Development and evaluation of a program to improve clinician and patient communication during a telehealth consultation : C.R.I.S.P. Telehealth

Introduction: The delivery of health care in the 21st century will look like no other in the past. The fast paced technological advances that are being made will need to transition from the information age into clinical practice. The phenomenon of e-Health is the over-arching form of information technology and telehealth is one arm of that phenomenon. The uptake of telehealth both in Australia and overseas, has changed the face of health service delivery to many rural and remote communities for the better, removing what is known as the tyranny of distance. Many studies have evaluated the satisfaction and cost-benefit analysis of telehealth across the organisational aspects as well as the various adaptations of clinical pathways and this is the predominant focus of most studies published to date. However, whilst comments have been made by many researchers about the need to improve and attend to the communication and relationship building aspects of telehealth no studies have examined this further. The aim of this study was to identify the patient and clinician experiences, concerns, behaviours and perceptions of the telehealth interaction and develop a training tool to assist these clinicians to improve their interaction skills. Methods: A mixed methods design combining quantitative (survey analysis and data coding) and qualitative (interview analysis) approaches was adopted. This study utilised four phases to firstly qualitatively explore the needs of clients (patients) and clinicians within a telehealth consultation then designed, developed, piloted and quantitatively and qualitatively evaluated the telehealth communication training program. Qualitative data was collected and analysed during Phase 1 of this study to describe and define the missing 'communication and rapport building' aspects within telehealth. This data was then utilised to develop a self-paced communication training program that enhanced clinicians existing skills, which comprised of Phase 2 of this study to develop the interactive program. Phase 3 included evaluating the training program with 26 clinicians and results were recorded pre and post training, whilst phase 4 was the pilot for future recommendations of this training program using a patient group within a Queensland Health setting at two rural hospitals. Results: Comparisons of pre and post training data on 1) Effective communication styles, 2) Involvement in communication training package, 3) satisfaction pre and post training, and 4) health outcomes pre and post training indicated that there were differences between pre and post training in relation to effective communication style, increased satisfaction and no difference in health outcomes between pre and post training for this patient group. The post training results revealed over half of the participants (N= 17, 65%) were more responsive to non-verbal cues and were better able to reflect and respond to looks of anxiousness and confusion from a 'patient' within a telehealth consultation. It was also found that during post training evaluations, clinicians had enhanced their therapeutic communication with greater detail to their own body postures, eye contact and presentation. There was greater time spent looking at the 'patient' with an increase of 35 second intervals of direct eye contact and less time spent looking down at paperwork which decreased by 20 seconds. Overall 73% of the clinicians were satisfied with the training program and 61% strongly agreed that they recognised areas of their communication that needed improving during a telehealth consultation. For the patient group there was significant difference post training in rapport with a mean score from 42 (SD = 28, n = 27) to 48 (SD = 5.9, n = 24). For communication comfort of the patient group there was a significant difference between the pre and post training scores t(10) = 27.9, p = .002, which meant that overall the patients felt less inhibited whilst talking to the clinicians and more understood. Conclusion: The aim of this study was to explore the characteristics of good patient-clinician communication and unmet training needs for telehealth consultations. The study developed a training program that was specific for telehealth consultations and not dependent on a 'trainer' to deliver the content. In light of the existing literature this is a first of its kind and a valuable contribution to the research on this topic. It was found that the training program was effective in improving the clinician's communication style and increased the satisfaction of patient's within an e-health environment. This study has identified some historical myths that telehealth cannot be part of empathic patient centred care due to its technology tag.

A new era : personal technology challenges educational technology

As we race towards a new era, rapid change of conventional models has become the norm. Just as technology has etched itself to the core of society, the sheer quantity of student devices connecting to university networks presents a sector wide challenge coinciding almost perfectly with many universities creating technology rich learning spaces. New fears include future proofing. It is not just a matter of technology becoming outdated. In seeking to accommodate the teaching styles and experience of staff across diverse faculties, is this technology simply too vanilla to meet their needs as they become increasingly skilled and inspired by technology’s potential? Through the early findings of a study into staff use of technology within Queensland University of Technology's next generation collaborative learning spaces, this paper explores whether the answers lie in a model presented by students equipping themselves with the tools they need to learn in the 21st century.

