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Evaluating whether sustainability indicator schemes contribute to better sustainable destination management has proven challenging. We adopt a systems thinking approach to shed light on the elusive impacts of sustainable tourism indicator schemes. We conduct online participatory workshops with 19 experts in sustainable tourism monitoring, to produce a causal loop diagram that illustrates how destination systems behave when indicator schemes are implemented. The results show that until now, these schemes have been expected to follow utopian, evidence-based, policy pathways to change, but we now understand that this linear-thinking approach fails to recognize the complex interplay of factors that occur during implementation. We find that indicator schemes can spark a rich, yet unappreciated, series of conceptual, instrumental, and structural dynamics. We conclude that the hidden power of these schemes lies in their ability to foster dialog, stimulate learning, incentivize network development, challenge stakeholder worldviews, and steer systems change toward sustainable destination management. [ABSTRACT FROM AUTHOR]

This paper presents causal loop diagrams (CLDs) as tools for studying complex public health problems like health inequality. These problems often involve feedback loops—a characteristic of complex systems not fully integrated into mainstream epidemiology. CLDs are conceptual models that visualize connections between system variables. They are commonly developed through literature reviews or participatory methods with stakeholder groups. These diagrams often uncover feedback loops among variables across scales (e.g. biological, psychological and social), facilitating cross-disciplinary insights. We illustrate their use through a case example involving the feedback loop between sleep problems and depressive symptoms. We outline a typical step-by-step process for developing CLDs in epidemiology. These steps are defining a specific problem, identifying the key system variables involved, mapping these variables and analysing the CLD to find new insights and possible intervention targets. Throughout this process, we suggest triangulating between diverse sources of evidence, including domain knowledge, scientific literature and empirical data. CLDs can also be evaluated to guide policy changes and future research by revealing knowledge gaps. Finally, CLDs may be iteratively refined as new evidence emerges. We advocate for more widespread use of complex systems tools, like CLDs, in epidemiology to better understand and address complex public health problems. [ABSTRACT FROM AUTHOR]

There is a gap in the literature regarding the complex interrelationships among hamstring injury (HI) risk factors. System dynamics (SD) modeling is considered an appropriate approach for understanding the complex etiology of HI for effective injury prevention. This study adopted the SD method and developed a causal loop model (CLD) to elucidate the intricate relationships among HI risk factors. This is performed by combining literature evidence and insights from expert stakeholders through a group model building (GMB) approach. The GMB methodology facilitated the identification of sixty-five critical factors influencing the HI risk, revealing the dynamic interplay between factors. Stakeholder engagement underscored the importance of previous injury characteristics (level of influence of previous injury, severity of previous injury, quality and size of scar tissue) and the quality of rehabilitation. HI-CLD revealed that many factors had indirect effects on HI risk. The HI-causal loop model establishes a foundation for a future stock and flow quantitative SD model aiming to advance HI prevention strategies through an interdisciplinary collaborative effort. These findings underscore the complexity of HI prevention, necessitating a holistic approach that integrates the views of diverse professional expertise. Appropriate inter-professional collaboration and continuous athlete screening are important for effective injury prevention strategies. [ABSTRACT FROM AUTHOR]

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Tingting Qin, Xingming Li, Kun Qiao, Xinyuan Bai, Mingyu Gu, Yao Wang School of Public Health, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Xingming Li, School of Public Health, Capital Medical University, No. 10 Xitoutiao, Youanmenwai, Fengtai District, Beijing, 100069, People’s Republic of China, Email xingmingli@ccmu.edu.cnPurpose: Group Model Building (GMB) is a qualitative method that refers to a participatory process. This project aims to identify barriers and facilitators of hypertension management in primary health care in China, through which, the leverage point for intervention may be found.Methods: The GMB was used to identify the factors influencing hypertension management. Graphs over time and causal loop diagram (CLD) were main tools of GMB. To propose the influencing factors, key stakeholders were invited to participate in a workshop. During the workshop, stakeholders were encouraged to plot the graphs over time of the variables about research issues and give a descriptive explanation. And based on this, a CLD was initially developed to establish a model of the interaction of factors. After the workshop, the research group further improved the CLD through repeated mutual discussions, and gave feedback to the participants. The Vensim PLE 9.0 software package was used to build CLD.Results: A total of 14 key stakeholders were invited to participate in the workshop. Finally, 26 influencing factors were identified, which were divided into three dimensions, including the institutional, the community health workers (CHWs), and the patient level. And 5 reinforcing loops and 4 balancing loops were formed in the CLD. Promoting the building of the Medical Community/Regional Medical Association, implementing the family doctor contract service (FDCS), and enhancing the motivation of CHWs may be potential leverage points for hypertension management in China.Conclusion: By using GMB, we have identified key factors in the management of hypertension in primary health care and provided comprehensive suggestions to overcome the obstacles.Keywords: group model building, hypertension management, primary health care, causal loop diagram, system dynamics

Banyumas is one of the famous tourist destinations in Central Java with its natural attractions. Tourism growth in Banyumas requires capable and sustainable transportation infrastructure. However, current policies and investments in Banyumas are inappropriate for developing transportation and tourism infrastructure that creates non-significant impact. Therefore, the development of tourism projection should consider environmental, social, economics, and technology interrelated in developing transportation and tourism infrastructure issues. The tourism supply chain has a unique structure that is different from typical supply chains with high complexity because many stakeholders are involved. This research aims to project Banyumas tourism development with the impact of transportation system improvement. This conceptual model was developed from literature reviews and other necessary sources, and then validated by experts. The conceptual model examines the relationship between variables involved in the tourism supply chain and transportation system in Banyumas that can be developed into a quantitative model using Causal Loop Diagram, an initial stage of system dynamics. This model used to analyze the behavior of visitor projection of the Banyumas tourism supply chain system in Indonesia. [ABSTRACT FROM AUTHOR]

