Development of a Psychosocial Risk Screener for Siblings of Children With Cancer: Incorporating the Perspectives of Parents.

Objective: Although many siblings experience distress after a child's cancer diagnosis, their psychosocial functioning is seldom assessed in clinical oncology settings. One barrier to systematic sibling screening is the lack of a validated, sibling-specific screening instrument. Thus, this study developed sibling-specific screening modules in English and Spanish for the Psychosocial Assessment Tool (PAT), a well-validated screener of family psychosocial risk. Methods: A purposive sample of English- and Spanish-speaking parents of children with cancer (N = 29) completed cognitive interviews to provide in-depth feedback on the development of the new PAT sibling modules. Interviews were transcribed verbatim, cleaned, and analyzed using applied thematic analysis. Items were updated iteratively according to participants' feedback. Data collection continued until saturation was reached (i.e., all items were clear and valid). Results: Two sibling modules were developed to assess siblings' psychosocial risk at diagnosis (preexisting risk factors) and several months thereafter (reactions to cancer). Most prior PAT items were retained; however, parents recommended changes to improve screening format (separately assessing each sibling within the family and expanding response options to include "sometimes"), developmental sensitivity (developing or revising items for ages 0-2, 3-4, 5-9, and 10+ years), and content (adding items related to sibling-specific social support, global assessments of sibling risk, emotional/behavioral reactions to cancer, and social ecological factors such as family and school). Conclusions: Psychosocial screening requires sibling-specific screening items that correspond to preexisting risk (at diagnosis) and reactions to cancer (several months after diagnosis). Validated, sibling-specific screeners will facilitate identification of siblings with elevated psychosocial risk.

Sustainability assessment and prioritisation of bottom ash management in Macao.

In Macao, about 7200 t yr-1 of bottom ash (BA) is generated and conventionally landfilled with construction waste. Because the properties of BA are similar to those of natural aggregates, it is suitable to be recycled as construction material. However, pre-treatment processes for BA reuse may require more resource input and may generate additional environmental impacts. Life cycle assessment, multi-media transport model analysis, cost-benefit analysis and the analytical hierarchy process were conducted to evaluate the impacts of current and potential BA management scenarios regarding environmental, economic, social and regulatory aspects. The five analysed scenarios are as follows: (0) BA buried with construction and demolition waste (current system); (1) pre-treated BA used to replace 25% of the natural aggregate in asphalt concrete; (2) pre-treated BA used to replace 25% of the natural aggregate in cement concrete; (3) pre-treated BA used to replace 25% of cement in cement concrete; and (4) pre-treated BA sent to China, blended with municipal solid waste for landfill. The results reveal the following ranking of the scenarios: 3 > 2 > 0 > 1 > 4. Scenario 3 shows the best conditions for BA recycling, because the quantity of cement concrete output is the highest and this brings the greatest economic benefits. Our use of integrated analysis provides multi-aspect investigations for BA management systems, particularly in accounting for site-specific characteristics. This approach is suitable for application in other non-western regions.