The health effects of temperature : current estimates, future projections, and adaptation strategies

Climate change is expected to be one of the biggest global health threats in the 21st century. In response to changes in climate and associated extreme events, public health adaptation has become imperative. This thesis examined several key issues in this emerging research field. The thesis aimed to identify the climate-health (particularly temperature-health) relationships, then develop quantitative models that can be used to project future health impacts of climate change, and therefore help formulate adaptation strategies for dealing with climate-related health risks and reducing vulnerability. The research questions addressed by this thesis were: (1) What are the barriers to public health adaptation to climate change? What are the research priorities in this emerging field? (2) What models and frameworks can be used to project future temperature-related mortality under different climate change scenarios? (3) What is the actual burden of temperature-related mortality? What are the impacts of climate change on future burden of disease? and (4) Can we develop public health adaptation strategies to manage the health effects of temperature in response to climate change? Using a literature review, I discussed how public health organisations should implement and manage the process of planned adaptation. This review showed that public health adaptation can operate at two levels: building adaptive capacity and implementing adaptation actions. However, there are constraints and barriers to adaptation arising from uncertainty, cost, technologic limits, institutional arrangements, deficits of social capital, and individual perception of risks. The opportunities for planning and implementing public health adaptation are reliant on effective strategies to overcome likely barriers. I proposed that high priorities should be given to multidisciplinary research on the assessment of potential health effects of climate change, projections of future health impacts under different climate and socio-economic scenarios, identification of health cobenefits of climate change policies, and evaluation of cost-effective public health adaptation options. Heat-related mortality is the most direct and highly-significant potential climate change impact on human health. I thus conducted a systematic review of research and methods for projecting future heat-related mortality under different climate change scenarios. The review showed that climate change is likely to result in a substantial increase in heatrelated mortality. Projecting heat-related mortality requires understanding of historical temperature-mortality relationships, and consideration of future changes in climate, population and acclimatisation. Further research is needed to provide a stronger theoretical framework for mortality projections, including a better understanding of socioeconomic development, adaptation strategies, land-use patterns, air pollution and mortality displacement. Most previous studies were designed to examine temperature-related excess deaths or mortality risks. However, if most temperature-related deaths occur in the very elderly who had only a short life expectancy, then the burden of temperature on mortality would have less public health importance. To guide policy decisions and resource allocation, it is desirable to know the actual burden of temperature-related mortality. To achieve this, I used years of life lost to provide a new measure of health effects of temperature. I conducted a time-series analysis to estimate years of life lost associated with changes in season and temperature in Brisbane, Australia. I also projected the future temperaturerelated years of life lost attributable to climate change. This study showed that the association between temperature and years of life lost was U-shaped, with increased years of life lost on cold and hot days. The temperature-related years of life lost will worsen greatly if future climate change goes beyond a 2 °C increase and without any adaptation to higher temperatures. The excess mortality during prolonged extreme temperatures is often greater than the predicted using smoothed temperature-mortality association. This is because sustained period of extreme temperatures produce an extra effect beyond that predicted by daily temperatures. To better estimate the burden of extreme temperatures, I estimated their effects on years of life lost due to cardiovascular disease using data from Brisbane, Australia. The results showed that the association between daily mean temperature and years of life lost due to cardiovascular disease was U-shaped, with the lowest years of life lost at 24 °C (the 75th percentile of daily mean temperature in Brisbane), rising progressively as temperatures become hotter or colder. There were significant added effects of heat waves, but no added effects of cold spells. Finally, public health adaptation to hot weather is necessary and pressing. I discussed how to manage the health effects of temperature, especially with the context of climate change. Strategies to minimise the health effects of high temperatures and climate change can fall into two categories: reducing the heat exposure and managing the health effects of high temperatures. However, policy decisions need information on specific adaptations, together with their expected costs and benefits. Therefore, more research is needed to evaluate cost-effective adaptation options. In summary, this thesis adds to the large body of literature on the impacts of temperature and climate change on human health. It improves our understanding of the temperaturehealth relationship, and how this relationship will change as temperatures increase. Although the research is limited to one city, which restricts the generalisability of the findings, the methods and approaches developed in this thesis will be useful to other researchers studying temperature-health relationships and climate change impacts. The results may be helpful for decision-makers who develop public health adaptation strategies to minimise the health effects of extreme temperatures and climate change.

