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Every scientific or intellectual movement rests on central premises and assumptions that shape its philosophy. The purpose of this study is to review a brief account of the main philosophical bases of grey systems theory (GST) and the paradigm governing its principles. So, the recent studies on the philosophical foundations of GST have been reviewed and tried to pay attention to some key ambiguities in the previous studies and give more and clearer explanations in this paper. Also, this paper tries to fill the gap among the previous studies and to provide a purposeful connection between them by expressing two key concepts: complete information and imbalance knowledge. Primarily, the study addresses the theoretical foundations of uncertainty and the concept of greyness. Next, it focuses on the notion of "complete information" and challenges to it. Then, it reviews such processes as perception, cognition, and understanding, as well as their dynamic nature. It explains how knowledge is produced through understanding and interpreting information/data and the dynamics governing the whole process. Also, the study describes any dataset, no matter how large it may be, will remain incomplete, imperfect, and grey, so humans only rely on incomplete datasets to interpret the world. As such, information and knowledge are always grey and uncertain because they are basically contingent on subjective understandings and interpretations and imperfect inputs and data. Finally, as a key development, this study also demonstrates that human grey knowledge remains imbalanced across different disciplines and spheres. In the end, a brief overview of the philosophical paradigm of GST is also provided. GST is depicted as an anti-realistic, anti-positivistic, and non-deterministic approach, which is inherently pluralistic and ideographic. According to GST principles, dynamicity and change are essential parts of human narratives of the world and systems, and human knowledge is constantly reproduced through collecting new information. As a result, knowledge, theories, narratives, and scientific laws dynamically change. Given this premise, one could argue that GST is considerably compatible with the postulates of post-modern thinking. [ABSTRACT FROM AUTHOR]

The complex relationship between water, energy, food, and ecological systems, known as the WEFE nexus, has emerged as a major topic in the debate about sustainable economic development and resource management. This subject is of special interest in Mediterranean coastal areas as rapid economic expansion driven by population growth, higher influx of tourists, and intensification of agriculture is leading to structural water scarcity conditions. However, addressing the diverse range of issues associated with the nexus is a difficult task due to the existence of intricate interconnections, interdependencies, and nonlinearities within and across its various components. Accordingly, this case study applies a combination of participatory systems modeling and network analysis tools to yield insights into the complexity of this nexus in Axarquia, a region with features that make it an example of water-stressed jurisdictions in the Mediterranean. Overall, our results provide a strong foundation to understand the dynamics that govern this nexus in regions where the availability of freshwater resources is a significant concern. Furthermore, they lay the groundwork for the development of models and scenarios to simulate the impact of various policies and interventions on the overall system. [ABSTRACT FROM AUTHOR]

Background: Low-quality care for low back pain (LBP) is pervasive in Australia. Drivers of low-quality care have been identified elsewhere and include misconceptions about LBP, vested interests and limited funding for evidence-based interventions. Yet, the literature that identified such drivers is not specific to the Australian context, and therefore, it is likely to represent only part of the local problem. This study aimed to determine where the most influential drivers of LBP care are in the Australian healthcare system and what could be done to address them. Methods: Clinical leaders from various disciplines, academics, hospital managers, policy-makers, consumers involved in LBP advocacy, board members of relevant health profession boards and private insurers were invited to participate in one-on-one interviews. Interviews were transcribed verbatim. Interview data were analysed using content analysis. Results: We interviewed 37 stakeholders. Challenges that hinder LBP care in Australia included variability in care and inconsistent messages, funding models that are not supportive of appropriate care for LBP, the community's understanding of LBP, vested interests and commercial forces, difficulties in accessing timely and affordable conservative care, neglect of social determinants and health inequities, short consultations, siloed practices, uncertainties that stem from gaps in evidence and the experience of having LBP, individual and contextual variability, the mismatch between evidence and practice, the Australian healthcare system itself, the lack of political will and acknowledgement of LBP as a public health issue, stigma, the need to improve human aspects and the compensation system. When discussing factors that could improve LBP care, participants raised collaboration, changes in funding, improvement of access to – and affordability of – models of care and care pathways, public health campaigns targeting LBP, enhancement of policy and governance, increasing and better training the workforce, consideration of inequities, making improvements in information sharing and reforming the worker's compensation sector. Conclusions: LBP is a wicked problem, influenced by several systemic factors. An agenda for system change in the LBP landscape should be guided by a collaborative, coherent and integrated approach across sectors to enhance quality of care and system efficiency for those who seek and provide care. [ABSTRACT FROM AUTHOR]

(1) Background: Osteoarthritis (OA) is a serious chronic disease mostly affecting the knee joint. Despite the many efforts for developing strategies to predict and control Knee Osteoarthritis (KOA), the disease is on the rise. This paper describes the process for the creation of a simulation model, the Dynamic Knee Osteoarthritis Simulation (DYNAMIKOS) model, that captures the complex interrelationships of the risk factors for the development of KOA; (2) Methods: The DYNAMIKOS model will be based on the System Dynamics approach. The first step will be to develop a Causal Loop Diagram (CLD) model for the risk factors involved incorporating a series of Group Modeling Building (GMB) workshops with experts and stakeholders. Using data from a representative sample of KOA patients, the statistical approaches Exploratory Factor Analysis, Confirmatory Factor Analysis, and Structural Equation Modeling (SEM) will be carried out. (3) Results: This study will develop a simulation System Dynamics model for the risk factors of KOA based on the results of CLD and SEM; (4) Conclusions: The proposed DYNAMIKOS model could be used for effectively analyzing the complex interrelationships among the multiple factors that constitute the spread of KOA. In this way, plausible prevention strategies could be implemented for effectively managing and leading the potential eradication of KOA. [ABSTRACT FROM AUTHOR]

Urban forest management is a multistakeholder, multi-objective situation whereby a surfeit of synergistic or competing goals may exist. Greater research and applied guidance for what works in which urban forest contexts could help improve urban tree and forest outcomes. The challenge in conducting research of this nature is systematic definitions of "what works" and "which contexts" across multidimensional, polycentric urban forest social-ecological systems. This paper presents a comprehensive framework for studying the complexities in urban forest systems (synthesized from numerous other frameworks in the field) that could be used to generate context-specific insights into urban forest management and dynamics. The logic of using frameworks and specific frameworks that already exist within the field are reviewed. Then, I present the urban forest social-ecological system (UFSES) framework. The UFSES framework specifies 5 first-tier factors: the Characteristics of Trees in the Urban Forest (T); the Surrounding Growing Environment (E); Management & Institutions (M); and Characteristics of the Human Community (H); which influence Urban Forest Outcomes (O). A detailed set of second-tier variables nested within these factors are presented in tables at the end of the paper. The framework can foster holistic systems thinking in a systematic yet flexible way; provide a working draft of a common language for thinking about and studying urban forest systems; and enable comparative case research. [ABSTRACT FROM AUTHOR]

Background/Objectives: The concept of educational systems thinking shows the rugby educational system as a network of multiple interactive and interconnected elements. However, the frameworks presented in the literature for developing sports practice through an educational vision and multisport engagement do not always have direct transferability to instructors' training courses. The study aims to evaluate the correlation between rugby instructors' methodological and didactical competencies and compare them with children's motor competence and psychological aspects. Methods: Two hundred twenty children (9.6 ± 1.1 years) and 50 instructors (39.0 ± 13.6 years) were enrolled. Instructors' competencies were investigated during the internship through evaluation sheets, questionnaires, and video analysis. Children's motor competence and psychological aspects were investigated through motor tests, questionnaires, and video analysis. Results: The correlation between methodological competencies and didactical-communicative competencies showed a positive significance, especially regarding production styles. Motor competence and play skills in children showed poor results. The group of instructors with more methodological competencies (a greater number of teaching styles used) showed a strong correlation between motor competence and psychological aspects. Conclusions: For successful teaching, knowledge of specific technical skills is not enough, and it is important to consider all the factors (in particular, the teaching-communicative and methodological skills) that contribute most to instructors' skills. [ABSTRACT FROM AUTHOR]

