A New Conceptual \u2018Cylinder\u2019 Framework for Sustainable Bioeconomy Systems and Their Actors

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Concepts for sustainable bioeconomy systems are gradually replacing the ones on linear product chains. The reason is that continuously expanding linear chain activities are considered to contribute to climate change, reduced biodiversity, over-exploitation of resources, food insecurity, and the double burden of disease. Are sustainable bioeconomy systems a guarantee for a healthy planet? If yes, why, when, and how? In literature, different sustainability indicators have been presented to shed light on this complicated question. Due to high degrees of complexity and interactions of actors in bioeconomy systems, trade-offs and non-linear outcomes became apparent. This fueled the debates about the normative dimensions of the bioeconomy. In particular, the behavior of actors and the utilization of products do not seem to be harmonized according to the environmental, social, and economic pillars of sustainability. Potential conflicts require a new conceptual framework that is here introduced. It consists of a ‘sustainability’ cylinder captured between an inner-cylinder, representing order, and an outer-cylinder for chaos, based on the laws of physics and complex adaptive systems. Such a framework permits (bioeconomy) systems to propagate in the sustainability zone only if they follow helical pathways serving as the new norms. Helices are a combination of two sinusoidal patterns. The first represents here the sustainable behavior of interacting actors and the second the balanced usage of resources and products. The latter counteracts current growth discourses. The applicability of the conceptual cylinder framework is positively verified via 9 cases in Europe, which encompass social-organizational and product-technological innovations. –

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  • Cite Count Icon 6
  • 10.4314/ajfand.v1i1.19128
CO-EXISTENCE OF OVER- AND UNDERNUTRITION RELATED DISEASES IN LOW INCOME, HIGH-BURDEN COUNTRIES: A CONTRIBUTION TOWARDS THE 17TH IUNS CONGRESS OF NUTRITION, VIENNA AUSTRIA 2001
  • Jan 1, 2001
  • African Journal of Food, Agriculture, Nutrition and Development
  • R Rutengwe + 3 more

Adequate nutrition is a basic human right, but globally it remains unmet for many pre-school children. Poverty, food insecurity and malnutrition continue to be obstacles to human rights, quality of life and dignity. The 1995 goal to eradicate poverty in the world by 2020 is not on target in developing countries; rather, poverty has been increasing. Over 800 million people suffer from malnutrition in developing countries and over 20 % of the populations are hungry. About one third of the world's population suffer from micronutrient deficiencies and hundreds of millions suffer from chronic diseases of lifestyle. Prevalence rates, particularly low birth weight, stunting and underweight, remain high particularly in Eastern Africa and South Central Asia. More than a third of all children in developing countries remain constrained in their physical growth and cognitive development. The 1990 ambitious goal of halving childhood underweight prevalence by the year 2000 has not been achieved by most countries. Global progress in fighting malnutrition is slow and crippled by rapid increase of both communicable and non-communicable diseases, the so-called "double burden of disease". About 115 million people suffered from obesity related diseases in the year 2000. Overweight and obesity (globesity) prevalence is advancing rapidly in developing countries. Cardiovascular diseases (CVD), myocardial infarction, angina pectoris and stroke as one of the most important causes of mortality and morbidity globally, will continue to be first and second leading causes of death in the world. Most developing countries, including South Africa, currently are in the process of transition and experiencing the double burden of both communicable and non-communicable diseases in which chronic diseases of lifestyle such as CVD have emerged while the battle against infectious diseases has not been won. In the last few years the HIV/AIDS epidemic has spread extremely rapidly and is likely to double overall mortality rates, undermine child survival and halve the life expectancy over the next five years. The co-existence of over- and under-nutrition calls for urgent innovative strategies and interventions to tackle the problem. The importance of prevention as the most sensible strategy is emphasised. This overview emphasises that, in planning nutrition strategies and interventions in low income, high-burden countries such as South Africa risk factors for both over- and under-nutrition and related diseases should be targeted and addressed. Keywords: over- and under-nutrition, double burden of disease and developing countries. (Af. J. Food and Nutritional Sciences: 2001 1 (1): 34-42)