Educating for digital futures : what the learning strategies of digital content professionals can teach higher education

Beginning in the second half of the 20th century, ICTs transformed many societies from industrial societies in which manufacturing was the central focus, into knowledge societies in which dealing effectively with data and information has become a central element of work (Anderson, 2008). To meet the needs of the knowledge society, universities must reinvent their structures and processes, their curricula and pedagogic practices. In addition to this, of course higher education is itself subject to the sweeping influence of ICTs. But what might effective higher education look like in the 21st century? In designing higher education systems and learning experiences which are responsive to the learning needs of the future and exploit the possibilities offered by ICTs, we can learn much from the existing professional development strategies of people who are already successful in 21st century fields, such as digital media. In this study, I ask: (1) what are the learning challenges faced by digital media professionals in the 21st century? (2) what are the various roles of formal and informal education in their professional learning strategies at present? (3) how do they prefer to acquire needed capabilities? In-depth interviews were undertaken with successful Australian digital media professionals working in micro businesses and SMEs to answer these questions. The strongest thematic grouping that emerged from the interviews related to the need for continual learning and relearning because of the sheer rate of change in the digital media industries. Four dialectical relationships became apparent from the interviewees’ commentaries around the learning imperatives arising out of the immense and continual changes occurring in the digital content industries: (1) currency vs best practice (2) diversification vs specialisation of products and services (3) creative outputs vs commercial outcomes (4) more learning opportunities vs less opportunity to learn. These findings point to the importance of ‘learning how to learn’ as a 21st century capability. The interviewees were ambivalent about university courses as preparation for professional life in their fields. Higher education was described by several interviewees as having relatively little value-add beyond what one described as “really expensive credentialling services.” For all interviewees in this study, informal learning strategies were the preferred methods of acquiring the majority of knowledge and skills, both for ongoing and initial professional development. Informal learning has no ‘curriculum’ per se, and tends to be opportunistic, unstructured, pedagogically agile and far more self-directed than formal learning (Eraut, 2004). In an industry impacted by constant change, informal learning is clearly both essential and ubiquitous. Inspired by the professional development strategies of the digital media professionals in this study, I propose a 21st century model of the university as a broad, open learning ecology, which also includes industry, professionals, users, and university researchers. If created and managed appropriately, the university learning network becomes the conduit and knowledge integrator for the latest research and industry trends, which students and professionals alike can access as needed.

A grand challenge : reflecting on university science curriculum design, collaborative partnerships and integration of information literacy skills

In 2012, Queensland University of Technology (QUT) committed to the massive project of revitalizing its Bachelor of Science (ST01) degree. Like most universities in Australia, QUT has begun work to align all courses by 2015 to the requirements of the updated Australian Qualifications Framework (AQF) which is regulated by the Tertiary Education Quality and Standards Agency (TEQSA). From the very start of the redesigned degree program, students approach scientific study with an exciting mix of theory and highly topical real world examples through their chosen “grand challenge.” These challenges, Fukushima and nuclear energy for example, are the lenses used to explore science and lead to 21st century learning outcomes for students. For the teaching and learning support staff, our grand challenge is to expose all science students to multidisciplinary content with a strong emphasis on embedding information literacies into the curriculum. With ST01, QUT is taking the initiative to rethink not only content but how units are delivered and even how we work together between the faculty, the library and learning and teaching support. This was the desired outcome but as we move from design to implementation, has this goal been achieved? A main component of the new degree is to ensure scaffolding of information literacy skills throughout the entirety of the three year course. However, with the strong focus on problem-based learning and group work skills, many issues arise both for students and lecturers. A move away from a traditional lecture style is necessary but impacts on academics’ workload and comfort levels. Therefore, academics in collaboration with librarians and other learning support staff must draw on each others’ expertise to work together to ensure pedagogy, assessments and targeted classroom activities are mapped within and between units. This partnership can counteract the tendency of isolated, unsupported academics to concentrate on day-to-day teaching at the expense of consistency between units and big picture objectives. Support staff may have a more holistic view of a course or degree than coordinators of individual units, making communication and truly collaborative planning even more critical. As well, due to staffing time pressures, design and delivery of new curriculum is generally done quickly with no option for the designers to stop and reflect on the experience and outcomes. It is vital we take this unique opportunity to closely examine what QUT has and hasn’t achieved to be able to recommend a better way forward. This presentation will discuss these important issues and stumbling blocks, to provide a set of best practice guidelines for QUT and other institutions. The aim is to help improve collaboration within the university, as well as to maximize students’ ability to put information literacy skills into action. As our students embark on their own grand challenges, we must challenge ourselves to honestly assess our own work.

