstract Economic growth is not the only factor to explain human development. Therefore, many authors have prioritized studies to measure the Human Development Index. However, these indexes do not analyze how Economic Complexity can increase Human Development. This paper aimed to determine how efficiently nations from Latin America and Asia measure a country’s performance in converting Economic Complexity into Human Development, between 2010 and 2014. We used Data Envelopment Analysis (DEA), through the Variable Returns of Scale (VRS) Model and Window Analysis. Results showed that in 2014, all Asian countries, except China and the Philippines, were efficient; on the other hand Cuba was the benchmark for inefficient countries. Window Analysis showed Japan, South Korea and Singapore were efficient over time. This result confirms the initial hypothesis of this article: the more complex countries are the more efficiently they create Human Development