Choice versus valuation in spatial decisions: Framing, attention, and preference reversal.

Food pantries serve as critical community nutrition access points, particularly during emergencies when demand for food assistance increases. However, the operational systems needed to sustain nutrition services under surge conditions are not well characterized. This study assessed emergency preparedness and scalability readiness among food pantries to identify systems-based leverage points for improving continuity of nutrition care during crises. A cross-sectional evaluation was conducted with 19 food pantries in Baltimore City and Baltimore County. Directors completed two instruments: a 38-item preparedness questionnaire grouped into four domains (Training/Knowledge, Operations, Communication, and Safety) and an 87-item environmental checklist measuring characteristics relevant to scalability. Descriptive statistics, Pearson correlations, and nonparametric group comparisons were used to examine preparedness, scalability, and associated pantry characteristics. Overall preparedness was moderate (mean = 1.18 on a 0-2 scale), with large variability across domains. Communication preparedness was lowest, and 42.1% of pantries had low scalability readiness. Preparedness and scalability were strongly correlated (r = 0.90, p < 0.001). Pantries able to deliver food to off-site locations and those with higher recent neighbor throughput demonstrated significantly higher preparedness and scalability (p < 0.05). Traditional infrastructure characteristics showed no associations. Communication systems, surge workflows, and workforce capacity were the primary determinants of emergency response capability. Strengthening these interconnected system functions may support both preparedness and scalability, helping food pantries maintain equitable nutrition access during emergencies. These findings highlight opportunities for registered dietitian nutritionists to advance systems-based practice within the charitable food system.

Access to mental health and psychosocial support among migrants in transit in Colombia

Australia's increasingly diverse classrooms include growing numbers of refugee-background students whose educational experiences are shaped by cultural, linguistic, and socio-emotional complexity. Yet assessment in Australian schools still relies heavily on standardised, language-dependent, norm-referenced measures that privilege monolingual, middle-class, Eurocentric benchmarks. These systems often overlook multilingual repertoires and culturally mediated ways of demonstrating knowledge, misrepresenting capability and reinforcing structural inequities. This systematic review examines how Culturally Responsive Assessment (CRA) can address such bias and promote equity for refugee-background learners in Australian K–12 schools.Guided by the PRISMA 2020 framework, a systematic search of Scopus, ERIC, Web of Science, ProQuest, and Google Scholar identified 21 peer-reviewed studies published between 2010 and 2025. The corpus included qualitative, mixed-methods, conceptual, and review-based research. Data extraction and coding, managed in NVivo, followed Thomas and Harden’s (2008) thematic synthesis approach and were informed by Vygotsky's Sociocultural Theory.Findings show that standardised assessments such as NAPLAN, grounded in monolingual, Eurocentric, and middle-class norms, systematically misrepresent refugee-background students' knowledge and potential. By contrast, CRA practices—arts-based, narrative, multilingual, and community co-designed tasks—recast assessment as multimodal, relational, and dialogic, foregrounding students’ cultural identities, linguistic resources, and participatory agency. These practices enact key Vygotskian concepts of mediation, cultural tools, and the zone of proximal development by emphasising what learners can do with scaffolded support rather than decontextualised written performance. However, CRA implementation is constrained by test-centric accountability regimes, tokenistic school–community engagement, fragmented policy settings, and gaps in teacher preparation and trauma-informed support.The review concludes that CRA can serve as a transformative framework for assessment equity when embedded within a broader sociocultural–intersectional, trauma-informed, and socioecological agenda. It proposes a typology of four systemic domains—policy alignment, teacher professional capacity, community partnership and co-design, and trauma-informed integration—as key leverage points for reform to move CRA from isolated classroom innovation toward sustained institutional change.

Current consumption of animal-based protein sources is environmentally unsustainable and poses risks to human health, animal welfare, and food security. Policymakers in many countries seek to reduce the consumption of animal-based protein sources. However, this transition is affected by many factors, and it remains unclear how they interact and what their potential is for stimulating systemic change. This study synthesized stakeholders' perspectives on factors driving the consumption of animal- and plant-based protein sources into a Causal Loop Diagram (CLD), visualiing factors and their cause-and-effect relationships. Three Group Model Building sessions with 28 stakeholders (consumers, researchers, industry representatives, policymakers, interest group members) from the Netherlands informed the CLD. The Action Scales Model was used to categorize factors into system levels (events, structures, goals, and beliefs), providing insights into their potential for systemic change. The resulting CLD reveals the complexity of protein consumption across five interconnected subsystems: 1) Individual Aspects, 2) Social Interactions & Culture, 3) Physical Food Environment, 4) Food Industry & Natural Food Environment, and 5) Politics & Regulation. The high interconnectivity indicates isolated interventions are unlikely to be sufficient for systemic change, as feedback mechanisms may counteract or neutralize their effects. Addressing multiple elements across the system is thus essential to accelerate the protein transition. This study provides a foundation for understanding the system dynamics shaping consumption of animal- and plant-based protein sources. However, further research is needed to incorporate quantitative weighting, determine the relative importance of mechanisms and identify leverage points for systemic change to guide policy development.