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Food insecurity and COVID-19-related experiences among people with HIV: A mixed methods analysis and conceptual framework.
  • Feb 12, 2026
  • PloS one
  • Dini Harsono + 6 more

Food insecurity is a key driver of health disparities in the United States and globally, and is associated with increased likelihood of chronic diseases and poorer health outcomes. Social and economic disruptions during the COVID-19 pandemic increased the level of food insecurity and disproportionately impacted low-income households and racial and ethnic minority groups. In this mixed methods study, we explored relationships between sociodemographic factors, HIV care engagement, and experiences of food insecurity in people with HIV (PWH) during the first wave of the COVID-19 pandemic. We administered a one-time telephone survey to PWH engaged in two HIV clinics in the U.S. Northeast (n = 283) and conducted four focus groups with clinical staff (n = 23). Among the surveyed PWH, 30.7% (n = 87) reported experiences of food insecurity early in the COVID-19 pandemic. Receiving care in Brooklyn, NY, being unemployed prior to the pandemic, and experiencing some or a lot of changes in daily routine due to the pandemic were associated with food insecurity experiences. Qualitative analysis of patients' free-text survey responses and clinical staff focus group transcripts identified factors at individual, intrapersonal, community, and structural levels contributing to food insecurity experiences during the pandemic. Informed by the findings, we developed a conceptual social-ecological framework illustrating the linkages between experiences of food insecurity and COVID-19 among PWH. Efforts to address food insecurity among PWH should include screening for food needs in HIV care settings, communicating about food assistance resources and programs, and implementing evidence-based interventions that can improve food security and nutrition.

  • Research Article
  • 10.1371/journal.pone.0342667.r004
Food insecurity and COVID-19-related experiences among people with HIV: A mixed methods analysis and conceptual framework
  • Feb 12, 2026
  • PLOS One
  • Dini Harsono + 7 more

Food insecurity is a key driver of health disparities in the United States and globally, and is associated with increased likelihood of chronic diseases and poorer health outcomes. Social and economic disruptions during the COVID-19 pandemic increased the level of food insecurity and disproportionately impacted low-income households and racial and ethnic minority groups. In this mixed methods study, we explored relationships between sociodemographic factors, HIV care engagement, and experiences of food insecurity in people with HIV (PWH) during the first wave of the COVID-19 pandemic. We administered a one-time telephone survey to PWH engaged in two HIV clinics in the U.S. Northeast (n = 283) and conducted four focus groups with clinical staff (n = 23). Among the surveyed PWH, 30.7% (n = 87) reported experiences of food insecurity early in the COVID-19 pandemic. Receiving care in Brooklyn, NY, being unemployed prior to the pandemic, and experiencing some or a lot of changes in daily routine due to the pandemic were associated with food insecurity experiences. Qualitative analysis of patients’ free-text survey responses and clinical staff focus group transcripts identified factors at individual, intrapersonal, community, and structural levels contributing to food insecurity experiences during the pandemic. Informed by the findings, we developed a conceptual social-ecological framework illustrating the linkages between experiences of food insecurity and COVID-19 among PWH. Efforts to address food insecurity among PWH should include screening for food needs in HIV care settings, communicating about food assistance resources and programs, and implementing evidence-based interventions that can improve food security and nutrition.

  • Book Chapter
  • Cite Count Icon 11
  • 10.1016/b978-0-12-800769-3.00020-2
Chapter 20 - Drivers and Consequences of Food Insecurity Among Illicit Drug Users
  • Jan 1, 2015
  • Health of HIV Infected People
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Chapter 20 - Drivers and Consequences of Food Insecurity Among Illicit Drug Users

  • Addendum
  • Cite Count Icon 32
  • 10.1186/s13012-016-0415-5
Erratum to: ‘Toward the sustainability of health interventions implemented in sub-Saharan Africa: a systematic review and conceptual framework’
  • Dec 1, 2015
  • Implementation Science : IS
  • Juliet Iwelunmor + 9 more

