Changes In System Research Articles

Applying the Multimodal Improvement Strategy framework to understand current gaps in the use of antibiograms in hospitals caring for children with cancer in the Eastern Mediterranean and African regions

Abstract Background Empiric use of antibiotics in sick children guided by local antimicrobial susceptibilities (AMS) increases initial therapy effectiveness. Antibiograms (ABG) are cumulative AMS based on results of isolates susceptible to antimicrobial agents routinely tested in an institution over a specific time period. Although ABG use can enhance healthcare quality, for optimum quality healthcare the World Health Organization (WHO) recommends the use of frameworks such as the multimodal improvement strategy (MMIS). We used the MMIS framework to analyze the literature and understand gaps in using ABG in low- and middle-income countries (LMIC). The 5 WHO MMIS components are: system change, training and education, monitoring and feedback, reminders and communication, and a culture of safety, summarized as “build it, teach it, check it, sell it, and live it”. By combining elements of a scoping methodology with the MMIS framework, we reviewed the literature surrounding ABG and report the results here. Methods We assembled a 24-member working group (WG) interested in improving infection care and prevention (ICP) in their institutions in the Eastern Mediterranean and African regions. The WG members (physicians, pharmacists, and microbiologists) met virtually twice monthly from March to October 2023. We searched PubMed using essential keywords such as antibiogram, antibiotic, antimicrobial, antibacterial, isolate, and sensitivity test, and supporting keywords such as misuse, resistance, adherence, guideline, susceptibility, development, improvement, stewardship, low-income, middle-income and LMIC. Any identified additional papers were screened for relevance. We grouped the literature according to the five components of the MMIS framework focusing on information on the ABG tool, training in ABG, the outcomes of its use, promotion of its use, and elevation of its importance institutionally. The WG members reviewed literature assigned to each of the five MMIS components, and presented oral reports of main points, gaps, and how to fill the gaps according to a rubric encompassing relevance assessment, methodological evaluation, content evaluation and recommendations. Results We identified 66 publications with authors originating from Africa (n=23, 34.8%), the Americas (n=29, 43.9%), Asia (n=13, 19.7%), Europe (n=12, 18.2%) and Oceania (n=2, 3%). The publications fell into MMIS-Build (n=16, 24.2%), MMIS-Teach (n=16, 24.2%), MMIS-Check (n=14, 21.2%), MMIS-Sell (n=10, 15.2%), and MMIS-Live (n=10, 15.2%). WG members reviewed their assigned papers, discussed them in virtual meetings, and identified 20 papers as strongly relevant. According to the WG members, the literature reviews and discussion improved their ABG knowledge and perception of the utility of evaluation and education applied to ABG. The multidisciplinary WG composition and the MMIS allowed ABG perspectives of new solutions and ideas. Although using a complex framework as MMIS applied to a scarce literature of ABG was challenging, it promoted a deeper understanding of topics and enhanced group cohesion and communication. Conclusion We found a gap in the literature of ABG, especially in LMIC, and it was not often recommended. A lower number of publications within MMIS-Live and MMIS-Sell indicated suboptimal emphasis in sustaining this practice in healthcare. Using the MMIS framework focused discussions of WG members, improved ABG knowledge and clarified the utility of educational interventions.

Disease trajectories before dementia: evidence from a large-scale community-based prospective study.

Systemic changes in multiple diseases may influence the onset of dementia. However, the specific temporality between exposure diseases and dementia remains uncertain. By characterising the full spectrum of temporal disease trajectories before dementia, this study aims to yield a global picture of precursor diseases to dementia and to provide detailed instructions for risk management and primary prevention of dementia. Using the multicentre, community-based prospective UK Biobank, we constructed disease trajectories before dementia utilising the phenome-wide association analysis, paired directional test and association quantification. Stratified disease trajectories were constructed by dementia subtypes, gender, age of diagnosis and Apolipoprotein E (ApoE) status, respectively. Our study population comprised 434 266 participants without baseline dementia and 4638 individuals with all-cause dementia. In total, 1253 diseases were extracted as potential components of the disease trajectory before dementia. We identified three clusters of disease trajectories preceding all-cause dementia, initiated by circulatory, metabolic and respiratory diseases occurring approximately 5-15 years before dementia. Cerebral infarction or chronic renal failure following chronic ischaemic heart disease was the specific trajectory before vascular dementia. Apolipoprotein E (ApoE) ε4 non-carriers exhibited more complex trajectories compared with carriers. Lipid metabolism disorders remained in the trajectories regardless of dementia subtypes, gender, age of diagnosis and ApoE status. This study provides a comprehensive view of the longitudinal disease trajectories before dementia and highlights the potential targets of midlife cardiometabolic dysfunction for dementia screening and prevention.