Chiang Mai Old City, a cultural heritage site and major tourist destination in Thailand, has significant cultural capital but lacks a well-designed urban lighting system, limiting its nighttime development potential. This issue arises from the absence of an urban lighting master plan, a crucial tool for guiding the city's growth. The challenge lies in reconciling the diverse perspectives of stakeholders to create a comprehensive lighting master plan that meets shared goals. This research proposes a system dynamics approach to analyze stakeholder complexity. A qualitative, multi-stage method was employed, through in-depth interviews and focus groups with 60 stakeholders from three groups: government, professionals, and end users, to prioritize critical factors. Causal Loop Diagrams (CLDs) were used to illustrate the interrelations among those factors, leading to alternative scenarios for the lighting master plan's development. The findings demonstrate that safety and security is the top priority, followed by cultural and economic factors. Eleven reinforcing loops and two balancing loops are proposed through CLD visualization. This framework highlights the importance of a participatory process, advocating for a systematic and holistic approach where all stakeholders with diverse perspective collaborate side-by-side in the development of the urban lighting master plan for Chiang Mai Old City. [ABSTRACT FROM AUTHOR]

The vital role of extensive information exchange among stakeholders across diverse sectors and the interconnection of various scientific fields with nonhomogeneous technology readiness levels has created a new form of a complex engineering problem in the climate change era. Comprehensive sustainability assessment to enable the realization of needs requires transdisciplinary thinking to achieve systematic solutions that bridge the gap between multiple collaborative systems in a portfolio. Although the principal aim of dedicated sustainability regulations is to force companies to move toward sustainability development, general and non-engineered metrics that have not defined clear thresholds for evaluation have encountered severe challenges regarding implementation and economic viability. Therefore, adopting a transdisciplinary systems engineering approach can address multifaceted challenges like sustainability by overcoming collaboration barriers, and traditional disciplinary limits. This paper systematically reviews sustainability-dictated regulations from a transdisciplinary perspective. Different standards are compared, raised opportunities and challenges are discussed, and future remarks are highlighted. The sustainability problem is analyzed from a transdisciplinary systems engineering lens. Finally, a two-level resilient system sustainability assessment framework is proposed to effectively handle and enhance the resilience of companies' sustainability development roadmaps by enabling decision makers to find robust and highly reliable solutions regarding sustainable system design. The impact of this research is to create a new insight into addressing climate change which not only assesses the current situation but also considers uncertainty sources that affect decision making for the future. [ABSTRACT FROM AUTHOR]

In an era where digital technologies are integral to daily life and sustainable education is increasingly critical, developing higher-order thinking skills with appropriate information and communication technology (ICT) support is crucial for achieving Sustainable Development Goals (SDGs). The purpose of this study was to examine synergies of systems thinking and technology-enhanced learning from the perspective of flow theory within the context of sustainable education. We surveyed more than 65 pre-service preschool teachers engaged in a design, technology, and engineering (DTE) course at the University of Ljubljana. Mapping of systems thinking revealed that pre-service preschool teachers needed support regarding feedback and understanding the interrelationship dimension of systems thinking—essential components of sustainable education. Predictive and mediation analyses yielded noteworthy results. Participants in the ICT-enhanced DTE course rated their cognitive and social engagement above the mid-point of the scale, with this higher engagement correlating with higher systems thinking crucial for sustainable education. In contrast, their aesthetic engagement was below the mid-point of the scale. Experiencing a flow state during ICT activities positively influenced systems thinking, particularly in terms of clear goals and autotelic experiences. Flow theory thus emerges as a solid and appropriate framework to use for studying synergies in technology-enhanced systems thinking for sustainable education. These findings underscore the importance of integrating systems thinking into curricula to enhance learning outcomes and prepare students for future challenges, thereby contributing to the achievement of SDGs through sustainable education. [ABSTRACT FROM AUTHOR]

Inequalities in physical activity are well documented, especially between socioeconomic groups. However, progress on reducing these inequalities is proving challenging. In this commentary, we argue that a complex system perspective is needed, specifically to reorient our thinking of inequalities in physical activity to be emergent features of complex systems. Operationalising this perspective involves acknowledging the multiple dynamic and non-linear interactions which take place between system parts and, over time aggregate to become macro patterns such as physical activity inequalities. We argue that this framing will enhance our understanding of the emergence of inequalities in physical activity and, therefore, provide interventions better suited to the subgroups of the population they are designed to help. [ABSTRACT FROM AUTHOR]

Background: Climate change is increasingly affecting the supply of resources such as water and food. From 2015 to 2018, Cape Town endured its most severe drought on record. Yet, resource management often occurs in isolation, which contrasts with the holistic perspective provided by the nexus concept that recognizes the interdependence of resource sectors. This study employs system dynamics modeling, to examine the City of Cape Town's (CoCT) water-food trade-offs and interactions using qualitative and quantitative approaches. It assesses various policies proposed by the CoCT, to improve system resilience and to boost future water supplies, examining their efficacy and potential drawbacks. These policies are tested against future scenarios including population growth and climate change predictions of different severities. Results: The simulation results show an increase in food demand, which is mainly linked to population growth and a significant decrease in water availability. Without intervention, the CoCT is expected to experience serious water shortages within the 40-year simulation period. Conclusions: The findings indicate that the CoCT's strategies will effectively secure adequate water for its expanding population. However, a major concern was found to be the proposed intensification of aquifer exploitation. The model predicts that such an approach could lead to overabstraction of some aquifers, compromising their sustainability. [ABSTRACT FROM AUTHOR]

Previous reviews of experience-based codesign (EBCD) projects have shown non-participant observations (NPOs) are omitted or unreported in the majority of studies, despite academics' insistence of their value. We undertook Stage 1 of an EBCD project using a Case Study Research approach to organise the inquiry. NPOs were used as the first object (frame of analysis) of the case subject, exploring and understanding the experience of users and providers of ED care. 162 hours of NPOs were conducted by six research team members across three hospital Emergency Departments (EDs), representing a local nested case. The four principles of EBCD were used to guide the inquiry, providing rich understanding and description of the context, and valuable insights into critical issues. Summarised NPO narratives allowed the research team to familiarise themselves with the different physical environments, workflows, and processes, as well as think more deeply about work and interactions. Conducted within complex healthcare settings, this example demonstrates the value of observing Work-As-Done and has advanced knowledge of institutional logic that will be critical in considering realistic and sustainable change initiatives. Commitment to intentional design and well-reported research methods for exploring and understanding lived experience can satisfy academic audiences of the study integrity and provide comprehensive information for those undertaking accelerated EBCD. [ABSTRACT FROM AUTHOR]

The existential threat of climate change requires reimagining foundational aspects of society, including jobs, transportation, energy, the built environment, natural resources, health, and water and food supplies. We argue that to realize such broad scale change requires systems thinking. In this introduction to the special issue on Nonprofits and Climate Policy, we outline four systems-based views of global social change, organized by source of change and assumptions about the technical rationality of the system: engineering, evolutionary, social constructivist, and (critical) realist. By elaborating this framework, we shed light on the fundamental assumptions embedded in climate advocacy and policymaking. Along with describing key scholarship and practice-based examples for each approach, we align the articles in this special issue with the four views of global social change to inspire systems-based research and practice at the nonprofit and climate policy intersection. We hope that creating more explicit accounts of the key beliefs and expectations about how social change occurs at a global systemic level will help to advance research and practice in sustainability. [ABSTRACT FROM AUTHOR]

As wildlife habitats become increasingly fragmented, sharing landscapes with wildlife is becoming difficult and complex. Because stakeholders with diverging interests struggle to collaborate to manage human–wildlife interactions, new approaches are needed. Here we reflect on a novel participatory learning program we implemented with farmers in communal conservancies in the Zambezi region of Namibia. The 9 week program aimed to understand why human–wildlife conflict remained a challenge. We combined three theoretical framings in the program design—systems thinking, nonviolent communication, and learning based approaches. We summarize key outcomes of each session and reflect on the overall program. We found a synergistic effect of the three framings and concluded that our integrated program had been a useful collaborative learning tool to understand the human–wildlife governance system, identify interventions, empower communities, and build capacity for collaboration to improve human wellbeing and human–wildlife interactions. Drawing on our experience, we make suggestions for how the program could be adapted for similar or other environmental problems elsewhere. [ABSTRACT FROM AUTHOR]

This paper outlines the purposeful adaptation and utilization of the design thinking process in an innovation case involving market segmentation in social network research. Based on a case study, this paper combines the design thinking process with systems approach methods to foster innovation in social network analyses. The paper details the entire process, from the initial stages to the development of a viable solution defined in the final assignment for programmers. The case study emphasizes the effective use of systems thinking tools and demonstrates the value of combining these two approaches to meet the needs of the innovation process. The paper aims to narrate the entire process and highlight critical points in a real-world case study. The focus was on the challenge of creating a market segmentation tool for researchers and marketers in the realm of social network analysis. [ABSTRACT FROM AUTHOR]