Understanding inpatient nurse turnover among new graduates: A scoping review of factors impacting the first 2 years of practice.

Accurate estimation of the population mean is often hindered by the presence of outliers, leverage points, and departures from the model assumptions in survey data. To overcome these challenges, this article suggests a new class of hybrid exponential–logarithmic estimators for the population mean under simple random sampling (SRS). The proposed estimators integrate robust regression techniques namely, Huber-M, Hampel-M, Tukey-M, least trimmed squares (LTS), least median of squares (LMS), and Huber-MM, with exponential and logarithmic transformation structures. Algebraic expressions for bias and mean squared error (MSE) are derived up to the first-order approximation. Theoretical efficiency comparisons demonstrate the superiority of the proposed estimators over the existing robust counterparts. Extensive Monte Carlo simulations and a real data application further validate the theoretical results, demonstrating that the suggested estimators consistently achieve lower MSE in outlier-contaminated data. These findings highlight the practical utility of the proposed hybrid class as a reliable and efficient tool for the robust mean estimation in survey sampling.

Sea-level rise threats to food security: A review of agrifood system resilience in the Lower Fraser Valley, BC.

Assessment frameworks do not capture the complexity of the social-ecological dynamics of small-scale fisheries (SSF), which support millions of livelihoods yet face persistent sustainability challenges. Reciprocal feedbacks between fish populations and fishers that are central to sustainability remain insufficiently integrated into assessment approaches because conventional fisheries management emphasizes population dynamics, whereas social-ecological systems research focuses on social drivers and faces operational challenges. We propose an integrative diagnostic approach that explicitly links fish population dynamics with theories of fisher behavior and governance. We illustrate its application using co-managed arapaima fisheries in the Amazon Basin, where sustainability emerges from multi-scalar social and ecological interactions. By capturing these feedbacks, the approach bridges ecological and social dimensions to identify key drivers of sustainability. It provides a replicable, interdisciplinary framework for diagnosing SSF sustainability and identifying leverage points to support adaptive governance across diverse contexts.

Waste management and carbon emission reduction, both central to the Sustainable Development Goals, are increasingly encouraged to be integrated due to the strong and inherent linkages between waste generation and greenhouse gas emissions. A system-wide understanding of this relationship across the entire supply chain, from production to final consumption, is fundamental for identifying leverage points for source reduction. This study provides a novel city-level assessment of the coupling coordination between waste and carbon emissions in China. The results reveal that, although megalopolises act as consumption hubs, benefiting from reduced local generation of hazardous waste, industrial solid waste, and carbon emissions through outsourced production, they still exhibit consistently high coupling coordination between carbon and waste emissions. Furthermore, demand-side strategies are equally critical because coupling coordination is 20.4-68.8% higher from the consumption perspective than from the production perspective, underscoring the decisive role of final demand in driving upstream environmental pressures. Between 2015 and 2019, the average coordination between hazardous waste and carbon emissions from a production perspective increased by 18.4%, whereas other coordination indicators remained relatively stable. The strengthening was particularly pronounced in medium and small cities, where increases in hazardous waste and carbon intensities were the primary drivers, outweighing the influence of sectoral output changes. These findings provide a foundation for integrated environmental governance to support both carbon neutrality and zero-waste development goals.