Moroccan Secondary School English Teacher’s Perception: Science and Literary Stream Students’ Performance

The study investigates the perceptions of Moroccan secondary school teachers regarding the academic performance of science and literary stream students aged 16 to 18. Through a combination of mail surveys, unstructured interviews with English teachers, and discourse analysis, the research identifies that English as the second foreign language in Moroccan schools influences the perceived advantages of science stream students over their literary counterparts. The findings align with a previous study and suggest that science students often pursue literary studies at Moroccan universities post-baccalaureate. The research delves into the distinctive characteristics of science stream students and proposes recommendations for governmental and ministerial reforms in the Moroccan educational system. The study underscores the historical incorporation of English in the Moroccan educational system since 1956 and highlights recent developments, such as the expansion of English language teaching to middle schools. It emphasises the impact of English language learning on students’ future orientations and tendencies in higher education. Ultimately, the study aims to draw attention to English teachers’ perceptions to facilitate positive changes in the Moroccan educational system, urging the education ministry and relevant authorities to consider reforms.

Sustainable energy transition, knowledge co-creation and trade: the case of EU residential energy efficiency

ABSTRACT The European Union (EU) sustainable energy transition requires radical changes of economic, technological, societal and political systems. This paper empirically investigates the relationships among environmental policy, innovation and technological capabilities, and economic performances, in terms of country export competitiveness, focusing on residential energy efficiency goods, a core pillar of the EU energy and climate strategy. We combine network analysis with a gravity model to investigate the evolution of the EU bilateral trade and co-patenting activities from 1990 to 2015, based on a panel of 19 European countries. Our results show that the technological skills of the exporting country, related to the production of the households’ energy-consuming appliances, strongly enhance its export performances, and this effect is stronger when countries are EU members. Cooperation in knowledge creation and institutional proximities between trade partners are further key determinants of export performances of analysed countries.

Alterations in the Renin-Angiotensin System in Experimental Septic Shock.

To analyze dynamic changes in the renin-angiotensin system (RAS) during septic shock, focusing on angiotensin-converting enzyme (ACE) activity and the balance between angiotensin peptides, using a mass spectrometry method. Experimental septic shock model induced by peritonitis in swine. Experimental Laboratory, Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles. Forty time points from eight mechanically ventilated pigs. Septic shock was induced using intraperitoneal instillation of autologous feces, followed by standardized fluid resuscitation, norepinephrine infusion, antibiotic administration, and peritoneal lavage. The induction of sepsis resulted in a significant increase in plasma renin activity and levels of angiotensin I and II, with a significant decrease in ACE activity observed from 4 hours post-resuscitation and a notable rise in the angiotensin I/angiotensin II ratio at 12 hours. Additionally, a shift toward the angiotensin-(1-7) axis was observed, evidenced by an increased angiotensin-(1-7)/angiotensin II ratio. The study highlighted dynamic shifts in the RAS during septic shock, characterized by reduced circulating ACE activity, elevated angiotensin I/II ratio, and a shift toward the angiotensin-(1-7) axis. These findings suggest an adaptive response within the RAS, potentially offering new insights into sepsis management and therapeutic targets.

Financial flow management of trading companies based on business process modeling

The issues of process approach implementation in enterprise financial flows management system have been highlighted. The stages of financial flows management within the framework of business processes model have been defined. The advantages of the balanced scorecard have been revealed. The approach to financial flows management based on business process models and their optimization methods has been proposed. The approach to enterprise process management is based on the Deming-Shewhart cycle. The strategic map has been considered as tools for process management and metrics control. The composition of balanced scorecard has been proposed, reflecting the dependence of profit, accounts receivable, and equity turnover rate on the key indicators of cost, fragmentation. and time of fulfilling tasks of the AS-IS and TO-BE business process models. The cause-and-effect relationships between the business processes tasks and a company’s financial performance have been considered. The paper presents the results of the analysis and visualization of the dynamics of change in indicators depending on business process model transformation. In order to reduce risks and increase the efficiency of implementing process optimization results, a number of simulation experiments have been conducted for a company actively developing online sales channels. Practical recommendations have been developed and changes in the key business process management system justified. The system effect from simulation modeling results implementation has been obtained.