The success of marine environmental regulations in terms of social challenges in Belt and Road Initiative (BRI) countries is the main subject of this study, which compares and contrasts them with an eye toward sustainability, the integration of digital technologies, environmental law, and reducing ecological degradation. Environmental solid governance is essential as BRI countries increase their marine activity, an important part of the world economy by systems thinking; the marine industry includes a broad range of operations about the ocean and its resources through social challenges to promote environmental legislation in terms of emissions in the countries participating in the BRI. This study evaluated the effects of institutional quality and technical advancements in marine policies between 2013 and 2024. This project aims to examine how various policy contexts relate to marine conservation, how well they comply with international environmental regulations, and how digital technology can improve the monitoring and implementation of policies through systems thinking. This study aims to determine common obstacles and best methods for enforcing marine policies by examining research from different BRI countries. The results deepen our understanding of how these policies can be best utilized to meet sustainable development objectives while preventing the degradation of marine ecosystems due to economic growth and business. [ABSTRACT FROM AUTHOR]

Sustainable agriculture involves complex interactions among social, economic, and ecological dimensions, each with distinct interests and goals. Achieving sustainable agricultural development is challenging and requires a comprehensive response. This study focuses on Indonesia's garlic production, employing a systems thinking approach to provide a holistic understanding of the interconnected factors influencing sustainable agricultural systems. We utilized the first two steps of the five-step systems thinking methodology--problem articulation and the formulation of dynamic hypotheses. This process involved developing a causal loop diagram (CLD) to represent the dynamic hypotheses and identifying system archetypes to determine leverage and potential intervention points. Our analysis identified three system archetypes--Drifting Goals, Fixes that Fail, and Limit to Growth--as key patterns influencing the sustainability of garlic production. The Drifting Goals archetype reveals that efforts to boost local garlic stock in Indonesia are hindered by the allocation of garlic for seeds, due to the lack of a clear distinction between garlic for consumption and seed. The Fixes that Fail archetype illustrates the long-term detrimental effects of short-term agricultural practices, such as the overuse of chemical fertilizers and pesticides. The Limit to Growth archetype underscores the critical need for enhanced market access and a shift in consumer preferences to sustain garlic farming. To address these challenges, we recommend establishing clear distinctions between garlic for consumption and seed production, developing the seed industry, promoting integrated pest management, and reducing reliance on chemical inputs through environmentally friendly technology. Additionally, ensuring market and price stability is vital to maintain farmers' interest in garlic cultivation. Therefore, the government should prioritize market penetration for local garlic and consistently enforce import restrictions to ensure the sustainability of garlic production in Indonesia. [ABSTRACT FROM AUTHOR]

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Navigating social‐ecological systems toward sustainable trajectories is an important challenge of the Anthropocene. Models of social‐ecological systems can increase our understanding of how social and ecological subsystems interact, their response to environmental changes, and how their dynamics may be altered by management interventions. However, the level of representational detail required for models to describe a particular social‐ecological system with high fidelity (i.e., accurately quantifying system dynamics) may hamper both the interpretability of model results and our ability to identify key processes and feedbacks within the system. In contrast, stylized models describe simplified interactions between a small subset of social‐ecological system elements. Stylized models are a useful tool to identify potential consequences of specific key processes and feedbacks on system functioning. However, the relatively low level of representational detail in these models limits their ability to deliver concrete management options for a particular social‐ecological system. Here, we describe how an exploratory modeling approach can utilize the strengths of stylized models before the construction of social‐ecological system models with high fidelity and representational detail. This exploratory modeling approach is an iterative strategy, with the initial steps comprising the development of stylized models informed by empirical observations. We illustrate this with two examples of stylized modeling of isolated and connected social‐ecological systems. Through repeated confrontation of alternative models with empirical data, exploratory modeling provides useful stepping stones toward the development of models that describe social‐ecological systems in increasingly specific settings with increasing levels of representational detail. When these latter types of models reach a high level of fidelity, they could be used for scenario‐based analyses and participatory decision‐making processes. At this stage, the conceptual insights previously obtained during the exploratory modeling phase may aid in the interpretation and communication of the outcomes of scenario‐based analyses. Hence, exploratory modeling aims to create a synergy between the insights obtained from stylized models and system‐specific, high‐fidelity models in order to generate a deep understanding of the drivers of social‐ecological system dynamics, and how to leverage these drivers to initiate desired changes. [ABSTRACT FROM AUTHOR]

Supply chain management is grounded on the assumption that endless economic growth is compatible with environmental and social sustainability. Yet scholars from ecological economics question this assumption due to ever increasing evidence showing how hard it is to decouple growth from negative environmental and social externalities. In response, pressure from social movements is mounting, and the agendas of several countries already consider alternatives to growth. Therefore, this article presents a critical thought experiment for the supply chain management discipline: What are the implications of moving from the current endless growth paradigm to a post‐growth paradigm for businesses and their supply chains? Using the umbrella term "post‐growth," this article identifies three key post‐growth principles—(i) socio‐ecological wellbeing, (ii) selective downscaling, and (iii) systems thinking—and then examines their implications for supply chain management research and practice. [ABSTRACT FROM AUTHOR]