Sub-Saharan Africa (SSA) is facing a double burden of disease with a rising prevalence of non-communicable diseases (NCDs) while the burden of communicable diseases (CDs) remains high. Despite these challenges, there remains a significant need to understand how or under what conditions health interventions implemented in sub-Saharan Africa are sustained. The purpose of this study was to conduct a systematic review of empirical literature to explore how health interventions implemented in SSA are sustained. We searched MEDLINE, Biological Abstracts, CINAHL, Embase, PsycInfo, SCIELO, Web of Science, and Google Scholar for available research investigating the sustainability of health interventions implemented in sub-Saharan Africa. We also used narrative synthesis to examine factors whether positive or negative that may influence the sustainability of health interventions in the region. The search identified 1819 citations, and following removal of duplicates and our inclusion/exclusion criteria, only 41 papers were eligible for inclusion in the review. Twenty-six countries were represented in this review, with Kenya and Nigeria having the most representation of available studies examining sustainability. Study dates ranged from 1996 to 2015. Of note, majority of these studies (30 %) were published in 2014. The most common framework utilized was the sustainability framework, which was discussed in four of the studies. Nineteen out of 41 studies (46 %) reported sustainability outcomes focused on communicable diseases, with HIV and AIDS represented in majority of the studies, followed by malaria. Only 21 out of 41 studies had clear definitions of sustainability. Community ownership and mobilization were recognized by many of the reviewed studies as crucial facilitators for intervention sustainability, both early on and after intervention implementation, while social and ecological conditions as well as societal upheavals were barriers that influenced the sustainment of interventions in sub-Saharan Africa. The sustainability of health interventions implemented in sub-Saharan Africa is inevitable given the double burden of diseases, health care worker shortage, weak health systems, and limited resources. We propose a conceptual framework that draws attention to sustainability as a core component of the overall life cycle of interventions implemented in the region.

  • Discussion
  • Cite Count Icon 74
  • 10.1093/jn/133.7.2117
Understanding Obesity and Program Participation in the Context of Poverty and Food Insecurity
  • Jul 1, 2003
  • The Journal of Nutrition
  • Edward A Frongillo

Understanding Obesity and Program Participation in the Context of Poverty and Food Insecurity

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  • Cite Count Icon 1
  • 10.5937/zrpfn0-23298
Pravo kao kompleksni adaptivni sistem - put ka samoodrživosti pravnog okvira
  • Jan 1, 2019
  • Zbornik radova Pravnog fakulteta Nis
  • Predrag Cvetković

The topic of the paper is the possible implementation of the Complex Adaptive Systems (CAS) concept in the field of law. The CAS concept rests on the existence of a dynamic network with many actors (individuals, companies, states, and international institutions), acting simultaneously and constantly responding to the behavior of other actors in the network. The Complex Adaptive System is based on connections that are generated by gradual induction of certain rules; thus, the newly established order is not conditioned by a superior authority, but it functions as a self-regulated one. The CAS concept is not hierarchical, but heterarchical. Unlike the hierarchical structure, heterarchy is a structure that rests on a number of centers of equal standing in the system. The heterarhical system does not rest on the premise of fundamental unity, universal interests, and alike (as common features of the hierarchical system). Instead, the heterarchical system generates rules that cannot be observed and analyzed separately from the application process. The ability of actors or agents to respond to new challenges determines the adaptive character of this system. Applied to the field of law, the CAS concept is especially important when the legal situation at stake is prone to the change of the fundamentals on which it was based at the outset. The actors of the legal relationship (viewed as part of the CAS network) define mutual relations on the basis of the acquired experience resulting from the operation of the particular system. The Complex Adaptive System has tendency to retain patterns that have proved to be adequate and usable for a further process of self-construction of the order in the system. The factors driving and enabling the connection within the elements of "law-oriented" complex adaptive systems are embodied in common values, principles and methods of interpretation. The paper illustrates the application of the CAS concept by providing the example of convergence among the agreements from the field of Foreign Investments Law (FIL).