Dynamic control of elastic wave transmission by a digital metalayer

Piezoelectric materials with shunt circuits have aroused much research interest due to flexible parameter adjustment. However, shunted piezoelectric elements are difficult to respond to the dynamic changes in the whole system due to the absence of autonomous control ability, which constrains their practical applications. Here, we propose a digital metalayer to control the wave energy transmission across different materials in real time. This digital metalayer comprises a stack of multiple piezoelectric lead zirconate titanate (PZT) disks connected with shunt capacitance circuits (SCCs). The external digital control system adjusts the effective acoustic impedance of the PZT disks through digital potentiometers and microprogrammed control unit, thereby enabling digital manipulation of wave transmission. Utilization of optimized SCCs further enhances adjustment accuracy, supporting both negative and positive capacitance values. The experiments demonstrate that this digital metalayer exhibits remarkable performance in controlling wave transmission. Moreover, the distinct variations in transmitted amplitudes, precisely controlled by the digital metalayer, are harnessed as binary signals for information transmission. An image of letters is encoded into a series of amplitude-modulated waves by the digital metalayer and clearly transmitted. The proposed digital metalayer shows great promise for applications in intelligent impedance matching and the real-time modulation systems.

Evaluation of the chronic oral toxicity of the classical ancient prescription Kai-Xin-San

Ethnopharmacological relevanceThe Kai-Xin-San (KXS), as an ancient classic prescription, has been used for the treatment of amnesia for thousands of years. Modern clinical and non-clinical pharmacological studies have found that it has significant therapeutic effects on dementia and depression, but there are relatively few studies on its safety. Aim of the studySubacute and chronic toxicity studies were conducted to investigate the symptoms, severity, target organs, development and recovery of toxic reactions, as well as the toxic dose. These studies provide technical data for ensuring the safety of KXS. Materials and methodsIn the sub-acute toxicity study, rats were orally administered KXS at doses of 0.80, 1.61, 3.22, and 6.43 g/kg body weight for a duration of 4 weeks. In the chronic toxicity study, rats were orally administered KXS at doses of 0.27, 0.81, and 2.43 g/kg body weight for a duration of 26 weeks, and a withdrawal study was conducted for a period of 4 weeks after the treatment.The rats were observed daily for clinical signs and mortality. Changes in body weight, food consumption, and water consumption were periodically monitored. Additionally, urinalysis results, hematological and biochemical parameters, relative organ weights, and pathology were monitored at specific observation time points. ResultsIn the sub-acute toxicity study, necropsy of dead and moribund rats revealed evident distension and swelling of the gastrointestinal tract, as well as thinning of the intestinal wall. The main adverse reactions observed included flatulence, piloerection, abnormal breathing sounds, and emaciation. Doses of 1.61 g/kg and below did not cause animal death. The gastrointestinal system is the main target organ of toxicity. In the chronic toxicity study, the no-observed-adverse-effect-level (NOAEL) of KXS was 0.27 g/kg, and its toxic effects were primarily concentrated in the gastrointestinal system. This led to secondary pathological changes in the immune system, hematopoietic system, and heart, suggesting that relevant indicators should be monitored when large doses are used clinically for an extended period of time. ConclusionsDuring the rodent toxicity evaluation, severe gastrointestinal damage was observed when KXS, powdered with crude drugs, was administered. The NOAEL for rats was found to be 0.27 g/kg/day.

Metabolomic Profiling Reveals Potential of Fatty Acids as Regulators of Stem-like Exhausted CD8 T Cells During Chronic Viral Infection.

This study examines systemic metabolite changes during acute and chronic viral infections. Notably, we identified an early, transient nutrient shift in chronic infection, marked by an increase in medium- and long-chain fatty acid related species. Concomitantly, a virus-specific stem-like T cell population, essential for maintaining other T cells, displayed high lipid avidity and was capable of metabolizing exogenous fatty acids. Administering fatty acids late in chronic infection, when endogenous lipid levels had normalized, expanded this stem-like T cell population and enhanced their mitochondrial fitness. These findings highlight the potential role of fatty acids in regulating stem-like T cells in chronic settings and offer a valuable resource for studying other metabolic signatures in both acute and persistent infections.