The incidence of Chlamydia trachomatis (C. trachomatis) infections is increasing globally, with approximately 131 million new cases annually, leading to significant reproductive health complications. Evidence on the impact of chlamydia prevention and treatment programs in developing countries is scarce, leaving a critical gap in implementation. This study, conducted in Guangdong Province, China, aims to identify leverage points to facilitate evidence implementation by visualizing key factors and their interrelationships influencing chlamydia control through a causal loop diagram (CLD). In this mixed-methods study, variables were systematically identified through literature review (n = 15 studies), forming an initial conceptual model. Qualitative interviews with 70 stakeholders across five cities revealed implementation barriers and facilitators, refining the model. Second, a semi-quantitative MICMAC (Impact Matrix Cross-reference Multiplication Applied to Classification) analysis was employed to calculate link density and ranked influence-dependence measures. The initial CLD consists of a main framework and four subsystems-Center for Public Health (CPH), Hospital, Target Audience, and the Government-comprising a total of 47 variables. A thematic analysis of the interview data revealed four major themes: health education, policy support, accurate identification of high-risk populations, and adherence. Two central feedback loops capture the core mechanisms. The first is a balancing loop involving policy requirements, community mobilization, and health education coverage and influencing variables such as condom promotion, infection rates, and disease burden. The second is a reinforcing loop driven by the public's awareness of chlamydia prevention and control, amplifying the effects of educational outreach and stigma reduction efforts. Triangulation revealed alignment in health education centrality. These findings inform the development of context-specific interventions for chlamydia control in resource-limited settings. Health education, supported by policy and community engagement, may represent a central intervention. Targeted actions, such as expanding premarital and prenatal consultations and youth outreach in remote areas, could help reduce transmission through addressing stigma and other social barriers to care. Future system dynamics modeling is recommended to evaluate the long-term economic impact of chlamydia control and guide sustainable policy investment. Not applicable.

Red lists provide critical knowledge regarding biodiversity decline, especially in Finland, where broad assessments have been made regularly since the 1980s. They deliver information on the threat status of species and ecosystems, propose actions to guide conservation policy, and have the potential to spur transformative change. We examined whether the transformative potential of the proposals has changed over time. We analyzed the contents qualitatively and quantitatively of seven Finnish Red Lists of Species or Ecosystems from 1986 to 2019. We used a prior analysis of transformative potential of conservation actions in the Conservation Measures Partnership classification (such as outreach or conservation designation and planning), which identified Meadows' sustainability leverage points (i.e., in complex systems, a point at which a small change can lead to large changes) associated with each action category. We also determined the number of proposals that overlapped with sectors beyond conservation. We used a nonparametric Mann-Kendall trend test and linear models to analyze temporal trends in the data. Cross-sectoral proposals increased over time, but there was only a small shift toward actions that influenced the root causes of biodiversity loss (i.e., deep leverage actions). In the qualitative assessment of how the actions were proposed to be implemented, actions became more complex and effectiveness of implementation increased, demonstrating a change within conservation action categories toward deeper leverage points. This increasing transformative potential can be a catalyst and a consequence of broader societal change driven by ongoing biodiversity loss. Red lists could play a role in transformative change, but the engagement of actors across society in devising action proposals must be inclusive and cover expertise from the social sciences and humanities. Our results emphasize the importance of considering complementary dimensions of transformative change simultaneously to achieve a comprehensive understanding of viable paths to societal change.

Participatory system dynamics (SD) approaches view public health problems as the result of a complex system of interactions. However, most public health research makes a direct leap from system mapping-often through causal loop diagrams (CLDs)-to identifying actions for change, without trying to understand the behaviour of the system as a whole and how actions could intervene. This is possibly because robust methods are lacking. This study aimed to explore whether 'systems archetypes' can bridge this gap to (1) better understand system behaviour, (2) identify leverage points (LPs) for change deeper in the system, and (3) provide a more structured and traceable analysis. We developed a novel approach using 11 systems archetypes for a post hoc analysis of the LIKE project-a participatory SD project on childhood obesity prevention in Amsterdam, the Netherlands. For each LIKE mechanism, we compiled a complete archetype profile, including the storyline, CLD, and behaviour over time graph, for which two were cross-checked with empirical data over time. We identified six systems archetypes. The most common was 'fixes that fail', in which a 'fix' applied to a problem creates unintended consequences that reinforce the problem. This can lead to 'shifting the burden' in which resources are siphoned from addressing the root cause of the problem. Compared with the original analysis, we identified LPs deeper in the system and found that systems archetypes structured the process, suggesting that systems archetypes can effectively help public health researchers hypothesize how to change system behaviour.