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  • Cite Count Icon 13
  • 10.1353/csd.2023.0005
Food Insecurity Among College Students with Disabilities During the COVID-19 Pandemic
  • Jan 1, 2023
  • Journal of College Student Development
  • Krista M Soria + 1 more

Food Insecurity Among College Students with Disabilities During the COVID-19 Pandemic Krista M Soria (bio) and Vanessa Coca (bio) Over the last several years, scholars have drawn attention to the growing rates of food insecurity among college and university students in the US (Broton & Goldrick-Rab, 2018; The Hope Center for College, Community, and Justice [The Hope Center], 2021). Food insecurity is a multifaceted concept commonly defined as the limited availability of nutritious foods, the uncertain ability to acquire nutritious foods, or the inability to acquire nutritious foods (Anderson, 1990). Food insecurity also constitutes interrupted eating patterns or a reduction in the quality of diet due to the lack of resources to access nutritious food (Coleman-Jensen et al., 2020). An estimated 40% of undergraduate students experience food insecurity (The Hope Center, 2021). Although research on food insecurity in college students is expanding, examinations into whether there are different rates of food insecurity by students' demographic characteristics have focused primarily on students' race/ethnicity, age, income or socioeconomic status, and sex or gender (The Hope Center, 2021; Morris et al., 2016; Wood & Harris, 2018). At present, researchers have not focused on food insecurity rates among college students with disabilities. The omission of food insecurity research on college students with disabilities is concerning due to the prevalence of students with disabilities in higher education—nearly one in five undergraduates has a disability (National Center for Education Statistics [NCES], 2021). Due to many forms of oppression, including ableism, racism, classism, and more, students with disabilities encounter more barriers in higher education, leading to reduced degree completion rates (Lett et al., 2020; NCES, 2022). Food insecurity is a factor associated with lower degree completion rates among students and is one of many factors that could exacerbate the existing disparities in degree completion rates (Wolfson et al., 2021). The topic of food insecurity is even more important to examine during the initial semesters of the COVID-19 pandemic when college students experienced significant and sudden financial hardships (Soria et al., 2022; The Hope Center, 2021). Therefore, the purpose of this study was to examine whether college students with disabilities had significantly different odds of experiencing food insecurity compared to their peers when controlling for additional demographic variables and COVID-19 experiences. CONCEPTUAL FRAMEWORK We used Glover and colleagues' (2020) conceptual framework for mitigating the equity harms of COVID-19. The model stipulated [End Page 102] that inequitable COVID-19 policies may have generated additional harms to individuals who were already marginalized, oppressed, and disenfranchised prior to the pandemic, including individuals with disabilities. Exacerbated food insecurity rates among marginalized groups (such as students with disabilities) during the pandemic may be a manifestation of pre-existing intersectional forms of oppression (i.e., ableism, racism) coupled with inequitable COVID-19-related policies. Glover et al. cited demographic variables associated with COVID-19 equity harms, including disability, employment, race/ethnicity, gender, and family education, and we used many of those demographic variables in our analysis. METHODOLOGY: INSTRUMENT, SAMPLE, MEASURES, AND ANALYSIS We used data from the 2020 #RealCollege Survey, which was administered to 1.84 million college students at 130 community and technical colleges and 72 four-year colleges in 42 states from September to November 2020. The response rate averaged 10.6% (N = 195,629), although only a smaller subset of 70,210 students who were also enrolled in spring 2020 answered the COVID-19-specific items (Table 1). The survey assessed students' food security using the U.S. Department of Agriculture's (USDA, 2012) 18-item set of questions (full items and methodology for summing the scale are available online via The Hope Center, 2021). The scale had excellent reliability in this study (α = .924) and can be converted to a four-level measure of food security level (i.e., very low, low, marginal, or high; The Hope Center, 2021). However, we dichotomized the results to provide a snapshot of whether students experienced food insecurity (0 = student is food secure [marginal or high food security], 1 = student is food insecure [very low or low food security]). Students reported demographic characteristics, which we converted using effect coding except in the case of dichotomous variables (e.g., full...