Background: This study takes on the challenge of quantifying a complex causal loop diagram describing how poverty and health affect each other, and does so using longitudinal data from The Netherlands. Furthermore, this paper elaborates on its methodological approach in order to facilitate replication and methodological advancement. Methods: After adapting a causal loop diagram that was built by stakeholders, a longitudinal structural equation modelling approach was used. A cross-lagged panel model with nine endogenous variables, of which two latent variables, and three time-invariant exogenous variables was constructed. With this model, directional effects are estimated in a Granger-causal manner, using data from 2015 to 2019. Both the direct effects (with a one-year lag) and total effects over multiple (up to eight) years were calculated. Five sensitivity analyses were conducted. Two of these focus on lower-income and lower-wealth individuals. The other three each added one exogenous variable: work status, level of education, and home ownership. Results: The effects of income and financial wealth on health are present, but are relatively weak for the overall population. Sensitivity analyses show that these effects are stronger for those with lower incomes or wealth. Physical capability does seem to have strong positive effects on both income and financial wealth. There are a number of other results as well, as the estimated models are extensive. Many of the estimated effects only become substantial after several years. Conclusions: Income and financial wealth appear to have limited effects on the health of the overall population of The Netherlands. However, there are indications that these effects may be stronger for individuals who are closer to the poverty threshold. Since the estimated effects of physical capability on income and financial wealth are more substantial, a broad recommendation would be that including physical capability in efforts that are aimed at improving income and financial wealth could be useful and effective. The methodological approach described in this paper could also be applied to other research settings or topics. [ABSTRACT FROM AUTHOR]

Reintroducing locally extinct/extirpated species has been considered as an approach for restoring ecosystems. Although such projects share the same goals of rebuilding previously affected ecosystems, the overall impacts that such reintroductions generate on both ecosystems and human society, i.e., on the social-ecological system, are difficult to measure. We propose a system dynamics approach, a platform on which both natural and social scientists could collaborate to identify the social-ecological impacts of species reintroduction as well as factors that affect such decision making. We use cases in Japan to demonstrate the potential applicability of system dynamics in terms of (1) understanding the impacts of a previously reintroduced species, the Oriental Stork (Ciconia boyciana), and (2) predicting the impacts of reintroduction of wolves (Canis lupus). We present a causal loop diagram of the social and ecological effects of Oriental Stork reintroduction, and we discuss how the relationships between factors could be articulated based on empirical data and ongoing projects in Japan. The model demonstrates how local residents began to appreciate the rich biodiversity, including the Oriental Stork, following its reintroduction, and how public support toward such reintroduction enhanced further projects to reintroduce these species in different parts of Japan. A similar diagram, created to illustrate the social and ecological effects of the potential reintroduction of wolves to Japan, demonstrates how social factors such as environmental education and public attitudes could affect decision making as well as ecological factors such as predator-prey dynamics and overall biodiversity. Further, humanwolf conflicts could negatively affect the overall loop. Creating causal loop diagrams can help managers and stakeholders understand that species reintroduction projects need to be considered via an interdisciplinary approach. The models illustrate that these problems are dynamic and that the factors affecting or affected by such projects change over time, implying the importance of both the spatial and temporal scales in managing reintroduction projects. [ABSTRACT FROM AUTHOR]

The research is expected to provide in-depth insight into how the role of the project owner affects the success of port infrastructure projects using a design-build approach, as well as provide a basis for increased efficiency and effectiveness in the implementation of the project. This research proposes a causal loop diagram model to provide an overview of the influence of the Owner's role in achieving the cost, time, and quality success of the Port Infrastructure Design-Build project. Research variables are obtained through in-depth literature studies and interviews with project owners and project practitioners experienced in design-build projects. Based on the literature study in this study, it has been formulated that the critical role of the owner is an essential factor of the owner in carrying out the project to achieve the goals that have been set. [ABSTRACT FROM AUTHOR]

Desert locust (Schistocerca gregaria) infestations cause significant damage to crops and pastureland, impeding food security and livelihoods globally. In recent years, some East African countries have suffered severe desert locust outbreaks, causing significant harm to agriculture and local communities. To comprehensively understand and mitigate the socio‐economic impacts of this pest, an integrated assessment approach is crucial. This study proposes an integrated assessment model that combines ecological, economic, and social dimensions to analyze the multifaceted impacts of the desert locust on the rate of urbanization changes, farming expansion, and food production and how they lead to food unavailability (demand, supply, and price) and food and nutrition insecurity in Eastern Africa. A system dynamics‐based assessment model was first developed for Sudan using the dynamic relations among the factors and their variations over time and how they affect the socio‐economic variables. The developed model was used to spatially simulate the impacts over the entire Eastern Africa. Various scenarios were further simulated and analyzed, incorporating different policy options to effectively mitigate the impacts. Results demonstrated that in all the countries, desert locusts extensively contribute to the slowing down of farming expansion and food production and supply. Consequently, these factors lead to increased urbanization rates through people rural‐urban migration and food demand at different magnitudes across different countries. By considering both short‐term and long‐term effects, this approach aims to provide policymakers, researchers, and practitioners with a holistic understanding of the complex dynamics involved and inform effective management strategies. For example, communities equipped with accurate breeding detection tools and employing an integrated pest management strategy combining chemical pesticides and biopesticides had the highest potential for effectively mitigating the future impacts of desert locusts for enhancing community livelihood. Plain Language Summary: Desert locusts are a major problem for agriculture and communities in East Africa. They eat crops and grasslands, which can lead to food shortages and higher prices. To better understand and deal with this issue, we have created a model that looks at how locusts affect things like farming, urbanization, and food supply. We studied this in Sudan and then applied it to the whole of East Africa. The results showed that locusts make farming harder and push more people to move from rural areas to cities. This causes more demand for food in cities. The study tested different ways to deal with locusts and found that communities with good tools for detecting locusts and using both chemical and biopesticide control methods were the best at reducing the impact of locusts on their lives. This study gives policymakers and others a better understanding of how locusts affect communities and how to manage them effectively in the future. Key Points: In Eastern Africa, desert locusts swarm in vast numbers, devouring crops, and vegetation, causing crop production losses ranging from 42% to 69%The system dynamics model was employed for a comprehensive analysis of the impacts, scenarios, and policy options for mitigating desert locust effectsDesert locusts hinder farming, reduce food production, spur urbanization, and heighten food insecurity across affected Eastern African countries [ABSTRACT FROM AUTHOR]