The future of tourism: interview with Jeremy Sampson on the need for systemic change in tourism

The future of tourism: interview with Jeremy Sampson on the need for systemic change in tourism

Why and how systemic change overcomes ineffectiveness

Why and how systemic change overcomes ineffectiveness Michael Beer, from Harvard Business School, provides insight into why and how systemic change overcomes ineffectiveness in organizations. According to leading academics and consultants, seventy percent of corporate transformations are failures. The organization is stuck in neutral, ineffective, and unable to make systemic change in order to perform better. Strategy changes follow changes in the competitive environment. The system of organizing, managing, and leading must then be realigned with the new strategy or friction and conflict between groups that must coordinate for the organization to survive will arise. A decline in effectiveness and performance will begin. Firing people or creating new programs to re-educate them doesn’t work. Edward Deming, the quality guru who taught the Japanese how to compete on quality, found that “94% of problems in business are system driven and only 6% are people driven.” When confronted with strategic inflection points, 7 silent capabilities must be confronted through honest conversations. Most managers do not, however, know why or how.

MicroRNAs as Indicators of Alterations in Reaction to Endurance Training

Without a doubt, endurance sports are beneficial for heart health and general fitness; regular physical exercise is thought to be one of the best ways to avoid cardiovascular disease. Gene expression is regulated by tiny molecules known as microRNAs, which are generated subsequent to transcription. Translational repression, mRNA deadenylation, and decapping are all caused by miRNAs when they attach to a certain region at the 3′ UTR of their target mRNAs (40, 41). Along with promoter regions, additional mRNA regions such as the 5′ UTR and coding sequence have also been shown to include miRNA binding sites. While it has been shown that miRNA contact with a promoter region may drive transcription, miRNA binding to the 5′ UTR and coding sections silences the expression of genes. According to preliminary research, miRNAs may serve as helpful indicators of the systemic changes brought on by exercise before they are identified using traditional imaging or laboratory methods. This study focused on four important physiological processes that help the body adapt to various endurance workouts. We found that miR-27, miR-221, miR-210, miR-328, miR-133a, miR-134a, and miR-20a are essential for adaptive response to exercise after conducting a thorough literature search.

Comparative targeted lipidomics between serum and cerebrospinal fluid of multiple sclerosis patients shows sex and age-specific differences of endocannabinoids and glucocorticoids

Multiple sclerosis (MS) is a complex chronic neuroinflammatory disease characterized by demyelination leading to neuronal dysfunction and neurodegeneration manifested by various neurological impairments. The endocannabinoid system (ECS) is a lipid signalling network, which plays multiple roles in the central nervous system and the periphery, including synaptic signal transmission and modulation of inflammation. The ECS has been identified as a potential target for the development of novel therapeutic interventions in MS patients. It remains unclear whether ECS-associated metabolites are changed in MS and could serve as biomarkers in blood or cerebrospinal fluid (CSF). In this retrospective study we applied targeted lipidomics to matching CSF and serum samples of 74 MS and 80 non-neuroinflammatory control patients. We found that MS-associated lipidomic changes overall did not coincide between CSF and serum. While glucocorticoids correlated positively, only the endocannabinoid (eCB) 2-arachidonoyl glycerol (2-AG) showed a weak positive correlation (r = 0.3, p < 0.05) between CSF and serum. Peptide endocannabinoids could be quantified for the first time in CSF but did not differ between MS and controls. MS patients showed elevated levels of prostaglandin E2 and steaorylethanolamide in serum, and 2-oleoylglycerol and cortisol in CSF. Sex-specific differences were found in CSF of MS patients showing increased levels of 2-AG and glucocorticoids in males only. Overall, arachidonic acid was elevated in CSF of males. Interestingly, CSF eCBs correlated positively with age only in the control patients due to the increased levels of eCBs in young relapsing-remitting MS patients. Our findings reveal significant discrepancies between CSF and serum, underscoring that measuring eCBs in blood matrices is not optimal for detecting MS-associated changes in the central nervous system. The identified sex and age-specific changes of analytes of the stress axis and ECS specifically in the CSF of MS patients supports the role of the ECS in MS and may be relevant for drug development strategies.