The need for evidence-based improvements at the workplace Work is an important social determinant of health (1). Decades of research on a wide range of different types of exposure, such as chemical, physical, biological, and psychosocial exposures at the workplace, has shown how poor working conditions are associated with adverse health outcomes and disparities in health. This has been well illustrated in the 2024 Discussion Paper series celebrating `50 years of research` in the Scandinavian Journal of Work, Environment & Health (2–9). With this rapidly increasing body of knowledge, it is quite disappointing to note that the increasing number of high-quality studies on identifying occupational risk factors are not matched by a similar number of high-quality studies aimed to design and evaluate measures that promote workers’ health and prevent work-related disease and disability (2). There is a scarcity of evidence-based workplace interventions that can guide appropriate workplace policies, programs, and practices. A linked issue is that, in situations when sufficient evidence seems available, there is a lack of urgency in utilizing research findings in the practice of occupational safety and health (OSH). A European Union report argued that, in order for research to have an impact on workers’ safety and health, there is a great need to improve the translation of OSH research findings into practice, both in the occupational health services and at workplaces (10). Both the lack of evidence-based guidance for healthy and safe workplaces as well as lack of implementation of available knowledge in practice can be partly attributed to the complexity of the workplace, given its multiple organizational levels, variety of settings and contextual factors, and required level of flexibility and adaptivity of interventions in order to be successful (11). Complex interventions require different research strategies, shifting the focus from the traditional binary question of effectiveness of a precisely defined intervention towards a broader understanding of mechanisms, processes, and outcomes of relevance to workers, companies, and OSH professionals (12). Rise and demise of the RCT Many researchers have been trained that randomized controlled trials (RCT) provide the most rigorous evidence on beneficial effects of preventive, diagnostic, and therapeutic interventions (13). With the rise of the evidence-based medicine approach, the RCT design became the gold standard, demonstrating with high quality and reliability the causal effects of the intervention. In the past 40 years, this gold standard has increasingly been critiqued and – in the era of complex system thinking and complex interventions – the status of the RCT is eroding (13,14). There is strong evidence that if evidence-based health care is limited to RCT, the evidence will favor individual-based over multicomponent interventions, highly standardized simple interventions over complex ones, and short- over long-term interventions (14). In occupational health, it has long been acknowledged that interventions often have an organizational or work environment context that hampers – or even excludes the possibility of – individual-level randomization and also makes cluster randomization very difficult (15). Very successful interventions in occupational health, eg, the introduction of a complete ban on asbestos (3) and the substitution of organic solvents in paints (4), would not have happened if knowledge from an RCT would have been the required level of evidence. Alternative study designs and research methods In recent years, there has been a big debate around which study designs are needed for a valid interpretation of an intervention`s effects. At the heart of the discussion is the inherent trade-off between causal estimation of an intervention effect and estimation of an intervention effect that matters for practice. Opinions remain strongly divided. Some researchers claim that observational studies will always be affected by bias and, thus, causal evidence can only be derived from experiments or trails emulated in observational studies (16). An experiment with randomization ensures exchangeability in that both groups are comparable for all known and unknown factors and, thus, these factors cannot bias the intervention effect. In the absence of an RCT, researchers have applied the ‘experimental causal inference’ framework to particular situations that may be interpreted as happening at random. These so-called `natural experiments` have specific statistical methods that try to ensure that the intervention of interest can be interpreted as an exogenous source (17). These natural experiment approaches include, among others, methods such as propensity-score matching, difference-in-differences, interrupted time series, instrumental variables, and regression discontinuity. An illustrative example is the introduction of a new nationwide graded return-to-work program whereby propensity-score matching demonstrated an increasing labor force participation and reduced permanent disability as a result of this intervention (18). Laaksonen and colleagues (19) used the regression discontinuity approach to show that vocational rehabilitation, assigned based on a threshold in earnings in past few years, increased paid employment, but results were far from being statistically significant. A difference-in-differences approach comparing trends before and after the introduction of a work reintegration program demonstrated reductions in the number of disability days, most notably among longer duration episodes (20). Jan Vandenbroucke and colleagues (21) have eloquently criticized this ‘causal inference’ movement, stating that truly natural experiments are rare and those that happen are usually not widely generalizable. Hence, complete reliance on natural experiments and linked statistical methods will limit much needed evidence in occupational health tremendously (22). On the other side of the spectrum, researchers argue for a paradigm shift towards more practice-relevant evidence with a system lens on multiple factors that interact in dynamic and unpredictable ways in the complex world of real data (23, 24). It is proposed to determine whether an intervention contributes, along with other factors, to a desirable outcome, acknowledging that multiple components of the intervention might each contribute to an overall beneficial effect through heterogeneous effects on disparate causal pathways (23). Such a question can often not be answered by a specific research design, but requires a myriad of new types of data, analytical methods, and interdisciplinary work (24). It will be of interest to see in the next few years whether the ‘experimentalists’ and the ‘system thinkers’ can bridge the huge gap in their appreciation of what is considered solid evidence. When is evidence strong enough to take action? Societal impact of our research requires research that matters, ie, research that provides compelling arguments to implement specific improvements in order to contribute to the health and wealth of workers and communities. Working longer in good health is an example of a key societal challenges in many countries (25), and, thus, researchers in occupational health are in the fortunate position to create societal impact by identifying determinants of healthy working-life expectancy and designing interventions that promote working longer in good health. However, this requires that scientific scrutiny for valid results does not result in postponing highly needed programs and policies in the workplace. Several articles celebrating `50 years of research` in the Journal have documented that some preventive measures have been delayed unnecessarily, sometimes in a deliberate strategy by industry to manufacture uncertainty (4, 26). Delays in taking necessary action can also be the result of scientists hesitating too long about the correct interpretation of results. A classic example is the infamous crocidolite-chrysotile asbestos debate during the 1980s and 1990s, whereby proponents of the `chrysotile is safe` argument delayed the ban on asbestos (3). In an earlier editorial, we have argued that causal inference considerations should hamper neither development nor implementation of evidence-based recommendations in occupational health when the evidence-base is reasonable (27). There are no golden rules to determine when our knowledge is sufficient to require preventive measures. I can only refer to the wise words of Sir Bradford Hill in his seminal address to the Royal Society of Medicine, describing the purpose of the newly-founded section of occupational medicine: “All scientific work is incomplete—whether it be observational or experimental. All scientific work is liable to be upset or modified by advancing knowledge. That does not confer upon us a freedom to ignore the knowledge we already have or to postpone action that it appears to demand at a given time (28)." With these words in mind, we look forward to research that provides compelling information on how to tackle the current challenges in occupational health and studies that document how this knowledge has guided successfully preventive measures at the workplace. Hopefully, we can redress the imbalance between risk-oriented research and intervention studies and create a long-lasting positive societal impact on workers’ health. References 1. Frank J, Mustard C, Smith P, et al. Work as a social determinant of health in high-income countries: past, present, and future. Lancet 2023;402:1357-67. https://doi.org/10.1016/S0140-6736(23)00871-1 2. Burdorf A, Rugulies R. Fifty years of research in the Scandinavian Journal of Work, Environment & Health. Scand J Work Environ Health 2024;50:3-10. https://doi.org/10.5271/sjweh.4135 3. Järvholm B, Burdorf A. Asbestos and disease - a public health success story? Scand J Work Environ Health 2024;50:53-60. https://doi.org/10.5271/sjweh.4146 4. Albin M, Johanson G, Hogstedt C. Successful prevention of organic solvent induced disorders: history and lessons. Scand J Work Environ Health 2024;50:135-41. https://doi.org/10.5271/sjweh.4155 5. Härmä M, Kecklund G, Tucker P. Working hours and health - key research topics in the past and future. Scand J Work Environ Health 2024;50:233-43. https://doi.org/10.5271/sjweh.4157 6. Kuijer PPFM, van der Wilk S, Evanoff B, Viikari-Juntura E, Coenen P. What have we learned about risk assessment and interventions to prevent work-related musculoskeletal disorders and support work participation? Scand J Work Environ Health 2024;50:317-28. https://doi.org/10.5271/sjweh.4172 7. Boot CRL, LaMontagne AD, Madsen IEH. Fifty years of research on psychosocial working conditions and health: From promise to practice. Scand J Work Environ Health 2024;50:395-405. https://doi.org/10.5271/sjweh.4180 8. Turner MC, Straif K, Kogevinas M, Schubauer-Berigan MK. Five decades of occupational cancer epidemiology. Scand J Work Environ Health 2024;50:489-502. https://doi.org/10.5271/sjweh.4190 9. Ropponen A, Rugulies R, Burdorf A. Towards the year 2049. The next 25 years of years of occupational health and safety research. 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Purpose – The ripple effect (i.e. disruption propagation in networks) belongs to one of the central pillars in supply chain resilience and viability research, constituting a type of systemic disruption. A considerable body of knowledge has been developed for the last two decades to examine the ripple effect triggered by instantaneous disruptions, e.g. earthquakes or factory fires. In contrast, far less research has been devoted to study the ripple effect under long-term disruptions, such as in the wake of the COVID-19 pandemic. Design/methodology/approach – This study qualitatively analyses secondary data on the ripple effects incurred in automotive and electronics supply chains. Through the analysis of five distinct case studies illustrating operational practices used by companies to cope with the ripple effect, we uncover a disruption propagation mechanism through the supply chains during the semiconductor shortage in 2020–2022. Findings – Applying a theory elaboration approach, we sequence the triggers for the ripple effects induced by the semiconductor shortage. Second, the measures to mitigate the ripple effect employed by automotive and electronics companies are delineated with a cost-effectiveness analysis. Finally, the results are summarised and generalised into a causal loop diagram providing a more complete conceptualisation of long-term disruption propagation. Originality/value – The results add to the academic discourse on appropriate mitigation strategies. They can help build scenarios for simulation and analytical models to inform decision-making as well as incorporate systemic risks from ripple effects into a normal operations mode. In addition, the findings provide practical recommendations for implementing short- and long-term measures during long-term disruptions.

Abstract In our interconnected world, Systems Thinking (ST) is increasingly being recognized as a key learning goal for science education to help students make sense of complex phenomena. To support students in mastering ST, educators are advocating for using computational modeling programs. However, studies suggest that students often have challenges with using ST in the context of computational modeling. While previous studies have suggested that students have challenges modeling change over time through collector and flow structures and representing iterative processes through feedback loops, most of these studies investigated student ST through pre and post tests or through interviews. As such there is a gap in the literature regarding how student ST approaches develop and change throughout a computational modeling unit. In this case study, we aimed to determine which aspects of ST students found challenging during a computational modeling unit, how their approaches to ST changed over time, and how the learning environment was supporting students with ST. Building on prior frameworks, we developed a seven-category analysis tool that enabled us to use a mixture of student discourse, writing, and screen actions to categorize seven ST behaviors in real time. Through using this semi-quantitative tool and subsequent narrative analysis, we found evidence for all seven behavior categories, but not all categories were equally represented. Meanwhile our results suggest that opportunities for students to engage in discourse with both their peers and their teacher supported them with ST. Overall, this study demonstrates how student discourse and student writing can be important evidence of ST and serve as a potential factor to evaluate ST application as part of students’ learning progression. The case study also provides evidence for the positive impact that the implementation of a social constructivist approach has in the context of constructing computational system models.