As part of the global efforts to mitigate climate change, policymakers are designing measures to reduce the carbon emissions of the freight transport system. As global agreements for decarbonisation specify strict time windows, it is important to understand the speed at which the transport system is capable of changing. Our paper proposes a causal loop diagram based on System Dynamics that qualitatively maps the system's causal and dynamic responses to five key decarbonisation strategies. As the main contribution, this conceptual model provided a broad overview of the freight system, formed by subsystems that interact with each other through feedback loops, forming its dynamic behaviour. Through this conceptual modelling effort, we can identify the rebound effects of policies over the whole system, which could defeat the desired decarbonisation results. The model pointed out policies and feedback loops as the dynamic levers to promote freight decarbonisation and influence the system's dynamic responses. [ABSTRACT FROM AUTHOR]

Abstract Background Healthy sleep is crucial for the physical and mental wellbeing of adolescents. However, many adolescents suffer from poor sleep health. Little is known about how to effectively improve adolescent sleep health as it is shaped by a complex adaptive system of many interacting factors. This study aims to provide insights into the system dynamics underlying adolescent sleep health and to identify impactful leverage points for sleep health promotion interventions. Methods Three rounds of single-actor workshops, applying Group Model Building techniques, were held with adolescents (n = 23, 12–15 years), parents (n = 14) and relevant professionals (n = 26). The workshops resulted in a multi-actor Causal Loop Diagram (CLD) visualizing the system dynamics underlying adolescent sleep health. This CLD was supplemented with evidence from the literature. Subsystems, feedback loops and underlying causal mechanisms were identified to understand overarching system dynamics. Potential leverage points for action were identified applying the Action Scales Model (ASM). Results The resulting CLD comprised six subsystems around the following themes: (1) School environment; (2) Mental wellbeing; (3) Digital environment; (4) Family & Home environment; (5) Health behaviors & Leisure activities; (6) Personal system. Within and between these subsystems, 16 reinforcing and 7 balancing feedback loops were identified. Approximately 60 potential leverage points on different levels of the system were identified as well. Conclusions The multi-actor CLD and identified system dynamics illustrate the complexity of adolescent sleep health and supports the need for developing a coherent package of activities targeting different leverage points at all system levels to induce system change.

Abstract Background Interest in applying a complex systems approach to understanding socioeconomic inequalities in health is growing, but an overview of existing research on this topic is lacking. In this systematic scoping review, we summarize the current state of the literature, identify shared drivers of multiple health and health behavior outcomes, and highlight areas ripe for future research. Methods SCOPUS, Web of Science, and PubMed databases were searched in April 2023 for peer-reviewed, English-language studies in high-income OECD countries containing a conceptual systems model or simulation model of socioeconomic inequalities in health or health behavior in the adult general population. Two independent reviewers screened abstracts and full texts. Data on study aim, type of model, all model elements, and all relationships were extracted. Model elements were categorized based on the Commission on Social Determinants of Health framework, and relationships between grouped elements were visualized in a summary conceptual systems map. Results A total of 42 publications were included; 18 only contained a simulation model, 20 only contained a conceptual model, and 4 contained both types of models. General health outcomes (e.g., health status, well-being) were modeled more often than specific outcomes like obesity. Dietary behavior and physical activity were by far the most commonly modeled health behaviors. Intermediary determinants of health (e.g., material circumstances, social cohesion) were included in nearly all models, whereas structural determinants (e.g., policies, societal values) were included in about a third of models. Using the summary conceptual systems map, we identified 15 shared drivers of socioeconomic inequalities in multiple health and health behavior outcomes. Conclusions The interconnectedness of socioeconomic position, multiple health and health behavior outcomes, and determinants of socioeconomic inequalities in health is clear from this review. Factors central to the complex system as it is currently understood in the literature (e.g., financial strain) may be both efficient and effective policy levers, and factors less well represented in the literature (e.g., sleep, structural determinants) may warrant more research. Our systematic, comprehensive synthesis of the literature may serve as a basis for, among other things, a complex systems framework for socioeconomic inequalities in health.