Developing sustainable ‘liveable’ buildings, cities and communities for a sub-tropical context : residents’ perspectives

A key challenge for the 21st Century is to make our cities more liveable and foster economically sustainable, environmentally responsible, and socially inclusive communities. Design thinking, particularly a human-centred approach, offers a way to tackle this challenge. Findings from two recent Australian research projects highlight how facilitating sustainable, liveable communities in a humid sub-tropical environment requires an in-depth understanding of people’s perspectives, experiences and practices. Project 1 (‘Research House’) documents the reflections of a family who lived in a ‘test’ sustainable house for two years, outlining their experience and evaluations of universal design and sustainable technologies. The study family was very impressed with the natural lighting, natural ventilation, spaciousness and ease of access, which contributed significantly to their comfort and the liveability of their home. Project 2 (‘Inner-Urban High Density Living’) explored Brisbane residents’ opinions about high-density living, through a survey (n=636), interviews (n=24), site observations (over 300 hours) and environmental monitoring, assessing opinions on the liveability of their individual dwelling, the multi-unit host building and the surrounding neighbourhood. Nine areas, categorised into three general domains, were identified as essential for enhancing high density liveability. In terms of the dwelling, thermal comfort/ventilation, natural light, noise mitigation were important; shared space, good neighbour protocols, and support for environmentally sustainable behaviour were desired in the building/complex; and accessible/sustainable transport, amenities and services, sense of community were considered important in the surrounding neighbourhood. Combined, these findings emphasise the importance and complexity associated with designing liveable building, cities and communities, illustrating how adopting a design thinking, human-centred approach will help create sustainable communities that will meet the needs of current and future generations.

Empirical approaches in knowledge city research

In the 21st century, it has become apparent that ‘knowledge’ is a major factor of postmodern production (Yigitcanlar et al., 2007). Beyond this, in today’s rapidly globalizing world, knowledge, along with the social and technological settings, is seen as a key to secure economic prosperity and quality of life (Yigitcanlar et al., 2008a). However, limiting the benefits of a ‘knowledge-based development’ to only economic gains—and to a degree to social ones—is quite a narrow sighted view (Yigitcanlar et al., 2008b). Thus, the concept of ‘knowledge-based urban development’ is coined to bring economic prosperity, environmental sustainability, a just socio-spatial order and good governance to cities, and as a result producing a purposefully designed city—i.e., ‘knowledge city’—generating positive environmental and governance outcomes as well as economic and societal ones (Yigitcanlar, 2011; Carrillo et al., 2014).

Lifestyle Journalism

Lifestyle journalism has experienced enormous growth in the media over the past two decades, but scholars in the fields of journalism and communication studies have so far paid relatively little attention to a field that is still sometimes seen as “not real journalism”. There is now an urgent need for in-depth exploration and contextualisation of this field, with its increasing relevance for 21st century consumer cultures. For the first time, this book presents a wide range of studies which have engaged with the field of lifestyle journalism in order to outline the various political, economic, social and cultural tensions within it. Taking a comparative view, the collection includes studies covering four continents, including countries such as Australia, China, Norway, Denmark, Singapore, the UK and the USA. While keeping the broader lifestyle field in mind, the chapters focus on a variety of sub-fields such as travel, music, food, health, fashion and personal technology journalism. This volume provides a fascinating account of the different facets of lifestyle journalism, and charts the way forward for a more sustained analysis of the field. This book was originally published as a special issue of Journalism Practice.

A discussion of “Estimating the historical and future probabilities of large terrorist events'' by Aaron Clauset and Ryan Woodard

The terrorist attacks in the United States on September 11, 2001 appeared to be a harbinger of increased terrorism and violence in the 21st century, bringing terrorism and political violence to the forefront of public discussion. Questions about these events abound, and “Estimating the Historical and Future Probabilities of Large Scale Terrorist Event” [Clauset and Woodard (2013)] asks specifically, “how rare are large scale terrorist events?” and, in general, encourages discussion on the role of quantitative methods in terrorism research and policy and decision-making. Answering the primary question raises two challenges. The first is identify- ing terrorist events. The second is finding a simple yet robust model for rare events that has good explanatory and predictive capabilities. The challenges of identifying terrorist events is acknowledged and addressed by reviewing and using data from two well-known and reputable sources: the Memorial Institute for the Prevention of Terrorism-RAND database (MIPT-RAND) [Memorial Institute for the Prevention of Terrorism] and the Global Terror- ism Database (GTD) [National Consortium for the Study of Terrorism and Responses to Terrorism (START) (2012), LaFree and Dugan (2007)]. Clauset and Woodard (2013) provide a detailed discussion of the limitations of the data and the models used, in the context of the larger issues surrounding terrorism and policy.