Abstract Background Low-quality care for low back pain (LBP) is pervasive in Australia. Drivers of low-quality care have been identified elsewhere and include misconceptions about LBP, vested interests and limited funding for evidence-based interventions. Yet, the literature that identified such drivers is not specific to the Australian context, and therefore, it is likely to represent only part of the local problem. This study aimed to determine where the most influential drivers of LBP care are in the Australian healthcare system and what could be done to address them. Methods Clinical leaders from various disciplines, academics, hospital managers, policy-makers, consumers involved in LBP advocacy, board members of relevant health profession boards and private insurers were invited to participate in one-on-one interviews. Interviews were transcribed verbatim. Interview data were analysed using content analysis. Results We interviewed 37 stakeholders. Challenges that hinder LBP care in Australia included variability in care and inconsistent messages, funding models that are not supportive of appropriate care for LBP, the community’s understanding of LBP, vested interests and commercial forces, difficulties in accessing timely and affordable conservative care, neglect of social determinants and health inequities, short consultations, siloed practices, uncertainties that stem from gaps in evidence and the experience of having LBP, individual and contextual variability, the mismatch between evidence and practice, the Australian healthcare system itself, the lack of political will and acknowledgement of LBP as a public health issue, stigma, the need to improve human aspects and the compensation system. When discussing factors that could improve LBP care, participants raised collaboration, changes in funding, improvement of access to – and affordability of – models of care and care pathways, public health campaigns targeting LBP, enhancement of policy and governance, increasing and better training the workforce, consideration of inequities, making improvements in information sharing and reforming the worker’s compensation sector. Conclusions LBP is a wicked problem, influenced by several systemic factors. An agenda for system change in the LBP landscape should be guided by a collaborative, coherent and integrated approach across sectors to enhance quality of care and system efficiency for those who seek and provide care.

Abstract Inequalities in physical activity are well documented, especially between socioeconomic groups. However, progress on reducing these inequalities is proving challenging. In this commentary, we argue that a complex system perspective is needed, specifically to reorient our thinking of inequalities in physical activity to be emergent features of complex systems. Operationalising this perspective involves acknowledging the multiple dynamic and non-linear interactions which take place between system parts and, over time aggregate to become macro patterns such as physical activity inequalities. We argue that this framing will enhance our understanding of the emergence of inequalities in physical activity and, therefore, provide interventions better suited to the subgroups of the population they are designed to help.

Abstract Background Climate change is increasingly affecting the supply of resources such as water and food. From 2015 to 2018, Cape Town endured its most severe drought on record. Yet, resource management often occurs in isolation, which contrasts with the holistic perspective provided by the nexus concept that recognizes the interdependence of resource sectors. This study employs system dynamics modeling, to examine the City of Cape Town’s (CoCT) water-food trade-offs and interactions using qualitative and quantitative approaches. It assesses various policies proposed by the CoCT, to improve system resilience and to boost future water supplies, examining their efficacy and potential drawbacks. These policies are tested against future scenarios including population growth and climate change predictions of different severities. Results The simulation results show an increase in food demand, which is mainly linked to population growth and a significant decrease in water availability. Without intervention, the CoCT is expected to experience serious water shortages within the 40-year simulation period. Conclusions The findings indicate that the CoCT’s strategies will effectively secure adequate water for its expanding population. However, a major concern was found to be the proposed intensification of aquifer exploitation. The model predicts that such an approach could lead to overabstraction of some aquifers, compromising their sustainability.

Background. Modern higher education is focused on creating conditions for developing systems thinking skills and reducing the negative impact of clip thinking on the cognitive abilities of the younger generation. Digital technologies contribute to the development of students’ skills such as multitasking, reaction speed, a high degree of adaptability, but also negatively affect the perception of the world around them, students stop analyzing the information they receive and do not strive to make a complete picture of the fragments received. Purpose. Identify psychological and pedagogical conditions for the formation of systems thinking skills and reducing the negative impact of clip thinking on the process of learning a foreign language. Materials and methods. The study was conducted by analyzing scientific, educational and methodological literature and pedagogical experience in the formation of cognitive competence among students of higher educational institutions. The article interprets, analyzes and generalizes the theoretical principles and practical experience of developing students’ systems thinking skills, and also studies the influence of clip thinking on the cognitive process in foreign language classes. Results. The author identified the main learning difficulties caused by the negative impact of clip thinking, and proposed psychological and pedagogical conditions for their minimization and the formation of systems thinking skills. The basis of the psychological and pedagogical conditions is the implementation of problem-based learning through solving communicative tasks in the process of studying modern forms of the English verb. The obtained research results contribute to the methodology and technology of modern professional education, expand the understanding of the role of problematic communicative tasks in foreign language classes and speak about the need to rely on students’ ability to multitask and the mechanism of adaptation to information overload.

This article presents a novel approach that integrates biophilic design, wellbeing science, and systems science into a holistic strategy designated as the Biophilic Wellbeing Systems Approach (BWSA). This transdisciplinary approach aims to enhance student wellbeing in educational settings by fostering a deep connection with nature, supported by positive psychology and systems thinking. The research explores how these combined disciplines can shape educational environments that improve learning outcomes and promote human thriving. The study advocates for a transformative redesign of school environments, emphasising the interdependence of individual and planetary health, drawing on Indigenous wisdom and contemporary scientific knowledge. This foundational strategy holds significant potential to fundamentally change how schools are designed and operated. By fostering environments that deeply integrate wellbeing principles, this approach not only influences the physical buildings but also extends to the entire school ecosystem. It works synergistically to promote educational excellence and holistic wellbeing, ensuring that all elements of the school environment contribute to the overall development and health of students and staff.

Abstract Background Current local food environments encourage poor diets, posing a significant threat to public and planetary health. Acknowledging and addressing its inherent complexity is vital to making meaningful improvements to the food environment. Using a participatory approach with local stakeholders, this study aims to gain insight into the factors and mechanisms underlying the local food environment and to identify leverage points and system-based actions to foster healthy and sustainable local food environments. Methods A systems-thinking approach was used in a Dutch municipality in 2022. Two group model building (GMB) workshops were held with community stakeholders (e.g. local policymakers, retailers and residents). During the first workshop (June 2022), factors and mechanisms influencing the local food environment were identified and visualized through a causal loop diagram (CLD). During the second workshop, leverage points and system-based actions to improve food environments were identified by the stakeholders. Four months after (October 2022), an action-implementation meeting was organized to stimulate the implementation of selected actions. Progress was monitored through brief telephone interviews 6 and 12 months after the second workshop. Results The CLD visualises the factors and mechanisms influencing the local food environment from the point of view of the community stakeholders. The CLD consists of 46 factors shaping the local food environment, which were categorized into four identified subsystems: societal factors, individual, socio-economic factors, commercial factors and political factors. Eight leverage points were identified within the CLD, for example, ‘lobby from food industry’, ‘governmental food policies’ and ‘e-commerce and platform economy’. Stakeholders formulated 20 actions targeting the identified leverage points. During the action-implementation meeting, long-term plans were created for five actions. After 1 year, only one participant (policy advisory role) remained actively engaged in three of these actions. Conclusions This study yields insight into the numerous factors and mechanisms underlying the local food environment and identified system-based actions as perceived by local stakeholders to improve this food environment locally. The CLD offers stakeholders valuable insights on employing a systems approach when enhancing food environments. More research is necessary, especially into the long-term processes and effects of implementing system-oriented actions to improve local food environments.

Abstract Background Healthcare system sustainability is challenged by several critical issues; one of the most pressing is the ageing population. Traditional, episodic care delivery models are not designed for older people who are medically complex and frail. These individuals would benefit from health and social care that is more comprehensive, coordinated, person-centred and accessible in the communities in which they live. Delivering this is a challenging endeavour. Community-based health and social care professionals are siloed, dispersed across various locations and sectors, each with their own mental models, electronic health information systems, and means of communication. To move away from fragmented care delivery models and towards a more integrated approach to care, an analysis of the process of community-based comprehensive geriatric assessment was conducted in an urban location in Atlantic Canada. The purpose of the study was to identify where in the community-based comprehensive geriatric assessment process challenges and opportunities existed for moving towards a more integrated model of care delivery. Method The functional resonance analysis method (FRAM) and dynamic FRAM (DynaFRAM) modelling were used to model the community-based health and social care system and create a hypothetical patient journey scenario. Data collected to inform modelling consisted of document review, focus groups, and semi-structured interviews with health and social care professionals providing care and service to older people in the community setting. Findings. Challenges and opportunities for implementing integrated care in the local context were identified. Findings from the FRAM and DynaFRAM analysis informed the co-design of multi-level process improvement recommendations that aim to move the local community-based comprehensive geriatric assessment process towards a more integrated model of care. Conclusions A transformative redesign of community-based health and social care in the local context is necessary but cannot be accomplished without an understanding of how health and social care professionals conduct their work and how older people may receive care under the dynamic conditions. The FRAM and DynaFRAM modelling provided an enhanced understanding of system operations and functionality and demonstrated a critical step that should not be overlooked for decision-makers in their efforts to implement a more integrated model of care.