Background: Healthy sleep is crucial for the physical and mental wellbeing of adolescents. However, many adolescents suffer from poor sleep health. Little is known about how to effectively improve adolescent sleep health as it is shaped by a complex adaptive system of many interacting factors. This study aims to provide insights into the system dynamics underlying adolescent sleep health and to identify impactful leverage points for sleep health promotion interventions. Methods: Three rounds of single-actor workshops, applying Group Model Building techniques, were held with adolescents (n = 23, 12–15 years), parents (n = 14) and relevant professionals (n = 26). The workshops resulted in a multi-actor Causal Loop Diagram (CLD) visualizing the system dynamics underlying adolescent sleep health. This CLD was supplemented with evidence from the literature. Subsystems, feedback loops and underlying causal mechanisms were identified to understand overarching system dynamics. Potential leverage points for action were identified applying the Action Scales Model (ASM). Results: The resulting CLD comprised six subsystems around the following themes: (1) School environment; (2) Mental wellbeing; (3) Digital environment; (4) Family & Home environment; (5) Health behaviors & Leisure activities; (6) Personal system. Within and between these subsystems, 16 reinforcing and 7 balancing feedback loops were identified. Approximately 60 potential leverage points on different levels of the system were identified as well. Conclusions: The multi-actor CLD and identified system dynamics illustrate the complexity of adolescent sleep health and supports the need for developing a coherent package of activities targeting different leverage points at all system levels to induce system change. [ABSTRACT FROM AUTHOR]

The purpose of this report is to provide a perspective on the use of qualitative systems mapping, provide examples of physical activity (PA) systems maps, discuss the role of PA systems mapping in the context of iterative learning to derive breakthrough interventions, and provide actionable recommendations for future work. Systems mapping methods and applications for PA are emerging in the scientific literature in the study of complex health issues and can be used as a prelude to mathematical/computational modeling where important factors and relationships can be elucidated, data needs can be prioritized and guided, interventions can be tested and (co)designed, and metrics and evaluations can be developed. Examples are discussed that describe systems mapping based on Group Model Building or literature reviews. Systems maps are highly informative, illustrate multiple components to address PA and physical inactivity issues, and make compelling arguments against single intervention action. No studies were identified in the literature scan that considered cardiorespiratory fitness the focal point of a systems maps. Recommendations for future research and education are presented and it is concluded that systems mapping represents a valuable yet underutilized tool for visualizing the complexity of PA promotion. [ABSTRACT FROM AUTHOR]

Project risk management (PRM) involves identifying risks, assessing their impact, and developing a contingency plan. A structured contingency management (CM) approach prevents subjective biases in analyzing risks and developing responses. Previous studies have either focused on improving the accuracy of risk estimates or analyzed, from a qualitative perspective, the relationships between perceived risk and project performance. This study aimed to improve PRM by providing a risk-perception-based contingency management framework (CMF). The CMF guides contingency depletion based on two short- and long-term cost overrun indicators and their respective thresholds. Thresholds and the initial contingency reserve amount are determined by applying the Monte Carlo method to a stochastic, discrete-event, finite-horizon, dynamic project simulation model. The study developed the CMF through a structured approach, validating the simulation model on eight specific project configurations. The results prove that the framework can be applied to any project, shaping the risk response strategy. This study contributes to PRM by explaining the relationships between risk perception and risk responses and providing a prescriptive CM tool. [ABSTRACT FROM AUTHOR]

Sustainable development (SD) is of prime importance in the present world, where resources are depleting fast and causing conflicts among nations to control essential resources. Since the construction industry (CI) consumes most of these resources, Construction Sustainability (CS) is a key focus of SD. Among the three pillars of sustainability, i.e., economic, environmental, and social, the first two have been amply addressed by researchers. However, the social aspects have been neglected or under-researched so far. The current research humbly attempts to fill this gap. Accordingly, a System Dynamics Model (SDM) has been developed to address this issue. After a comprehensive literature review, questionnaire survey, content analysis, and gathering the opinions of ten experts from CI, 11 key factors of social CS were identified. Using the system thinking approach, a causal loop diagram (CLD) was developed to assess the intensity and polarity of these factors. The CLD encompassed eight reinforcing loops and one balancing loop. Based on the CLD, an SDM was developed and simulated over 3 years. Primarily, the SDM had two stocks: "Government support for sustainable construction" and "Stakeholder awareness and knowledge". An additional stock named "Construction Sustainability" was added to observe the combined effect of the system. The results showed that CS increased over time. The CLD and resulting SDM help in understanding the complex interaction of the social CS factors and thereby addressing the associated complexity of the effects of these varied factors on a project. Such knowledge can be valuable for anyone dealing with projects where social factors play a significant role. The proposed SDM provides a structured approach to understanding and visualizing the intricate relationships and feedback loops within a social system, aiding in more effective decision making and problem solving. [ABSTRACT FROM AUTHOR]

To achieve the goals of carbon peaking and carbon neutrality, China is actively promoting carbon reduction in many areas. Agriculture is one of the main sources of greenhouse gas emissions, and promoting the development of low-carbon agriculture is a critical way to achieve carbon reduction targets. Taking Chongming District in Shanghai as an example, this study summarizes the experience of low-carbon agricultural development in Chongming and analyzes the problems and challenges faced during its development. Finally, based on the system dynamics method, the causal relationship of carbon emission in Chongming's agricultural development is constructed, and feasible loop optimization suggestions are put forward. [ABSTRACT FROM AUTHOR]