Standards and Research in Geographical Education: Current Trends and International Issues

What is the state of geographical education in the second decade of the 21st century? This volume presents a selection of peer reviewed papers presented at the 2012 Cologne Congress of the International Geographical Union (IGU) sessions on Geographical Education as representative of current thinking in the area. It then presents (perhaps for the first time) a cross-case analysis of the common factors of all these papers as a current summary of the “state of the art” of geographical education today. The primary aim of the individual authors as well as the editors is not only to record the current state of the art of geographical education but also to promote ongoing discussions of the longer term health and future prospects of international geographical education. We wish to encourage ongoing debate and discussion amongst local, national, regional and international education journals, conferences and discussion groups as part of the international mission of the Commission on Geographical Eduction. While the currency of these chapters in terms of their foci, breadth and recency of the theoretical literature on which they are based and the new research findings they present justifies considerable confidence in the current health of geographical education as an educational and research endeavour, each new publication should only be the start of new scholarly inquiry. Where should we, as a scholarly community, place our energies for the future? If readers are left with a new sense of direction, then the aims of the authors and editors will have been amply met.

Acoustic, electric and virtual noise : the cultural identity of the guitar

Guitar technology underwent significant changes in the 20th century in the move from acoustic to electric instruments. In the first part of the 21st century, the guitar continues to develop through its interaction with digital technologies. Such changes in guitar technology are usually grounded in what we might call the "cultural identity" of the instrument: that is, the various ways that the guitar is used to enact, influence and challenge sociocultural and musical discourses. Often, these different uses of the guitar can be seen to reflect a conflict between the changing concepts of "noise" and "musical sound."

Equal access to the opportunities available? Equity and diversity laws and policies in Australia

Australia has been populated for more than 40,000 years with Indigenous Australians joined by European settlers only 230 years ago. The first settlers consisted of convicts from more than 28 countries and members of the British army who arrived in 1788 to establish a British penal colony. Mass migration in the nineteenth century with one and a half million immigrants from Europe, principally from the United Kingdom and Ireland (Haines and Shlomowitz, 1992), established the continent as an Anglo society in the Pacific. In the twentieth century immigrants came from many European countries and in the latter decades from many parts of Asia and the Middle East (Collins, 1991, pp.10-13). In the 21st century Australia has an ethnically and culturally diverse population. The original Indigenous population of Australia accounts for approximately 460,000 or 2.5 per cent of the total population (ABS, 2006a). Estimates are that around 4.5m. persons in the population (close to 20 per cent), were born outside Australia with the majority of these arriving from Europe, principally the United Kingdom, and New Zealand (ABS, 2006b). Like many other countries, Australia has a legacy of discrimination and inequality in employment. Propelled by racist ideologies and the male breadwinner ideology, Indigenous Australians, and non-European immigrants, and women were barred from certain jobs and paid less for their work than any white male counterpart. These conditions were legally sanctioned through the industrial relations system and other laws in the nineteenth and first half of the twentieth century. Since the 1960s a dramatic change has occurred in social policy and national legislation and Australia today has an extensive array of laws which forbid employment discrimination on race, ethnicity, gender and many other characteristics, and other approaches which promote proactive organizational plans and actions to achieve equity in employment. This chapter outlines these developments.