Abstract Guinea-Bissau has among the world’s highest maternal and perinatal mortality rates. To improve access to quality maternal and child health (MCH) services and thereby reduce mortality, a national health system strengthening initiative has been implemented. However, despite improved coverage of MCH services, perinatal mortality remained high. Using a systems-thinking lens, we conducted a situation analysis to explore factors shaping timeliness and quality of facility-based care during labour, childbirth, and the immediate postpartum period in rural Guinea-Bissau. We implemented in-depth interviews with eight peripartum care providers and participant observations at two health facilities (192 h) in 2021-22, and analysed interview transcripts and field notes using thematic network analysis. While providers considered health facilities as the only reasonable place of birth and promoted facility birth uptake, timeliness and quality of care were severely compromised by geographical, material and human-resource constraints. Providers especially experienced a lack of human resources and materials (e.g., essential medicines, consumables, appropriate equipment), and explained material constraints by discontinued donor supplies. In response, providers applied several adaptation strategies including prescribing materials for private purchase, omitting tests, and delegating tasks to birth companions. Consequences included financial barriers to care, compromised patient and occupational safety, delays, and diffusion of health worker responsibilities. Further, providers explained that in response to persisting access barriers, women conditioned care seeking on their perceived risk of developing birthing complications. Our findings highlight the need for continuous monitoring of factors constraining timeliness and quality of essential MCH services during the implementation of health system strengthening initiatives.

Project-based organizations (PBOs) rely on project management as their core business process. These organizations are characterized by their disaggregated structure and diverse authority distribution, leading to complications in synchronizing projects, governance, and functional divisions. In this regard, there is a need of a tool to manage this complexity. This paper introduces a novel approach – the IModel- for modeling, designing and analyzing PBOs, following the Design Science Research Method, that seeks to is creating an artifact that solves a real-world problem in a specific context. This artifact is developed through a conceptual integration between project management (PM) and enterprise architecture (EA) sources based on ontologies. Ontologies are powerful, machine-readable graph-structured models which enables sophisticated models’ reasoning and querying. IModel fuses the organizational domain from the ArchiMate EA language with PM insights from PMBOK 7th edition. The resulting IModel has been submitted to an expert’s judgement to assess its intended purposes as well, its potential to be applied in the real-world to support the PBO.

The application of the resilience concept within socioecological systems has recently received much attention. Assessing the characteristics of cocoa agroecosystems in the dry and moist semi-deciduous ecological zones has become critical for resilience analysis in this era of climate change and the constant shrinking of cocoa suitability areas. Previous studies have used one of the dimensions of resilience to analyse complex adaptive systems, excluding critical factors and variables. This study applied a multi-criteria decision-making process, the Analytic Hierarchy Process (AHP) that accommodates the three dimensions of resilience, i.e., buffer capacity, adaptive capacity and self-organisation. The AHP is a multi-criteria decision-making tool that proceeds with the design of a hierarchy system for the goal, criteria, attributes and variables. Selected cocoa farmers were assigned weights related to criteria, attributes and variables in a comparison matrix. The resilience of the cocoa agroecosystems in Offinso Municipal and Adansi North Districts was 2.75 ± 0.06 (mean ± SD) and 3.23 ± 0.10 (mean ± SD), respectively. Buffer capacity contributed the highest proportion (44.3%) in the Offinso Municipal District, followed by adaptive capacity (38.7%) and self-organisation (17%). A similar trend was recorded for the Adansi North District: buffer capacity (42.9%), adaptive capacity (42.9%) and self-organisation (14.3%). Across the two study areas, shade trees, crop diversification, soil quality, cocoa variety, farm size, farm age, alternative livelihood, annual income and co-operative membership contributed prominently to the construction of cocoa agroecosystem resilience. The assessment of agroecosystem resilience is location-specific, and the study provides a simplified methodology for evaluating resilience. The paper aims to understand the importance of the components of the cocoa agroecosystem, and a simplified methodology for evaluating its resilience to perturbations. It presents a conceptual and methodological framework for the analysis and measurement of agroecosystem resilience in a participatory manner. [ABSTRACT FROM AUTHOR]

The One Health approach often reaches classrooms through Environmental Education (EE), which aims to guide society's response to current crises (environmental, health, economic, values). However, traditional EE teaching has focused on isolated ecological concepts and standardised solutions, ignoring the multidimensional nature of EE and failing to integrate the interdependence between environmental, animal, and human health. Moreover, teacher training often neglects didactic content knowledge, preventing students from acquiring the systemic vision needed to address eco-social problems and create sustainable solutions aligned with the Sustainable Development Goals (SDGs). This limits teachers' ability to influence students' concerns and behaviours. In this context, this study aims to reflect on the current state of the issue and propose strategies informed by Science Education research to improve EE teaching, enabling the integration of One Health dimensions through effective didactics to achieve Transformative Environmental Education (TEE). For this purpose, we begin by addressing the limitations identified in recent systematic reviews, shifting the paradigm towards a symbiosis of EE and Science Education through scientific practices. We then present practical examples showcasing successful EE initiatives that foster a deeper understanding of socio-environmental issues, encourage innovative solutions, and nurture engaged citizens from early education onwards. These proposals can support classroom practice and ongoing teacher self-development. Pedagogical strategies include tackling issues that require systemic and critical thinking by developing scientific and epistemic practices while raising awareness of Environmental Justice. Thus, this study advocates for a new vision of EE, integrating the One Health approach, which could be applied to develop new educational programs, including teacher training. This would lead to a new learning evaluation model and help identify key determinants that trigger pro-environmental behaviours. [ABSTRACT FROM AUTHOR]

Effective governance of complex social‐ecological systems requires diverse stakeholders to be engaged in meaningful participatory processes. Meaningful participation must be intelligible and significant to local actors and coherent within a broader, multilevel governance system. This study explores the complexities of participatory land and water governance in South Africa's Tsitsa River Catchment. Embedded within a transdisciplinary landscape restoration project (the Tsitsa Project), this study combines a diagram‐based analysis of local actor mental models with a narrative‐based analysis of participant observation data. Challenges, opportunities, and general principles are identified. Limited accessibility, resource constraints, and the legacy of centralised governance impede participation. The research identifies the critical role of local actors, particularly those with deep community ties, in driving inclusive processes. Building trust through face‐to‐face interactions and culturally appropriate communication strategies also emerged as vital elements for success. This research can inform participatory projects and interventions in rural and developing world contexts. [ABSTRACT FROM AUTHOR]

Introduction: Organizing the collection of valuable recyclable waste at the city level has always been a major challenge for municipalities due to unprincipled activities. So far, various attempts have been made to organize these people in Iran, but all of them have failed. Almost all municipalities have accepted the presence of these people as an informal part of urban waste management. The purpose of this study is to create a new financial structure in the form of an activity license and investigate the informal flow of waste collectors in three scenarios by the causal loop diagram of the waste management cycle in Vensim software. The causal loop model obtained in this research brings a new and complete understanding of stakeholders, effective variables in cooperation, and competition between formal and informal actors in the waste management cycle of Kerman City. Material and Methods: To simulate the performance of different financial license pricing scenarios, the concepts of simulation of system thinking, dynamic planning, and CLD model have been used in Vensim software. At first, the CLD model of the waste cycle in Kerman City was drawn and analyzed using local conditions, the infrastructures of Kerman Municipality, and the behavior of actors in collecting recyclable waste. The drawing model was developed in Vensim software based on the collected field data and statistics from 2021 to 2022. The new scenario was defined based on the use of financial licenses to organize the informal collectors of recycled waste and separation from the origin of the definition and the assumptions of the model. Three scenarios of the existing situation, the basic license price of 500000 and 1000000 Tomans were examined and compared with each other. Results and Discussion: According to the results, in scenario 2, the municipality's share of the recycling market has increased by about 204%, and the amount of the municipality's profit, including the amount of the license issuance along with the discount, has increased by 232%. In scenario 3, the municipality's share of the recycling market has increased by about 400% compared to the current situation, and compared to the second scenario, it has increased by 64%, and the amount of the municipality's profit has increased by 507% compared to the current situation. Conclusion: Financial licenses in the field of municipal waste management have been used in their simplest form so far, which have been mostly ineffective. The use of smart financial and licensing systems based on field conditions, the dynamics of actors' behavior, and smart policies can be a suitable solution for organizing urban waste management, especially the informal waste collection fleet. [ABSTRACT FROM AUTHOR]