Background: Interest in applying a complex systems approach to understanding socioeconomic inequalities in health is growing, but an overview of existing research on this topic is lacking. In this systematic scoping review, we summarize the current state of the literature, identify shared drivers of multiple health and health behavior outcomes, and highlight areas ripe for future research. Methods: SCOPUS, Web of Science, and PubMed databases were searched in April 2023 for peer-reviewed, English-language studies in high-income OECD countries containing a conceptual systems model or simulation model of socioeconomic inequalities in health or health behavior in the adult general population. Two independent reviewers screened abstracts and full texts. Data on study aim, type of model, all model elements, and all relationships were extracted. Model elements were categorized based on the Commission on Social Determinants of Health framework, and relationships between grouped elements were visualized in a summary conceptual systems map. Results: A total of 42 publications were included; 18 only contained a simulation model, 20 only contained a conceptual model, and 4 contained both types of models. General health outcomes (e.g., health status, well-being) were modeled more often than specific outcomes like obesity. Dietary behavior and physical activity were by far the most commonly modeled health behaviors. Intermediary determinants of health (e.g., material circumstances, social cohesion) were included in nearly all models, whereas structural determinants (e.g., policies, societal values) were included in about a third of models. Using the summary conceptual systems map, we identified 15 shared drivers of socioeconomic inequalities in multiple health and health behavior outcomes. Conclusions: The interconnectedness of socioeconomic position, multiple health and health behavior outcomes, and determinants of socioeconomic inequalities in health is clear from this review. Factors central to the complex system as it is currently understood in the literature (e.g., financial strain) may be both efficient and effective policy levers, and factors less well represented in the literature (e.g., sleep, structural determinants) may warrant more research. Our systematic, comprehensive synthesis of the literature may serve as a basis for, among other things, a complex systems framework for socioeconomic inequalities in health. [ABSTRACT FROM AUTHOR]

Complexity science and systems thinking are increasingly recognized as relevant paradigms for studying systems where biology, psychology, and socioenvironmental factors interact. The application of systems thinking, however, often stops at developing a conceptual model that visualizes the mapping of causal links within a system, e.g., a causal loop diagram (CLD). While this is an important contribution in itself, it is imperative to subsequently formulate a computable version of a CLD in order to interpret the dynamics of the modeled system and simulate "what if" scenarios. We propose to realize this by deriving knowledge from experts' mental models in biopsychosocial domains. This article first describes the steps required for capturing expert knowledge in a CLD such that it may result in a computational system dynamics model (SDM). For this purpose, we introduce several annotations to the CLD that facilitate this intended conversion. This annotated CLD (aCLD) includes sources of evidence, intermediary variables, functional forms of causal links, and the distinction between uncertain and known-to-be-absent causal links. We propose an algorithm for developing an aCLD that includes these annotations. We then describe how to formulate an SDM based on the aCLD. The described steps for this conversion help identify, quantify, and potentially reduce sources of uncertainty and obtain confidence in the results of the SDM's simulations. We utilize a running example that illustrates each step of this conversion process. The systematic approach described in this article facilitates and advances the application of computational science methods to biopsychosocial systems. Systems thinking is essential to study complex problems that arise from many interacting system parts at different levels. An example of a complex problem is depression, related to individual biological and psychological characteristics, but also our society and environment. To schematically describe which system parts are important in explaining a complex problem, it is common to draw a visual representation of the system that produces the problem, i.e., a causal loop diagram (CLD). Even though a CLD can tell us a lot about the origins of a complex problem, it cannot show what the effect would be if a system part were changed. For example, even if the CLD indicates that income inequality is an important system part in explaining depression, we still cannot tell from just this visual representation whether depression rates would change if income inequality were reduced. To answer such questions, we need to develop a computational model reflecting the CLD: a computer program that can calculate what would happen under different conditions. This article describes how to create a CLD that can be converted into a computational system dynamics model. We propose to achieve this conversion by asking experts to communicate their knowledge about individual system parts and storing this information within the CLD. This expert knowledge then helps us calculate what happens when all system parts interact simultaneously. This method can aid in answering questions about the effects of changes in system parts for a broader range of complex problems. [ABSTRACT FROM AUTHOR]

The discourse surrounding digital transformation (DT) and sustainable development (SD) is pervasive in contemporary business and organizational operations, with both processes considered indispensable for sustainability. The success or failure of these endeavors hinges significantly on factors such as the behavior and skill sets of individuals within organizations. Thus, the purpose of the paper is twofold: to investigate the perceptions of organizations on digital transformation and sustainable development with regards to skills and education, and, secondly, to use the insights from these perceptions as a starting point for the use of systems thinking as a tool that could assist in achieving these states. To achieve the objective, a research effort was conducted that included desktop research, interviews with experts, and the development of a survey that was disseminated across Europe with questions on digital transformation and sustainable development. Finally, a general causal loop diagram was designed, illustrating the processes of digital transformation and sustainable development within organizations from a top-down view. The study reveals commonalities between DT and SD, recognizing both processes as advantageous with shared deficiencies in specific skill sets. It highlights a synergistic relationship between initiating DT and fostering SD activities. Furthermore, the research underscores the temporal aspects of these processes, acknowledging delayed positive effects and immediate implementation costs that challenge decision-makers to balance long-term benefits with short-term viability. In conclusion, the exploration emphasizes the dynamic nature of DT and SD, urging continual attention to the evolving landscape and the imperative for a shared understanding within organizational contexts. [ABSTRACT FROM AUTHOR]

