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.
METHODS: 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.
RESULTS: 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.

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.

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.

A rapid review was conducted to explore the implementation determinants of human papillomavirus (HPV) vaccination in the World Health Organization African Region and describe their dynamic relationship. PubMed and Google Scholar were searched in October 2023 to find relevant literature. A total of 64 published studies that reported factors affecting HPV vaccination were identified. Analysis of identified factors yielded 74 implementation determinants of HPV vaccination across the five domains of the Consolidated Framework for Implementation Research (CFIR): two (2.70%) were in the innovation domain, seven (9.46%) were in the outer setting domain, 14 (18.92%) were in the inner setting domain, 37 (50%) were in the individual domain and 14 (18.92%) were in the implementation process domain. A causal loop diagram of these implementation determinants revealed four balancing and seven reinforcing loops. Applying systems lens promoted a more holistic understanding of the implementation determinants of HPV vaccination, exposing leverage points for interventions.

One Health is dedicated to maintaining and fostering a dynamic balance among humans, animals, and the environment. Since 2013, it has seen considerable developments globally. This review aims to encapsulate the history of One Health, as well as chart its future trajectory. Numerous research institutions founded under the principles of One Health have been established, and several pragmatic projects are currently underway. While it is imperative to solidify foundational education, further policy support is required to cultivate the One Health paradigm. Identifying research directions at a political level is necessary to provide the technical support needed for practical application. The future of One Health envisions a comprehensive approach to primary prevention, the utilization of open and shared data sets, as well as real-world surveys and interviews. This integrated approach is encapsulated in the concept of One Health Delivery. At this stage, One Health Delivery needs to build a systematic framework that focuses on integrating and communicating across disciplines and training researchers with complete practical skills.

We argue for reconsidering leadership development based on open systems theory and systems design principles. A primary advantage of open systems thinking is that it encourages holistic approaches to development and avoids episodic program-based training and piecemeal thinking. The latter approaches are both limited and limiting yet tend to be the preferred approach to leadership development in organizations. Open systems approaches to development offer numerous advantages both conceptually and pragmatically, especially through the incorporation of ongoing feedback cycles. Core practices that define a leadership development system are presented and implications are discussed.

The issue of lacking standardized organizational guidance is examined in the context of providing patient-centered care to meet the needs of an aging population. Standardization across an integrated organization is increasingly recognized as a social justice concern in the pursuit of equitable and timely healthcare delivery, particularly as the healthcare industry grapples with a severe nursing shortage in the United States. A master project plan methodology (MPPM) was tested to effectively develop an electronic Age-Friendly 4Ms documentation tool using the system development lifecycle (SDLC) framework. The MPPM successfully guided the design and national implementation, achieving an 84% installation rate across 124 facilities within one of America\'s largest integrated healthcare systems.

The implementation of health informatics in pre-registration health professional degrees faces persistent challenges, including curriculum overload, educator workforce capability gaps, and financial constraints. Despite these barriers, reports of successful implementation of health informatics pre-registration nursing programs exist. A virtual workshop was held during thein 15th International Nursing Informatics Conference in 2021 with the aim to explore successful implementation strategies for incorporating health informatics into the nursing curriculum to meet the accreditation standards. This paper reports recommendations from the workshop emphasising the importance academic-clinical partnerships to develop innovative approaches to enhance theof capacity of academic teams and access to contemporary point of care digital technologies that reflect applications of health informatics in interdisciplinary clinical settings.

UNASSIGNED: Athletes\' mind wandering during competition has positive and negative effects. The purpose of this study was to explore the reason for these bidirectional effects.
UNASSIGNED: We recruited 51 athletes from China to take part in semi-structured interviews in which we explored their experiences of mind wandering in competition. We used grounded theory combined with systems thinking to complete the data analysis and theoretical construction.
UNASSIGNED: Results showed that the influence of mind wandering on sporting performance was dynamically influenced by \"mind wandering source,\" \"competition anxiety,\" \"content of mind wandering,\" \"attentional resources\" and \"attentional control,\" resulting in our development of the theory of \"mind wandering in sporting performance (MWSP).\" The above factors determine how mind wandering occurs and how it affects the competition.
UNASSIGNED: Although the occurrence of mind wandering during competition has positive effects, its negative effects cannot be ignored, which may lead to athletes losing the race (costs over benefits). Potential strategies focusing on the mitigation of negative effects and promotion of positive effects of mind wandering are discussed.

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.