Depth of invasion and extranodal extension: the influential factors to predict survival rate of patients with oral tongue squamous cell carcinoma

BackgroundCancer staging is essential in determining patients’ prognoses and designing the appropriate treatment strategy. American Joint Committee on Cancer has released the latest version of the staging system for tongue SCC. However, it is interesting to know whether this change in staging and the addition of depth of invasion (DOI) and the extra-nodal extension (ENE) have any influence on patients’ prognosis.MethodsIn this retrospective cohort study, the pathology records of patients with tongue SCC who underwent surgery at the Pathology Department of Cancer Institute Hospital, 2017–2021, were collected by referring to the hospital information system. Then the rate of change of pT, pN, and overall stage were assessed based on American Joint Committee on Cancer 7th and 8th editions.ResultsThe records of 204 patients were included in the final analysis. Significant changes in the staging system 2021 resulted in upstaging 64 patients (31.4%) in the overall stage, 91 patients (44.6%) in pT, and 30 patients (14.7%) in pN. The survival of upstaged patients was inferior compared to those without upstaging. However, this was not statistically significant for tumor and overall upstaging in the univariate analysis, while those with upstaged pN had significantly shorter survival. In the multivariate analysis, pT upstage also significantly impacted survival.ConclusionThis study showed the importance of pathology reports based on the latest edition of the American Joint Committee on Cancer, the accuracy in examining factors such as depth of invasion and extra-nodal extension.

Impact of trastuzumab emtansine (T-DM1) on spleen volume in patients with HER2-positive metastatic breast cancer.

Trastuzumab emtansine (T-DM1) is a novel therapy for human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer, combining the targeted action of trastuzumab with the cytotoxic effects of emtansine. Although T-DM1 has demonstrated greater efficacy and safety compared to traditional therapies, concerns about hepatotoxicity and spleen-related complications have arisen. We conducted a retrospective study of 64 HER2-positive metastatic breast cancer patients treated with T-DM1 at our institution. Patients underwent computed tomography or magnetic resonance imaging at baseline and during treatment cycles. Spleen volume, portal vein diameter, and laboratory values were compared between baseline and 12months after T-DM1 treatment. Median spleen volume significantly increased from 201cm3 (IQR, 157-275) at baseline to 291cm3 (IQR, 215-420) after 12months of T-DM1 treatment (P<0.001). Spleen enlargement was observed in 87.5% of patients, while no significant alteration was detected in portal vein diameter. The change in spleen volume was positively correlated with changes in serum globulin levels, liver enzymes, and bilirubin levels, but did not impact survival outcomes. T-DM1 therapy in HER2-positive metastatic breast cancer leads to significant spleen enlargement and systemic biochemical changes. Future studies should focus on elucidating the long-term implications of these findings and optimizing monitoring strategies for spleen-related complications.

Motivated leadership and mutual learning: a case study of promoting sustainable food consumption in an early childhood education centre in Aotearoa New Zealand

ABSTRACT Food system transformation is urgently needed; although dominant food and sustainability discourses tend to focus on powerful stakeholders like governments and industries. We sought to understand how localised; community-based initiatives promote food system change; and how this is experienced by the people they are meant to involve or benefit. We conducted a reflexive qualitative case study with a community-oriented early childhood centre in Aotearoa New Zealand that developed an increasingly sustainable programme. This included providing plant-based food; a garden-to-table and nature-oriented pedagogical focus; and well-embedded low waste practices. We engaged with the community of school leaders; staff; and whānau to explore their processes; their experiences of changes made; and their challenges. Our case study methodology involved semi-structured interviews; group discussions; document analysis; and a reflexive thematic analysis. We identified two main themes; including (1) the importance of leadership for initiating and sustaining change; (2) experiences of changes were linked to relationships and shared learning. These findings contribute to understanding the complexities involved in shifting to sustainable food practices at a local; community-focused level; these might benefit other communities or the stakeholders working to better support them.

Temporalities of e-scooter practices and their systemic effects: The case of the city of Poznań, Poland

ABSTRACT Studies of e-scooters’ usage mushroomed in the social sciences almost as quickly as the new means of urban mobility themselves appeared in many European cities. After almost five years of their presence in Poland, it is still not clear whether e-scooters will and should remain part of the sustainability transition, and how they have contributed to it thus far. The article explores the potential of the social practice approach (SPA) to examine temporalities of e-scooters’ usage at the level of individual practices, their structuration effects, and at the systemic level. It is based on ethnographic interviews carried out with the most active e-scooter users in Poznań, a medium-size city in Poland. The authors find that the temporal characteristics of the e-scooter practices and of their structuring effects suggest that e-scooters induced systemic changes quickly but that their extent and timespan may be limited in many ways. They conclude that even if e-scooters disappear from the spaces in the city of Poznań, micromobility will continue while other means of transport are in use.