Background: Youth experiencing homelessness (YEH) suffer from poorer physical and mental health outcomes than stably housed youth. Additionally, YEH are forced to navigate fragmented health and social service systems on their own, where they often get lost between systems when transitioning or post-discharge. Inevitably, YEH require support with health system navigation and healthcare coordination. The aim of this study is to understand interactions within and between the emergency youth shelter (EYS) and health systems that affect healthcare coordination for YEH in Toronto, Canada, and how these interactions can be targeted to improve healthcare coordination for YEH. Methods: This study is part of a larger qualitative case study informed by the framework for transformative systems change. To understand interactions in healthcare coordination for YEH within and between the EYS and health systems, we developed a causal loop diagram (CLD) using in-depth interview data from 24 key informants at various levels of both systems. Open and focused codes developed during analysis using Charmaz's constructivist grounded theory methodology were re-analysed to identify key variables, and links between them to create the CLD. The CLD was then validated by six stakeholders through a stakeholder forum. Results: The CLD illustrates six balancing and one reinforcing feedback loop in current healthcare coordination efforts within the EYS and health systems, respectively. Increasing EYS funding, building human resource capacity, strengthening inter and intra-systemic communication channels, and establishing strategic partnerships and formal referral pathways were identified among several other variables to be targeted to spiral positive change in healthcare coordination for YEH both within and between the EYS and health systems. Conclusions: The CLD provides a conceptual overview of the independent and integrated systems through which decision-makers can prioritize and guide interventions to strengthen healthcare coordination within and between the EYS and health systems. Overall, our research findings suggest that key variables such as streamlining communication and improving staff–youth relationships be prioritized, as each of these acts interdependently and influences YEH's access, quality and coordination of healthcare. [ABSTRACT FROM AUTHOR]

This study aims to analyze how organizational culture can affect social sustainability indicators. Through an extensive review of the literature with a qualitative systems-based approach, multiple factors of organizational culture and social sustainability indicators are identified. Moreover, linkages and interdependencies among them in a complex system are generated from the data collected from 97 construction industry professionals. In total, five causal loop diagrams (CLDs) are developed in which the effect of organizational culture on social sustainability in the construction industry is illustrated. The result of a systematic analysis of content indicates the most impacting factors that incorporate the literature and industry scores. Among these factors, goal setting and teamwork orientation, respecting and caring for communities and impact assessment are most significant with scores of 0.124 and 0.126. Furthermore, to map the effect of organizational culture on social sustainability, the factors in CLD are prioritized because of their strength and speed of influence in the system. The results in CLDs highlight that respecting and caring for communities, impact assessment, awareness of social sustainability, and opportunity for skills development are the most crucial and mutually affecting factors among different loops impacted by organizational culture. Moreover, the identified CLDs indicate robust loops and resonant mechanisms which give information on different factors within the complex system and can assist decision-makers and top management to make robust strategies and policies for assessing the impact of organizational culture on social sustainability through their underlying interdependencies. [ABSTRACT FROM AUTHOR]

The world faced a crisis called the coronavirus pandemic, a disease that has been able to disrupt a large proportion of the power and activities of the whole world and has evolved all economic and social decisions. These decisions are primarily related to restrictions such as widespread lockdowns and social distancing. Different countries have taken various approaches and decisions to deal with this situation, each of which has positive and negative sides. Apart from this issue, the rapid spread of this pandemic has affected researchers' knowledge and viewpoints about this disease. Without any doubt, to expand our scientific knowledge and reduce the side effects of this challenge, it is essential to evaluate the behavior of COVID-19. Moreover, developing an effective vaccine in the short term was challenging. Regarding this issue, systematic thinking not only helps to find various ways to prevent this illness from spreading throughout the world but also reduces the mortality rate of this viral disease. From a systematic thinking perspective, governments and individuals play pivotal roles. They take care of vulnerable groups, support health employees, provide general education, identify new patients, and control specific situations in their countries. In such a situation where experts have not discovered any vaccine, governments and the people of society can be considered essential parameters to intensify or reduce the outbreak of this viral disease throughout the country. This paper's main objective and motivation are to utilize causal loop diagrams (CLDs) to evaluate and determine various affecting factors created by governments and members of societies that have direct impacts on deteriorating or decreasing the outbreak of COVID-19 in Iran from a system dynamics perspective. Hence, the statistics on the incidence and deaths caused by the coronavirus in Iran were extracted during some periods. Using the cause and effect diagrams, the behavior of the people and the government in increasing or decreasing the number of patients is discussed. [ABSTRACT FROM AUTHOR]

Banyumas is one of the famous tourist destinations in Central Java with its natural attractions. Tourism growth in Banyumas requires capable and sustainable transportation infrastructure. However, current policies and investments in Banyumas are inappropriate for developing transportation and tourism infrastructure that creates non-significant impact. Therefore, the development of tourism projection should consider environmental, social, economics, and technology interrelated in developing transportation and tourism infrastructure issues. The tourism supply chain has a unique structure that is different from typical supply chains with high complexity because many stakeholders are involved. This research aims to project Banyumas tourism development with the impact of transportation system improvement. This conceptual model was developed from literature reviews and other necessary sources, and then validated by experts. The conceptual model examines the relationship between variables involved in the tourism supply chain and transportation system in Banyumas that can be developed into a quantitative model using Causal Loop Diagram, an initial stage of system dynamics. This model used to analyze the behavior of visitor projection of the Banyumas tourism supply chain system in Indonesia.