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  • Cite Count Icon 11
  • 10.1108/mrjiam-01-2022-1265
Achieving organizational resilience through complex adaptive systems approach: a conceptual framework
  • Jul 7, 2022
  • Management Research: Journal of the Iberoamerican Academy of Management
  • Hatice Akpinar + 1 more

ObjetivoO ambiente de negócios global gera diferentes problemas que ameaçam a sobrevivência da organização. Como solução relevante, surge o conceito de resiliência organizacional que oferece uma filosofia holística. O conceito de resiliência oferece uma literatura multidisciplinar eclética e é valioso para estudos organizacionais que ajudam a produzir uma grande variedade de soluções, mas há falta de consenso para medir e aplicar resiliência a nível organizacional. Para colmatar esta lacuna, este trabalho oferece a Abordagem Complex Adaptive Systems (CAS) como uma lente para organizações. O objetivo deste estudo é demonstrar que os Sistemas Adaptativos Complexos (CAS) fornecem um conjunto adequado de ferramentas para abordar o conceito de resiliência organizacional, uma vez que tem o potencial de oferecer orientações mais generalizadas.Design/metodologia/abordagemPara atingir este objetivo, esta investigação segue duas fases de revisão sistemática da literatura. Na primeira fase, o objetivo foi procurar em cinco anos (2015–2020) investigar as tendências atuais nos conceitos de resiliência organizacional. Na segunda fase, verifica-se estudos de resiliência organizacional que incluem a abordagem CAS para analisar os procedimentos de alinhamento de dois conceitos.ConclusõesA literatura mostra que o conceito de resiliência organizacional não está ligado a Sistemas Adaptativos Complexos (CAS). Os sistemas adaptativos complexos são mais resistentes através da adaptação e da aprendizagem, pois dependem de interações locais que moldam e co-evoluem juntamente com o seu ambiente dinâmico que ajuda a emergir como auto-organização num futuro imprevisível. Para alcançar a resiliência organizacional, a lente CAS propõe um quadro generalizável aplicável aos estudos organizacionais.OriginalidadeA originalidade do estudo consiste em propor a obtenção de resiliência organizacional através de Sistemas Adaptativos Complexos (CAS) e oferece um quadro conceptual para alcançar a resiliência organizacional.Palavras-chaveResiliência organizacional, Abordagem de sistemas adaptativos complexos (CAS), Revisão sistemática de literatura, Modelo conceptualTipo de manuscritoPapel conceitual

  • Supplementary Content
  • 10.25904/1912/4084
Development of Sustainability Assessment Framework for Sewerage Infrastructure Projects in the Kingdom of Bahrain
  • Feb 17, 2021
  • Griffith Research Online (Griffith University, Queensland, Australia)
  • Ali D Alnoaimi