To map factors influencing nurses' engagement in clinical mentorship in nursing education and explore their interactions using network analysis. Observational cross-sectional study employing an online survey from July 2024 to May 2025. A total of 261 clinical mentors from healthcare institutions in Catalonia, Spain, completed the survey. Key variables included engagement in clinical mentorship (implication, motivation, satisfaction, compromise), perceived obstacles, ward manager support, emotional intelligence, emotional wellbeing, working and employment conditions. Data were analysed using regularized partial correlation network analyses. Centrality indices were calculated to determine the most influential variables within the network structure. Motivation, ward manager support, and emotional intelligence emerged as the most central, interconnected drivers of engagement. Motivation showed positive associations with commitment and implication in the mentoring role and a negative association with perceived obstacles. Ward manager support was linked to emotional wellbeing and peer support, reflecting the importance of psychosocial resources. Emotional intelligence appeared to support motivation, work control, and satisfaction with the mentoring role. In contrast, professional experience and employment conditions showed limited influence within the network. This study provides a comprehensive understanding of how multiple factors interact to shape nurses' engagement in clinical mentorship. Motivation, ward manager support, and emotional intelligence represent key leverage points for strengthening mentorship practices. Sustainable, high-quality clinical practicums require supportive work environments that recognize and foster mentors' intrinsic motivation, leadership support, and emotional skills. Clinical mentors are essential to student learning, and so is their engagement in the mentoring role. This study is the first to apply network analysis to this process, revealing that motivation, emotional intelligence, and ward manager support are central to engagement, while professional experience and employment conditions are less relevant. These findings can guide institutional strategies to promote supportive and nurturing clinical learning environments. The manuscript is based on the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). This study did not include patient or public involvement in its design, conduct, or reporting.

Background: Informal dementia caregiving constitutes a substantial yet underrecognized form of work that places significant demands on family caregivers. Mexican American families, who experience disproportionate dementia burden and structural barriers to care, often rely on intensive family-based caregiving. While prior research has examined cultural values, stigma, and resource barriers separately, less attention has been paid to how these factors interact within a work system to shape caregiver burden. Objective: We characterized informal dementia caregiving among Mexican American families as work performed within a sociotechnical system, and examined how work system components interact to shape caregiver outcomes using the Systems Engineering Initiative for Patient Safety (SEIPS) 3.0 framework. Methods: We conducted semi-structured interviews with 15 Mexican American dementia caregivers in a U.S.-Mexico border community. Using constructivist grounded theory, we analyzed informal caregiving as work embedded within everyday contexts through the SEIPS 3.0 lens. Analysis examined interactions among person characteristics, caregiving tasks, organizational supports, tools and resources, and the broader cultural and linguistic environment. Findings: Caregiving labor was sustained by strong cultural commitment but its structure limited delegation and support access. Cultural beliefs framing care as a non-delegable family responsibility, stigma inhibiting disclosure, demanding physical and emotional labor, language barriers restricting organizational access, and uneven distribution of care within families collectively imposed burden on individual family members, most often daughters or wives. Caregivers actively sought information and resources, yet system-level barriers constrained utilization. These interacting conditions produced predictable outcomes: exhaustion, declining health, and burnout. Conclusions: Viewing dementia caregiving as work clarifies why relationally meaningful care becomes unsustainable without supportive systems. Caregiver burden emerges from interactions within the caregiving work system rather than isolated cultural or individual factors. This perspective highlights stigma reduction and language-concordant services as key intervention leverage points through system-level approaches that sustain family caregiving without relying on individual endurance.

Rheumatology Care in an Aging World: Global Perspectives on Payment Models and Access for Older Adults.

ABSTRACTThere are high expectations that agricultural practices can mitigate climate change and improve soil health by increasing soil organic carbon (SOC) stocks. However, existing large scale SOC monitoring treats agricultural management as a black box, meaning that observed patterns and trends cannot inform on the option space of agricultural practices to improve or deteriorate SOC stocks. Here, we combine for the first time management data from large scale systematic farm surveys (n = 248,362 farms) and representative soil monitoring data (n = 8834 locations) to quantify the impact of agricultural practices on three SOC metrics across all pedoclimatic zones of Europe (EU + UK): stocks, stocks relative to pedoclimatic benchmarks, and yearly change in SOC concentration. Our findings show that in arable and tree crops, but not in grasslands, management intensity is a significant contributor to SOC loss, with impact varying by soil and climate region. However, we also observed that several practices (e.g., high share of manure, organic management, and a high proportion of leys in crop rotation) demonstrated potential for increasing SOC stocks. Under a scenario where all agricultural land in Europe would be managed as that of the 10% most optimally managed farms in terms of SOC benefit, SOC stocks would increase by 1.58 Pg C across Europe (95% CI: 1.27–1.89 Pg C). Whereas under a scenario where farms are managed as the 10% least optimally managed farms, SOC would decrease by −0.92 Pg C (−1.15 to −0.68 Pg C). However, it is important to note that these estimates reflect steady‐state SOC stocks only (i.e., they do not represent the transient build‐up or loss over time, or interactions with a changing climate). This paper thus quantifies how agricultural practices influence patterns in SOC stocks at the continental scale, identifying leverage points for site‐specific policies to improve SOC stocks.