Context-resonant systems perspectives in career theory

"The focus of this chapter is on context-resonant systems perspectives in career theory and their implications for practice in diverse cultural and contextual settings. For over two decades, the potential of systems theory to offer a context-resonant approach to career development has been acknowledged. Career development theory and practice, however, have been dominated for most of their history by more narrowly defined theories informed by a trait-and-factor tradition of matching the characteristics of individuals to occupations. In contrast, systems theory challenges this parts-in-isolation approach and offers a response that can accommodate the complexity of both the lives of individuals and the world of the 21st century by taking a more holistic approach that considers individuals in context. These differences in theory and practice may be attributed to the underlying philosophies that inform them. For example, the philosophy informing the trait-and-factor theoretical position, logical positivism, places value on: studying individuals in isolation from their environments; content over process; facts over feelings; objectivity over subjectivity; and views individual behavior as observable, measurable, and linear. In practice, this theory base manifests in expert-driven practices founded on the assessment of personal traits such as interests, personality, values, or beliefs which may be matched to particular occupations. The philosophy informing more recent theoretical positions, constructivism, places value on: studying individuals in their contexts; making meaning of experience through the use of subjective narrative accounts; and a belief in the capacity of individuals known as agency. In practice, this theory base manifests in practices founded on collaborative relationships with clients, narrative approaches, and a reduced emphasis on expert-driven linear processes. Thus, the tenets of constructivism which inform the systems perspectives in career theory are context-resonant. Systems theory stresses holism where the interconnectedness of all elements of a system is considered. Systems may be open or closed. Closed systems have no relationship with their external environment whereas open systems interact with their external environment and are open to external influence which is necessary for regeneration. Congruent with general systems theory, the systems perspectives emerging within career theory are based on open systems. Such systems are complex and dynamic and comprise many elements and subsystems which recursively interact with each other as well as with influences from the surrounding environment. As elements of a system should not be considered in isolation, a systems approach is holistic. Patterns of behavior are found in the relationships between the elements of dynamic systems. Because of the multiplicity of relationships within and between elements of subsystems, the possibility of linear causal explanations is reduced. Story is the mechanism through which the relationships and patterns within systems are recounted by individuals. Thus the career guidance practices emanating from theories informed by systems perspectives are inherently narrative in orientation. Narrative career counseling encourages career development to be understood from the subjective perspective of clients. The application of systemic thinking in practice takes greater account of context. In so doing, practices informed by systems theory may facilitate relevance to a diverse client group in diverse settings. In a world that has become increasingly global and diverse it seems that context-resonant systems perspectives in career theory are essential to ensure the future of career development. Translating context-resonant systems perspectives into practice offers important possibilities for methods and approaches that are respectful of diversity."--publisher website

Questions of Science [third edition]

Table of Contents Timeline of Thinkers Timeline of Thoughts Evolution of Science Chapter 1. Introduction Chapter 2. Humans: the measure of all things Chapter 3. Men with beards: long beards Chapter 4. I doubt it Chapter 5. With good reason Chapter 6. Here be dragons Chapter 7. Stirrings of science Chapter 8. Degrees of separation Chapter 9. The Greek legacy Chapter 10. A scientific focus Chapter 11. Questions of science Chapter 12. Creatures of habit Chapter 13. A scientific method Chapter 14. Outside the square Chapter 15. Probably Chapter 16. Human, all too human Chapter 17. Cultures of science Chapter 18. 21st Century Science Chapter 19. Science in question Chapter 20. How do we know? Chapter 21. Sources

Factor Five : Transforming the Global Economy through 80% Improvements in Resource Productivity

The 21st century will see monumental change. Either the human race will use its knowledge and skills and change the way it interacts with the environment, or the environment will change the way it interacts with its inhabitants. In the first case, the focus of this book, we would see our sophisticated understanding in areas such as physics, chemistry, engineering, biology, planning, commerce, business and governance accumulated over the last 1,000 years brought to bear on the challenge of dramatically reducing our pressure on the environment. The second case however is the opposite scenario, involving the decline of the planet’s ecosystems until they reach thresholds where recovery is not possible, and following which we have no idea what happens. For instance, if we fail to respond to Sir Nicolas Stern’s call to meet appropriate stabilisation trajectories for greenhouse gas emissions, and we allow the average temperature of our planets surface to increase by 4-6 degrees Celsius, we will see staggering changes to our environment, including rapidly rising sea level, withering crops, diminishing water reserves, drought, cyclones, floods… allowing this to happen will be the failure of our species, and those that survive will have a deadly legacy. In this update to the 1997 International Best Seller, Factor Four, Ernst von Weizsäcker again leads a team to present a compelling case for sector wide advances that can deliver significant resource productivity improvements over the coming century. The purpose of this book is to inspire hope and to then inform meaningful action in the coming decades to respond to the greatest challenge our species has ever faced – that of living in harmony with our planet and its other inhabitants.