Sustainable sewerage infrastructure projects are the keys in achieving sustainable development, as such infrastructure directly impacts on all sustainable development initiatives. Throughout its life cycle, a sewerage system faces a number of challenges and threats to its sustained efficiency, including the impact of ageing, aggressive environmental factors, underfunding, inadequate design, and insufficient operation and maintenance activities. These problems may lead to a rise in the risk of failure, including sewage leakage, overflow, discharge and odour issues. These issues can have significant impacts on the environment, public health and safety, the economy and the service lives of the assets, all of which will affect the sustainability of the sewerage system. Despite its importance and serious consequences, very little research has focused on assessing sustainability at the project level, and no research has assessed a sewerage system throughout its life cycle. In Bahrain, the sewerage system presents a notable variety of challenges related to environmental, economic, social and managerial issues that need to be considered in order to attain a sustainable sewerage system. The original contribution of this research is therefore, to develop a framework for assessing the sustainability of the Kingdom of Bahrain’s sewerage infrastructure projects, thereby ensuring their long-term sustainability. The sustainability-assessment framework will focus on all aspects of sustainability throughout a project’s life cycle, setting it apart from most existing frameworks that focus more on the environmental aspect than on the economic and social aspects. The framework will also support the decision-making process throughout the life cycles of the assets. It will also provide greater transparency for stakeholders. The results of this research are important in addressing shortcomings of the sewerage system in the developing counties by providing a framework for the assessment of the sustainability of sewerage projects for the Kingdom of Bahrain and throughout the Arabian Gulf region. Throughout the research for this thesis, several methodologies were adopted to achieve research objectives, including an extensive review of the relevant literature and of the secondary data that were utilized to clarify the research problem. Then, a conceptual sustainability assessment framework was developed; this framework includes sustainability indicators to determine the sustainability of sewerage infrastructure projects. Furthermore, a mixed-methods approach was used to enhance and verify the framework. First in this approach, experts were consulted to improve the developed framework. This stage of the research resulted in the preliminary sustainability indicators that were used in the next stages of framework development. In the second part of the approach, a pilot study was conducted to improve and enrich the survey. The third part included both quantitative and qualitative data collection through an open-ended survey conducted among experts working in the development of sewerage projects in Bahrain. In the fourth part, the collected data were analysed, resulting in the identification of 43 scored sustainability indicators that led to accomplishing the development of the framework. The developed framework has been applied to three case studies in Bahrain, thus demonstrating how it may be applied successfully. These applications outline the process of selecting indicators, identifying weights and scoring the indicators to determine the sustainability index for the different stages of sewerage projects. The decision-support system is built in line with the project life cycle and its associated six stages: 1) current sewerage system, involves identifying and understanding an existing sewerage network; 2) contextualizing a new project according to the sustainability of the wastewater collection system; 3) planning, designing and constructing, which includes addressing sustainability issues in the project; 4) operation and maintenance, which ensures sustainability performance within the project; 5) periodic assessment, which ensures continual, effective sustainability assessment; 6) rehabilitation/ upgrading, which implements the results of the sustainability assessment in the case of rehabilitation or upgrading. A multi-criteria analysis (MCA) methodology has been adopted in the framework, using sustainability criteria and indicators in assessing sewerage projects and providing a sustainability index.

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  • Cite Count Icon 30
  • 10.1017/s0029665123002720
Food banks: Understanding their role in the food insecure population in the UK.
  • Mar 31, 2023
  • Proceedings of the Nutrition Society
  • Rachel Loopstra + 1 more

The present paper reviews the growing body of literature on food insecurity and food bank use in the UK. It provides an overview of food insecurity in this context, followed by a description of the emergence of food banks, highlighting how any role that food banks play in the food insecure population is limited. Data on food insecurity and food bank use suggest many people experiencing food insecurity do not receive help from food banks. To better understand the factors influencing the relationship between food insecurity and food bank use, a conceptual framework is outlined, suggesting the relationship is far from straightforward and contingent on many factors. The nature and availability of food banks and other local support services and individual-level factors influence the likelihood of food banks being used in the context of food insecurity. Then, the extent to which food banks can impact food insecurity is also dependent on the quantity and quality of food distributed, as well as other support services offered from food banks. Closing reflections highlight rising living costs and food banks reporting that they do not have capacity to cope with increasing demand, underscoring the need for policy interventions. Reliance on food banks to respond to food insecurity may ultimately impede formulation of effective policy interventions to reduce food insecurity, giving the illusion of widespread available support, whilst food insecurity persists among those receiving help from food banks and those who experience food insecurity but do not use food banks.

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  • 10.47191/ijsshr/v4-i12-40
Phase Transitions and Bifurcation Points in the Initiation Dynamics of Venture Emergence: A Conceptual Framework
  • Dec 18, 2021
  • International Journal of Social Science and Human Research
  • N S Akilu

Based on isomorphic considerations, this paper attempts to establish an entrepreneur as complex adaptive system, which is one of the concepts that appear prominently in the field of complexity sciences. The attempt to equate the notion of an entrepreneur with the idea of a complex adaptive system, presupposes recognition of the entrepreneur’s role in adaptive agency. Along with this recognition, comes the convenience of contextualizing the concepts of phase transitions and bifurcation points in terms of venture emergence. The dynamics of these concepts are however more commonly explored within the workings of complex or dynamic physical systems. Yet, the broad applicability of the underlying ideas offers the possibility of identifying similar concepts in biological systems and by extension, the field of entrepreneurial cognition and behavior. Thus, the paper adopts an interdisciplinary approach and employs retroductive reasoning in the assemblage of relevant ideas, sought from diverse literary sources. The outcome is a conceptual framework, which presents certain propositions that offer implication for action.