Elderly age and tuberculosis: diagnostics difficulties and course features

ABSTRACT. The clinical observation of an elderly female patient, who was being treated at the Zaporizhzhia Regional Phthisiopulmonology Clinical Treatment and Diagnostic Center, is presented, the features of the diagnostics and the course of the tuberculosis process is determined. The clinical case demonstrates the difficulty of timely tuberculosis diagnostics due to numerous comorbidities in an elderly woman. Most cases of tuberculosis in the elderly are associated with the reactivation of old specific foci, which can be explained by age-related changes in the immune system. In this case, the difficulty of the timely tuberculosis diagnostics was associated with non-specific symptoms of the active process and the absence of bacterial excretion 2 years ago in an elderly woman. As a result, a diagnosis of malignant neoplasm of the upper lobe of the left lung was mistakenly made. The outcomes of the disease led to the development of fibrocavernous tuberculosis with multidrug resistance. The woman had a good adherence to the treatment, which gave a positive result.

Diagnostic value of effusion adenosine deaminase, γ-interferon release assay and effusion lactatedehy drogenase/effusion adenosine deaminase for tuberculous pleural effusion in patients aged 60 years and above.

China is experiencing rapid growth in its population of older adults, which may lead to increased susceptibility to tuberculous pleural effusion (TPE) due to age-related changes in the immune system. This study aimed to investigate the diagnostic potential of multiple biomarkers in individuals aged 60 years and above with pleural effusion. A total of 519 adult patients from Ningbo First Hospital were included in the study, with 7 biomarkers and their ratios in serum and pleural effusion analyzed using logistic regression analysis. Effusion Adenosine Deaminase(ADA), γ-Interferon Release Assay(IGRA), and Effusion lactatedehy drogenase(LDH)/Effusion ADA were identified as valuable parameters for differentiating TPE from non-TPE, particularly in individuals aged 60 years and older. Effusion ADA, IGRA, and Effusion LDH/Effusion ADA were identified as valuable parameters for the differential diagnosis of TPE from non-TPE, showing good diagnostic performance in individuals aged 60 years and older. The combined diagnosis of these three indexes achieved the highest diagnostic accuracy for TPE in this age group, with an AUC of 0.925, sensitivity of 85.23%, and specificity of 89.57%. Overall, the study highlights the importance of using multiple indicators for a combined diagnosis to improve diagnostic efficacy in detecting tuberculous pleurisy in older individuals as for young patients.

Five paradoxes navigated by incumbent private sector firms moving towards climate-oriented innovation in food systems

The role of large private sector firms in rerouting our food systems towards sustainability through climate-oriented innovation is highly contested. The contestation has resulted in a portrayal in academic literature of these incumbents as either the key driver of sustainability transitions or as fundamentally contradictory to addressing climate change in food systems. Controversies and tensions can reinforce stalemates, which hamper progress towards climate-oriented innovation. This study explores the utility of a paradox lens which shifts the research gaze to the emergence of unavoidable and persistent tensions in encounters of distinct logics and lines of action, and opens space to examine how these encounters can nevertheless be used productively and creatively in overcoming stalemates. Based on reflexive practice and interviews with professionals from seven purposefully selected incumbent private sector firms in the agri-food sector, we identify five paradoxes: the paradox of direction—between mitigation and adaptation; the paradox of justification—between exploration and exploitation; the paradox of internal alignment—between mainstreaming and specialization; the paradox of external alignment—between collaboration and competition; and the paradox of evidence—between accountability and learning. Our analysis of how agri-food firms navigate paradoxes focuses on considerations, tensions, and decisions in organizing climate-oriented innovation. In our discussion, we examine whether and how paradoxical thinking enables civil society practitioners to accelerate climate-oriented innovation in food systems through interactions and collaborations with the private sector. We conclude that a paradox lens affords researchers, practitioners, and policymakers to move beyond the binary view on the role of incumbents’ climate-oriented innovation, and instead provides strategic insights for engaging incumbents and their inherent contradictions in transforming our food systems under a changing climate.