Abstract Desert locust (Schistocerca gregaria) infestations cause significant damage to crops and pastureland, impeding food security and livelihoods globally. In recent years, some East African countries have suffered severe desert locust outbreaks, causing significant harm to agriculture and local communities. To comprehensively understand and mitigate the socio‐economic impacts of this pest, an integrated assessment approach is crucial. This study proposes an integrated assessment model that combines ecological, economic, and social dimensions to analyze the multifaceted impacts of the desert locust on the rate of urbanization changes, farming expansion, and food production and how they lead to food unavailability (demand, supply, and price) and food and nutrition insecurity in Eastern Africa. A system dynamics‐based assessment model was first developed for Sudan using the dynamic relations among the factors and their variations over time and how they affect the socio‐economic variables. The developed model was used to spatially simulate the impacts over the entire Eastern Africa. Various scenarios were further simulated and analyzed, incorporating different policy options to effectively mitigate the impacts. Results demonstrated that in all the countries, desert locusts extensively contribute to the slowing down of farming expansion and food production and supply. Consequently, these factors lead to increased urbanization rates through people rural‐urban migration and food demand at different magnitudes across different countries. By considering both short‐term and long‐term effects, this approach aims to provide policymakers, researchers, and practitioners with a holistic understanding of the complex dynamics involved and inform effective management strategies. For example, communities equipped with accurate breeding detection tools and employing an integrated pest management strategy combining chemical pesticides and biopesticides had the highest potential for effectively mitigating the future impacts of desert locusts for enhancing community livelihood.

There is a gap in the literature regarding the complex interrelationships among hamstring injury (HI) risk factors. System dynamics (SD) modeling is considered an appropriate approach for understanding the complex etiology of HI for effective injury prevention. This study adopted the SD method and developed a causal loop model (CLD) to elucidate the intricate relationships among HI risk factors. This is performed by combining literature evidence and insights from expert stakeholders through a group model building (GMB) approach. The GMB methodology facilitated the identification of sixty-five critical factors influencing the HI risk, revealing the dynamic interplay between factors. Stakeholder engagement underscored the importance of previous injury characteristics (level of influence of previous injury, severity of previous injury, quality and size of scar tissue) and the quality of rehabilitation. HI-CLD revealed that many factors had indirect effects on HI risk. The HI-causal loop model establishes a foundation for a future stock and flow quantitative SD model aiming to advance HI prevention strategies through an interdisciplinary collaborative effort. These findings underscore the complexity of HI prevention, necessitating a holistic approach that integrates the views of diverse professional expertise. Appropriate inter-professional collaboration and continuous athlete screening are important for effective injury prevention strategies.

Water supply and wastewater systems are essential infrastructure affected by floods. Additional risk is posed in developing countries, where access to sanitation is not universal. Few studies assess the flood risk to the sanitation-health nexus. Therefore, this study aims to present a theoretical and general framework for assessing the resilience of flood-sanitation-public health nexus in urban environments, composed by risk estimation and risk management assessment. The framework was developed from a system analysis approach focusing on central supply systems. Regarding risk assessment, the main vulnerability and exposure factors identified were land use, social vulnerability, coverage of sanitation systems, occurrence of waterborne diseases, number of people affected by floods and intersection with the flood map. From the risk management assessment stage three main typologies of trade-offs and synergies were identified: urban territorial planning versus runoff control, water quality versus sanitation infrastructure and flood management policy versus social behavior. [ABSTRACT FROM AUTHOR]

To achieve Goal 13, which addresses climate change and promotes sustainable development, mitigation policies, and measures have been implemented globally and nationally. However, such practices can lead to unintended side effects, which vary between countries based on their economic structures and governance status and may jeopardise the achievement of other goals. It is vital to alleviate these effects, especially in vulnerable countries. To do so, a comprehensive assessment of the potential impacts of policies must be conducted, and appropriate interventions must be implemented to mitigate the negative effects that have already begun in oil-exporting developing countries. This study aims to assess the cross-border consequences of response measures on Iran's economic, social, and environmental status using a Causal Loop Diagram (CLD). The findings indicate that these policies directly affect the government's revenues and expenditures, which in turn affect economic activities and indirectly affect socioeconomic variables. [ABSTRACT FROM AUTHOR]

Background: A hospital's operating theater service system is a large-scale, complicated system that must be carefully managed to offer the best possible results for its patients. Unlike other industries such as manufacturing and logistics, system dynamics (SD) methodologies are not extensively applied in hospital operating theaters. This study deals with the future development and possible future scenarios for hospital operating rooms in Bangladesh. Methods: Due to demographic dynamics and demographic processes, increased pressures on hospital care are expected in Bangladesh. The SD model anticipates possible future scenarios, reconciles service capacities and the variability of patient demand, and reduces patient congestion and waiting times in the hospital area. This study introduces a causal loop diagram to show a causal link between the hospital operating theater system variables. It also introduces a stock flow diagram to understand the dynamic behavior of the system. Results: The model validation testing reports that in extreme conditions, such as a 50% reduction in the patient arrival rate, the model is valid and runs as usual. Conclusions: This first work of SD modeling for hospital operating theater systems can help healthcare managers, decision makers, or researchers of any responsibility level make better predictions in order to reduce patient waiting times and backlogs and make appropriate decisions. [ABSTRACT FROM AUTHOR]