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  • Cite Count Icon 5
  • 10.1007/978-3-540-88203-9_13
Visualization of Sustainability Indicators: A Conceptual Framework
  • Jan 1, 2009
  • Ray Quay + 1 more

Due to complex, interwoven entities in the science of sustainability, an effective strategic approach that allows issues to be examined from various angles is needed to successfully integrate sustainability into public policy processes. Indicators can be an effective method for providing simple assessments of sustainability, however, there has been little research of indicator organization or visualization techniques to meet the unique information needs of public decision makers. There are numerous models for defining and organizing sustainability indicators but only a few provide defined methods of weighting and aggregation. There is also much published work on developing visualization methods and tools for decision making. However there is little research on how sustainable indicator visualization systems can be structured to meet the specific information needs of public decision makers as they address a wide range of issues at various spatial and functional scales. This article examines the current sustainability indicator and relevant visualization literature and proposes a theoretical organization and visualization framework for sustainability indicator data that blends data organization with flexible and simple information visualization.KeywordsSustainability Indicators (SI)Visual FrameworkPublic Decision MakersTheoretical OrganizationHuman Welfare IndicatorThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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  • Research Article
  • Cite Count Icon 2
  • 10.3389/fcdhc.2022.947552
Unpacking determinants and consequences of food insecurity for insulin resistance among people living with HIV: Conceptual framework and protocol for the NOURISH-OK study
  • Jan 1, 2022
  • Frontiers in Clinical Diabetes and Healthcare
  • Marianna S Wetherill + 10 more

BackgroundOver the past four decades, advances in HIV treatment have contributed to a longer life expectancy for people living with HIV (PLWH). With these gains, the prevention and management of chronic co-morbidities, such as diabetes, are now central medical care goals for this population. In the United States, food insecurity disproportionately impacts PLWH and may play a role in the development of insulin resistance through direct and indirect pathways. The Nutrition to Optimize, Understand, and Restore Insulin Sensitivity in HIV for Oklahoma (NOURISH-OK) will use a novel, multi-level, integrated framework to explore how food insecurity contributes to insulin resistance among PLWH. Specifically, it will explore how food insecurity may operate as an intermediary risk factor for insulin resistance, including potential linkages between upstream determinants of health and downstream consequences of poor diet, other behavioral risk factors, and chronic inflammation.Methods/designThis paper summarizes the protocol for the first aim of the NOURISH-OK study, which involves purposeful cross-sectional sampling of PLWH (n=500) across four levels of food insecurity to test our conceptual framework. Developed in collaboration with community stakeholders, this initial phase involves the collection of anthropometrics, fasting blood samples, non-blood biomarkers, 24-hour food recall to estimate the Dietary Inflammatory Index (DII®) score, and survey data. A 1-month, prospective observational sub-study (total n=100; n=25 for each food security group) involves weekly 24-hour food recalls and stool samples to identify temporal associations between food insecurity, diet, and gut microbiome composition. Using structural equation modeling, we will explore how upstream risk factors, including early life events, current discrimination, and community food access, may influence food insecurity and its potential downstream impacts, including diet, other lifestyle risk behaviors, and chronic inflammation, with insulin resistance as the ultimate outcome variable. Findings from these analyses of observational data will inform the subsequent study aims, which involve qualitative exploration of significant pathways, followed by development and testing of a low-DII® food as medicine intervention to reverse insulin resistance among PLWH (ClinicalTrials.gov Identifier: NCT05208671).DiscussionThe NOURISH-OK study will address important research gaps to inform the development of food as medicine interventions to support healthy aging for PLWH.