Moving Micro, Small and Medium Enterprises (MSMEs), in developing countries, from linear "take—make—dispose" production patterns to circular models where inputs and natural resources consumption is minimized, and products and waste reuse is promoted, is still a challenge. Environmental transition initiatives with multiple gaps, based on narrow and corrective approaches, isolated measures, and costly and complex technologies suitable for large companies, limit the incursion of MSMEs into the new circularity. It is in this context that the research aims to understand: How to accelerate the transition of MSMEs in developing countries towards circular production models? A critical literature review guided the design, development and analysis of the case study; a small coffee and pig farm located in Colombia, where a circular transition process was undertaken, acted as the unit of analysis. Interviews, theoretical and practical workshops, on-site measurements, systematic observations, and multi-stakeholder dialogs helped to collect and triangulate the empirical data provided by the case. By following systems thinking and sustainable and circular production principles, low-cost, simple and complementary clean technologies were implemented in the farm-system, resulting in multiple benefits at environmental, social and economic levels. This applied research helped to transform a small rural polluting enterprise into a greener and circular business. The study provides theoretical and empirical contributions to the field of research on the transfer of cleaner production and circular economy to MSMEs, expanding our knowledge on the subject. [ABSTRACT FROM AUTHOR]

Delivering effective messages is critical to creating a more sustainable and resilient culture. The explosion of social media has enhanced information access but has often reinforced and polarized pre-existing viewpoints and norms. In contrast, digital signs are an "in your face in your space" technology that have the potential to deliver common content to a diverse local audience. Environmental Dashboard (ED) is a communications platform and set of content applications that combines information on current environmental conditions, real-time resource consumption, positive actions being taken by community members, and a community calendar. We conducted a longitudinal study to assess whether ED content delivered via digital signs in public locations would result in desirable psychological changes within a community. Participants completed surveys in six designated signage locations prior to installation (N = 174) and following two years of continuous exposure (N = 133). We observed increases in pro-environmental social norms among people of color (a demographic emphasized); enhanced awareness of and sense of connection with the local community and ecology; increased self-reported electricity conservation; and increased perception of youth engagement (another demographic emphasized). Changes were mediated by exposure to digital signage. These findings support the hypothesis that content delivered through digital signs can strengthen pro-environmental and pro-social culture within communities. [ABSTRACT FROM AUTHOR]

This article presents a novel approach that integrates biophilic design, wellbeing science, and systems science into a holistic strategy designated as the Biophilic Wellbeing Systems Approach (BWSA). This transdisciplinary approach aims to enhance student wellbeing in educational settings by fostering a deep connection with nature, supported by positive psychology and systems thinking. The research explores how these combined disciplines can shape educational environments that improve learning outcomes and promote human thriving. The study advocates for a transformative redesign of school environments, emphasising the interdependence of individual and planetary health, drawing on Indigenous wisdom and contemporary scientific knowledge. This foundational strategy holds significant potential to fundamentally change how schools are designed and operated. By fostering environments that deeply integrate wellbeing principles, this approach not only influences the physical buildings but also extends to the entire school ecosystem. It works synergistically to promote educational excellence and holistic wellbeing, ensuring that all elements of the school environment contribute to the overall development and health of students and staff. [ABSTRACT FROM AUTHOR]

Like many Mediterranean areas, the Italian island of Sicily faces multiple environmental pressures such as soil loss, fire hazards, and extreme meteorological events, all of which negatively impact local food systems. In response to these threats, a re-thinking of local agriculture and natural resource management is increasingly needed. Agroecology is recognized as a robust proposal for building more resilient food systems grounded in farmers' knowledge and practices. However, agroecological farming experiences struggle to operate and survive in Sicily due to unfavorable political-cultural, environmental, and socio-economic conditions. Learning from small-scale farmers about the ways they perceive, understand, and overcome structural limits and environmental constraints is key for a transition to agroecology in the study area. Understanding its potentials and limits is essential for planning and identifying transformative actions. We approached the problem by adopting a participatory action research methodology involving selected groups of farmers in Western Sicily. We applied a co-creative approach and developed a systemic analysis of the socio-ecological narratives to identify possible leverage points for a transition to agroecology in the study area. We identified a local potential for shifting the current system of water and fire hazards management to new systems of participatory land stewardship. To be effective, these systems should support agroecological farmers' income by altering social practices related to food and reducing the influence of dominant agribusiness actors. Our findings indicate that implementing solutions based on the circulation of local ecological knowledge within systems of participatory guarantees can favor the development of solidarity economies and mutualistic relations between farmers, scientists, and communities. Our work suggests that scientists' facilitation and knowledge cocreation might be of key importance in structuring local, more sustainable food systems. [ABSTRACT FROM AUTHOR]

Background/Objectives: Given the complex nature of Anterior Cruciate Ligament (ACL) injury, it is important to analyze its etiology with suitable approaches in order to formulate intervention strategies for effective prevention. The present study employs system thinking techniques to develop a Causal Loop Diagram (CLD) Model for investigating the risk factors for ACL Injury (CLD-ACLI), through a Group Model Building approach. Methods: A two-stage procedure was applied involving a comprehensive literature review followed by several systems thinking group-modeling co-creation workshops with stakeholders. Results: Based on input from experts and stakeholders, combined with the latest scientific findings, the derived CLD-ACLI model revealed a series of interesting complex nonlinear interrelationships causal loops between the likelihood of ACL injury and the number of risk factors. Particularly, the interaction among institutional, psychological, neurocognitive, neuromuscular, malalignment factors, and trauma history seem to affect neuromuscular control, which subsequently may alter the biomechanics of landing, predisposing the ACL to injury. Further, according to the proposed CLD-ACLI model, the risk for injury may increase further if specific environmental and anatomical factors affect the shear forces imposed on the ACL. Conclusions: The proposed CLD-ACLI model constitutes a rigorous useful conceptual presentation agreed upon among experts on the dynamic interactions among potential intrinsic and extrinsic risk factors for ACL injury. The presented causal loop model constitutes a vital step for developing a validated quantitative system dynamics simulation model for evaluating ACL injury-prevention strategies prior to implementation. [ABSTRACT FROM AUTHOR]

The Swiss habitat-buildings and related mobility-faces multiple interconnected problems which can only be solved together. These include high energy consumption, significant climate impact, excessive material use with low circularity, accelerating urban sprawl and ecosystem destruction, high mobility costs, low inclusion, and mixed wellbeing outcomes. Guided by values of wellbeing for all within planetary boundaries, we propose a normative scenario based on a nationwide moratorium on new construction until 2100, coupled with four simultaneous neighborhood-scale interventions: renovating buildings to achieve energy class A with high indoor environmental quality, creating flexible shared living spaces, ensuring essential daily services are available within each neighborhood, and deconstructing unneeded settlements. Action levers, coordinated efforts on multiple system leverage points, are here combined with rethinking needs satisfiers. Our model predicts that full renovation could be accomplished in 14-18 years, significantly reducing labor, energy, materials, and costs both during and after the transition. Furthermore, it could reverse urban sprawl to levels seen in 1935 or even 1885, depending on deconstruction choices. These findings suggest that demand-side policies could be implemented with low risk, enhancing wellbeing, energy resilience, biodiversity, and climate action, thus providing a strong foundation for societal dialog and experimentation. [ABSTRACT FROM AUTHOR]

The Irish Food Vision 2030 (IFV 2030) seeks to restructure Ireland's agricultural food system to deliver long-term social, economic, and environmental sustainability in keeping with its commitment to the European Green Deal and the 2030 Sustainable Development Goals. This study investigates the effectiveness of the IFV 2030 in delivering on this commitment across the fresh produce supply chain in Ireland using a combination of data collected from stakeholders through a survey and systems thinking principles. A review of the literature and Foucault's genealogical methods guided the development of the survey. Systems thinking principles were used to review the IFV 2030 and assess its capacity to deliver large-scale change for a sustainable Irish food system. Barriers to change were identified, including historical patterns of behaviour between EU and Irish policymakers that have repeatedly hindered progress towards large-scale change events. The results demonstrate that successful, long-term change will depend on the involvement and incentives of stakeholders within the supply chain. Continuous stakeholder engagement is required through a bottom-up organisational and supply chain approach to deliver long-term sustainability within the fresh produce sector. Using a systems thinking lens brings benefits through transdisciplinary collaboration and fosters the multiple stakeholder perspectives needed to deliver new ideas and solutions. [ABSTRACT FROM AUTHOR]