This article details the first step in the system dynamics analysis of the systems engineering process for the evolution of legacy systems into an enterprise. This step develops a model that depicts the interaction of the various components associated with the system of interest. This model is a collection of causal loop diagrams that will foster the development of a novel framework known as the enterprise lifecycle model, which will support system dynamics analysis through three stages: planning, development, and execution. Peer‐reviewed academic and industry sources will be utilized to understand how accepted literature defines this analysis. Specifically, this model will be based on the Vee lifecycle model as well as the Agile and Iron Triangle frameworks. Supplemental elements will be added to these diagrams to incorporate the environment within which the system of interest is planned, developed, and executed. Additional factors, such as quality management, will be added to complete the super system and system of interest views of the enterprise lifecycle model—with the goal of creating a model depicting a reductive and holistic view that aids in the reduction of complexity surrounding the systems engineering process used to prepare legacy systems for evolution into an enterprise and support the definition of the desired target system. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to examine the dynamism of causal relationships among cloud computing (CC) adoption factors in the Indian context, considering the perspectives of both the cloud adopter and cloud provider. Design/methodology/approach: The case-study method has been used to understand the dynamics among the factors. Using data from specific cases in India, causal loop diagrams (CLDs) have been developed. System dynamic modeling (SDM) and simulation are used to study the relationships and their effect on the adoption rate. Findings: The results revealed that adoption of CC depends on various factors such as persuasion (time-saving, cost-saving and word of mouth) and constraint factors (security and financial loss). However, it is seen that the adoption rate is very sensitive to changes in adoption per contact and word of mouth. Further, the adopter firm has a quicker time to market, which gives an added advantage to the firm. Also, with CC services, a firm can fulfill its projects or clients' requirements with little to no upfront investment in information technology (IT) services. Practical implications: Lack of security, standardization and undefined service-level agreements are a few pressing issues that make it difficult for firms to evaluate the performance and reliability of services. Hence, immediate attention is needed to make transparent policies on CC and its services, thereby building trust. Originality/value: This is the first and only work that has tried to explore and empirically test the dynamics of critical factors while making an adoption decision, considering both the adopter and provider perspectives. This study shows the journey of a firm, starting from being a prospective adopter to an adopter and continuous user. The work also empirically tested how adopters of technology benefit from the technology. [ABSTRACT FROM AUTHOR]

This research aims to analyze vessel crew rotation during the COVID-19 pandemic at a national shipping company. Before the pandemic, vessel crew recruitment was carried out based on company procedures safely and on time. In contrast to when the COVID-19 pandemic swept the world, the vessel crew recruitment and rotation system significantly changed. Concerns about being infected with the deadly COVID-19 virus have made vessel crew rotations unpredictable and scheduled on time. Mapping and identification of vessel crew rotation variables dynamically using the causal loop diagram (CLD) technique. This model shows that the vessel crew rotation process requires handling, quick adjustments to the existing situation, and planning strategies on the vessel crew rotation during this pandemic. The CLD analysis results show that in systems thinking, vessel crew performance and company performance have the highest impact. The delay in implementing and handling the vessel crew rotation will affect the company's reputation. Also, it may result in the termination of collaboration between the company and the recruitment agency, resulting in distrust in the company. [ABSTRACT FROM AUTHOR]

The Water-Ecosystem-Food Nexus is a powerful framework developed for analyzing complex interlinkages among natural resource domains and overcoming "siloed" management practices. Multi-actor participatory approaches are increasingly recognized in Nexus research as the most effective way to identify trade-off solutions between divergent interests. Despite this acknowledged potential, the active engagement of stakeholders for the co-creation of knowledge is still limited to date, missing the opportunity for innovation processes and policy designs to be grounded in context-specific knowledge and experiences. This paper outlines the methodological framework developed to integrate stakeholder analysis and participatory tools for exploring Nexus challenges in a pilot area in Tarquinia, Italy, where a multi-stakeholder group was set up encompassing several categories at different levels, from policymakers and authorities to farmers and other end users. Systematic methodologies to target, analyze, and actively engage stakeholders were applied and multidomain participatory tools were developed, i.e., Stakeholder Analysis and Mapping, Learning and Action Alliance, Participatory System Dynamic Modelling, which broaden the agreement on potential locally-tailored solutions for sustainable farming practices and integrated management of natural resources. Mutual learning activities, tapping into actors' deep understanding of specific local dynamics, served to better frame the complexity of the Nexus and build a common understanding of local societal challenges as well as of potential innovations in farming practices, land, and water management. The methodological innovation of integrating stakeholder mapping and analysis with relevant spatial information from participatory activities, provides the fundamental baseline for spatially explicit scenario analysis in the area, ultimately increasing the relevance and transferability of the Nexus findings. [ABSTRACT FROM AUTHOR]

Dental caries is a prevalent chronic disease among adolescents. Caries activity increases significantly during adolescence due to an increase in susceptible tooth surfaces, immature permanent tooth enamel, independence in pursuing self-care, and a tendency toward poor diet and oral hygiene. Dental caries in permanent teeth is more prevalent among adolescents in low-income families and racial/ethnic minority groups, and these disparities in adolescent dental caries experience have persisted for decades. Several conceptual and data-driven models have proposed unidirectional mechanisms that contribute to the extant disparities in adolescent dental caries experience. Our objective, using a literature review, is to provide an overview of risk factors contributing to adolescent dental caries. Specifically, we map the interactive relationships of multilevel factors that influence dental caries among adolescents. Such interactive multilevel relationships more closely reflect the complex nature of dental caries experience among the adolescent population. The methods that we use are two-fold: (1) a literature review using PubMed and Cochrane databases to find contributing factors; and (2) the system dynamics approach for mapping feedback mechanisms underlying adolescent dental caries through causal loop diagramming. The results of this study, based on the review of 138 articles, identified individual, family and community-level factors and their interactions contributing to dental caries experience in adolescents. Our results also provide hypotheses about the mechanisms underlying persistence of dental caries among adolescents.ConclusionsOur findings may contribute to a deeper understanding of the multilevel and interconnected factors that shape the persistence of dental caries experience among adolescents.