  • Supplementary Content
  • 10.17638/03070338
Creating an agile ethics and ethical compliance consulting practice in Ontario's automotive retail industry
  • Dec 31, 2019
  • University of Liverpool
  • Femi Jegede

This doctoral thesis is centered around an Action Research inquiry aimed at revamping the ethics advisory practice at Dealers R’Us Ltd., an automotive management consulting firm located in Ontario, Canada. The inquiry occurred in four phases and over two action cycles. In Phase I, a semi-structured questionnaire administered to eighty automotive dealers and salespeople at four client organizations suggested that the firm’s ethics consulting practice was not adaptive to varied situational contexts and unpredictable changes in the regulatory domain. This resulted in abysmal ethical compliance rates, regulatory fines, and general client dissatisfaction. A thematic analysis of open-ended responses provided by respondents yielded five broad themes - knowledge gaps, organizational structure, interpersonal relationships, internal collaboration, and service design. The objective of this interventive research is to create an agile ethics advisory practice through the generation of actionable knowledge that addresses the aforementioned thematic angles. By leveraging the emancipatory capacity of social constructivism in Phase II, an internal focus group comprising of fifteen stakeholders, utilized Soft System Methodology, an Action Research approach to elucidate the organizational problem. The structured inquiry culminated in the first cycle of remedial actions with implications for the firm’s personnel, internal politics, corporate structure, and go-to-market strategy. In Phase III, organizational outcomes were validated internally and externally through the reflexive analysis of data collected with semi-structured questionnaires and focus group interviews in the post-intervention era. Open-ended responses were explored using thematic analysis. Due to the small size of the firm, a total population sampling strategy was adopted within the organization encompassing all twenty internal stakeholders. Critical case data sampling was carried out at a representative client site in a test case ethical compliance consulting project that involved twenty-eight external stakeholders. In the post-intervention survey, 87% of the external respondents agreed that Dealers R’Us’ ethics and ethical compliance program became responsive to varied and evolving ethical compliance needs in Ontario’s automotive retail industry. In contrast, only 16% of survey respondents agreed with the same statement in the pre-intervention phase. This outcome resulted from a reduction in consultant knowledge gaps; a transition from a hierarchical functional organizational structure to a matrix structure comprised of interdisciplinary teams; a deliberate focus on improving interpersonal relationships between consultants; the equalization of power within the firm and a service redesign effort that entailed the field colocation of interdisciplinary teams. In Phase IV, this outcome informed a second action cycle geared towards an entrenchment of the transformative research agenda. Based on agreements in management literature, I conceptualized agility using ideas from Complex Adaptive Systems (CAS) theory including self-organization and spontaneous emergence. Other applied theories include Social Identity Theory and Contingency Theory. The results obtained challenge the traditional approach to ethics consulting. They inspired the development and recommendation of a Conceptual Framework for Agile Ethics Consulting to the firm. This original contribution to ethics advisory practice and consulting literature codifies relevant agility drivers, enablers, capabilities and practices. Foundational recommendations border on data proximity, selective contingency, the establishment of active feedback loops, incremental solution execution; the attainment of a common internal identity and the incentivization of strong interpersonal bonds within the firm. For automotive dealerships, this inquiry provides accessibility to custom-tailored ethical compliance programs, higher compliance rates and the mitigation of risks and liabilities resulting from non-compliance. In a reflective manner, I draw conclusions on the post-intervention status of the ethics practice under review based on CAS theory metrics. In addition to taking stock of my scholar-practitioner experience, I also discuss transitions in my leadership philosophy. The small size of Dealers R’Us translates into a relatively small sample size. This is a research limitation that must be considered when interpreting the outcomes of this research. The collection of data from external sources at different intervals and the utilization of multiple dialectics afforded by Soft System Methodology helped to seek out disconfirming evidence and mitigate this limitation. The infancy of the proposed conceptual framework makes it an appropriate target for future research and validation.

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