Background: Current local food environments encourage poor diets, posing a significant threat to public and planetary health. Acknowledging and addressing its inherent complexity is vital to making meaningful improvements to the food environment. Using a participatory approach with local stakeholders, this study aims to gain insight into the factors and mechanisms underlying the local food environment and to identify leverage points and system-based actions to foster healthy and sustainable local food environments. Methods: A systems-thinking approach was used in a Dutch municipality in 2022. Two group model building (GMB) workshops were held with community stakeholders (e.g. local policymakers, retailers and residents). During the first workshop (June 2022), factors and mechanisms influencing the local food environment were identified and visualized through a causal loop diagram (CLD). During the second workshop, leverage points and system-based actions to improve food environments were identified by the stakeholders. Four months after (October 2022), an action-implementation meeting was organized to stimulate the implementation of selected actions. Progress was monitored through brief telephone interviews 6 and 12 months after the second workshop. Results: The CLD visualises the factors and mechanisms influencing the local food environment from the point of view of the community stakeholders. The CLD consists of 46 factors shaping the local food environment, which were categorized into four identified subsystems: societal factors, individual, socio-economic factors, commercial factors and political factors. Eight leverage points were identified within the CLD, for example, 'lobby from food industry', 'governmental food policies' and 'e-commerce and platform economy'. Stakeholders formulated 20 actions targeting the identified leverage points. During the action-implementation meeting, long-term plans were created for five actions. After 1 year, only one participant (policy advisory role) remained actively engaged in three of these actions. Conclusions: This study yields insight into the numerous factors and mechanisms underlying the local food environment and identified system-based actions as perceived by local stakeholders to improve this food environment locally. The CLD offers stakeholders valuable insights on employing a systems approach when enhancing food environments. More research is necessary, especially into the long-term processes and effects of implementing system-oriented actions to improve local food environments. [ABSTRACT FROM AUTHOR]

Background: Healthcare system sustainability is challenged by several critical issues; one of the most pressing is the ageing population. Traditional, episodic care delivery models are not designed for older people who are medically complex and frail. These individuals would benefit from health and social care that is more comprehensive, coordinated, person-centred and accessible in the communities in which they live. Delivering this is a challenging endeavour. Community-based health and social care professionals are siloed, dispersed across various locations and sectors, each with their own mental models, electronic health information systems, and means of communication. To move away from fragmented care delivery models and towards a more integrated approach to care, an analysis of the process of community-based comprehensive geriatric assessment was conducted in an urban location in Atlantic Canada. The purpose of the study was to identify where in the community-based comprehensive geriatric assessment process challenges and opportunities existed for moving towards a more integrated model of care delivery. Method: The functional resonance analysis method (FRAM) and dynamic FRAM (DynaFRAM) modelling were used to model the community-based health and social care system and create a hypothetical patient journey scenario. Data collected to inform modelling consisted of document review, focus groups, and semi-structured interviews with health and social care professionals providing care and service to older people in the community setting. Findings.: Challenges and opportunities for implementing integrated care in the local context were identified. Findings from the FRAM and DynaFRAM analysis informed the co-design of multi-level process improvement recommendations that aim to move the local community-based comprehensive geriatric assessment process towards a more integrated model of care. Conclusions: A transformative redesign of community-based health and social care in the local context is necessary but cannot be accomplished without an understanding of how health and social care professionals conduct their work and how older people may receive care under the dynamic conditions. The FRAM and DynaFRAM modelling provided an enhanced understanding of system operations and functionality and demonstrated a critical step that should not be overlooked for decision-makers in their efforts to implement a more integrated model of care. [ABSTRACT FROM AUTHOR]

The mangrove forest in Palawan has the most extensive distribution in the Philippines. The fisher community's perception of the mangrove forest as a known habitat for saltwater crocodiles (Crocodylus porosus) and its fishery benefits in Bugsuk Island were gathered using a participatory systems mental modeling framework for the coastal social-ecological system. From the causal loop diagram, six reinforcing and one balancing feedback loop were derived. The respondents observed a positive growth in the interaction between mangroves and crocodiles in Bugsuk Island, with both populations expanding and providing support to fishery resources. Bugsuk Island represents a unique diversity with great potential for resource conservation and economic benefit. [ABSTRACT FROM AUTHOR]

Workplaces cause employees to adopt sedentary behaviors for most of their daytime, negatively impacting psychophysical health. A new office concept (UP150) was designed to reduce sedentary behaviors at work through architectural changes, proactive technologies, and wellness coaches (education to active lifestyles). The present study examined the effects of the UP150 concept, previously investigated in dedicated workspaces, with a 12-month longitudinal trial in a real worksite environment. Forty-eight desk workers comprised the experimental (EG) and control (CG) groups. All participants worked in the same working environment, having the UP150 features inserted in a usual working environment, but the CG was not allowed to interact with the UP150 specifics. During the experimental year, physical (physical activity, motor efficiency, and anthropometric features), clinical (metabolic parameters and cognitive-capacity-related parameters), and psychological (well-being and discomfort, job social and psychological perceptions, and perceived workload) features were assessed. The prolonged application of the UP150 procedure in a mixed working context for involvement in corporate policies positively affected EG workers' physical (physical activity and motor efficiency increased, and body fat unchanged), clinical (blood glucose, insulin, and total cholesterol decreased; HDL increased), and psychological (well-being and social support raised; job demand and perceived workload lowered) parameters, confirming the previous studies. [ABSTRACT FROM AUTHOR]

A holistic approach to decision-making in modern energy systems is vital due to their increase in complexity and interconnectedness. However, decision makers often rely on narrowly-focused strategies, such as economic assessments, for energy system strategy selection. The approach in this paper helps considers various factors such as economic viability, technological feasibility, environmental impact, and social acceptance. By integrating these diverse elements, decision makers can identify more economically feasible, sustainable, and resilient energy strategies. While existing focused approaches are valuable since they provide clear metrics of a potential solution (e.g., an economic measure of profitability), they do not offer the much needed system-as-a-whole understanding. This lack of understanding often leads to selecting suboptimal or unfeasible solutions, which is often discovered much later in the process when a change may not be possible. This paper presents a novel evaluation framework to support holistic decision-making in energy systems. The framework is based on a systems thinking approach, applied through systems engineering principles and model-based systems engineering tools, coupled with a multicriteria decision analysis approach. The systems engineering approach guides the development of feasible solutions for novel energy systems, and the multicriteria decision analysis is used for a systematic evaluation of available strategies and objective selection of the best solution. The proposed framework enables holistic, multidisciplinary, and objective evaluations of solutions and strategies for energy systems, clearly demonstrates the pros and cons of available options, and supports knowledge collection and retention to be used for a different scenario or context. The framework is demonstrated in case study evaluation solutions for a novel energy system of clean hydrogen generation. [ABSTRACT FROM AUTHOR]

With growing awareness of the environmental, economic, and social costs associated with food waste, there is a concerted effort on multiple scales to recover the nutrient value of discarded food. These developments are positive, but the rapid movement toward alternatives and the complexity of solving problems located at the intersection of economic, social, and environmental systems also have the potential to produce unanticipated risks. This paper draws upon long-term stakeholder-engaged research throughout New England, with a focus on Maine, to develop a transdisciplinary, systems-based model of the potential social, economic, and environmental risks of food waste nutrient cycling. Our effort is intended to help inform the creation of safe, functional, and environmentally benign circular food systems. [ABSTRACT FROM AUTHOR]

In response to the pressing need for effective implementation of the Circular Economy (CE), this research introduces a comprehensive theoretical framework for CE roadmapping. This study addresses the prevalent issue of fragmented and inconsistent CE strategies that often hinder the successful translation of long-term goals into achievable KPIs. Through a carefully designed methodology, this framework incorporates strategic management, systems thinking, sustainability science, and other disciplines, providing a structured approach to navigating the complexities of long-term planning for CE. The foundation for this framework is laid through an extensive review of the literature, which identifies theoretical gaps and guides its development. Practical insights are gained through an examination of various CE roadmaps, including sectoral, municipal, national, and regional strategies, thereby enhancing this framework's applicability and robustness. This research highlights substantial variations in current CE roadmapping methods, emphasizing the need for a standardized approach. While acknowledging limitations due to the diverse contexts of the case studies, this study offers significant implications for policymakers, business leaders, and sustainability practitioners by presenting a versatile tool for strategic CE planning. Its interdisciplinary construction mirrors the multifaceted nature of CE, rendering it exceptionally adaptable across various disciplines and levels, reflecting the diverse reality of CE applications. [ABSTRACT FROM AUTHOR]