Mental health services fail to provide culturally safe care for Aboriginal peoples, contributing to persistent health disparities. Understanding how psychiatric care is organized, alongside lived experiences of care, may identify leverage points for service redesign. To examine Aboriginal mental health care pathways using integrated qualitative and quantitative analysis. This mixed-methods study was conducted from June 2022 to December 2023 at the Great Southern Mental Health Service in Western Australia. Twenty Aboriginal adults were recruited; the quantitative component included 19 patients with 1108 documented clinical interactions, and 7 participated in in-depth yarning interviews. Novel analytical methods included a community-preserving surrogate network algorithm and transition-matrix trajectory clustering. Centrality metrics identifying key agents in the clinical interaction network; patient trajectory clustering based on clinical action sequences; qualitative themes from yarning interviews using reflexive thematic analysis. A total of 20 Aboriginal adults were recruited; the quantitative analysis included 19 patients (mean [SD] age, 38.4 [15.9] years; 10 women and 9 men) with 1108 documented interactions, with 7 patients (mean [SD] age, 44.0 [17.8] years; 4 women and 3 men) participating in qualitative yarning interviews. The clinical interaction network had a core-periphery structure in which patients often served as the main link between external agents and hospital staff. Aboriginal mental health workers had closeness centrality above the 99th percentile in surrogate networks, indicating a structurally distinctive central position within the network. Trajectory analysis identified 3 care pathways: predominantly internal care, prolonged internal engagement, and complex external referral with repeated readmissions. Qualitative themes emphasized cultural safety, kinship, and ongoing trauma and showed inconsistent Aboriginal mental health worker presence during crises, while integrated analyses highlighted their pivotal yet vulnerable role within fragmented care pathways, underscoring the need for trauma-informed, culturally safe redesign. In this mixed-methods study, Aboriginal mental health workers occupied central bridging positions, and patients were intermediaries between disconnected parts of the system. Strengthening culturally grounded roles and redesigning care pathways based on operational information flow may improve care coordination and cultural safety in multisetting mental health systems.

African swine fever (ASF) poses an ongoing threat to pig production and wild boar across Europe. Controlling ASF in wild boar builds a complex system with many stakeholders involved. Participatory modelling complements traditional risk assessments by identifying leverage points, revealing practical barriers, and supporting adaptive, context-sensitive management in complex animal health systems. To strengthen ASF preparedness in Switzerland, we applied participatory modelling by engaging stakeholders from two regions in the co-development of semi-quantitative system models for the anticipated control of ASF in wild boar. Through a structured series of workshops, participants collaboratively identified key control measures, their leveraging and hindering factors and potential consequences within and beyond the ASF response system. Within the model, control measures were prioritised based on their expected impact over time within the system. Across regions, the stakeholder-informed model consistently prioritized measures related to coordination, operational communication amongst stakeholders and risk communication to the public, and carcass search and disposal. Many of the top-ranked measures came from thematic areas not covered in that-time existing technical guidelines, reflecting the added value of participatory approaches. Across regions, influencing factors such as coordination structures, legal frameworks, and resource availability, including trained personnel and carcass search dogs, were identified as critical enablers for effective ASF control. The analysis revealed a growing emphasis on clear and centralised government leadership. Beyond model outputs, the participatory modelling process fostered trust, strengthened cross-sectoral networks, and enhanced co-construction of knowledge. These findings highlight the value of participatory approaches for embedding stakeholder expertise into disease control planning, leading to shared ownership of ASF preparedness strategies.

In this viewpoint, we argue that developing a sustainable future for the built environment requires new relationships – among humans, between humans and organisations, and between humans and non-humans – as both a prerequisite and a powerful leverage point for sustainable change. We contend that nurturing relationships among stakeholders is fundamental to transformative change in the built environment, and that context-specific, creative, and participatory strategies are essential for building trust. We illustrate our viewpoint with examples from a New European Bauhaus project that supported such leverage points by engaging the local community and multiple actors through interventions incorporating artistic practices as well as place-based, creative, and participatory design methods. • Forming relationships are key leverage points for a sustainable built environment. • Nurturing deep leverage points can lead to transformative shifts in mindsets. • Emphasis should be on studying their formation over time through local processes and interactions. • A sustainability focus advocates for new relationships among humans and nonhumans. • Engaging through artistic, place-based, and design can impact relationships among multiple stakeholders.