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Background Whole‐systems approaches (WSAs) are well placed to tackle the complex local environmental influences on overweight and obesity, yet there are few examples of WSAs in practice. Amsterdam Healthy Weight Approach (AHWA) is a long‐term, municipality‐led program to improve children's physical activity, diet, and sleep through action in the home, neighborhood, school, and city. Adopting a WSA, local political, physical, social, educational, and healthcare drivers of childhood obesity are viewed as a complex adaptive system. Since 2013, AHWA has reached >15,000 children. During this time, the estimated prevalence of 2–18‐year‐olds with overweight or obesity in Amsterdam has declined from 21% in 2012 to 18.7% in 2017. Declining trends are rarely observed in cities. There is a need to formally articulate AHWA program theory in order to: (i) inform future program evaluation which can interpret this decline within the context of AHWA and (ii) contribute a real‐life example of a WSA to the literature. Methods This study aimed to formally document the program theory of AHWA to permit future evaluation. A logic framework was developed through extensive document review and discussion, during program implementation. Results The working principles of the WSA underpinning AHWA were made explicit in an overarching theory of change, articulated in a logic framework. The framework was operationalized using an illustrative example of sugar intake. Conclusions The logic framework will inform AHWA development, monitoring, and evaluation and responds to a wider need to outline the working principles of WSAs in public health.

How does warming affect maturation and reproductive investment in ectotherms? Younger age and smaller size at maturation, as well as altered reproduction processes, have been found in a few species subjected to elevated temperatures. These observations, however, come from studies that do not distinguish effects of warming on maturation from those on growth, are also restricted to single generation responses to warming, or have additional stressors besides warming in the study system. Here, we study warming effects on maturation and reproductive investment in wild, unexploited fish populations using a whole‐ecosystem heating experiment. The experiment is conducted on Eurasian perch (Perca fluviatilis) in a heated and control area (with >5°C temperature difference) in the Baltic Sea. We compare female perch size at maturation using estimated probabilistic maturation reaction norms (PMRNs) and the gonado‐somatic index over 17 years of heating, spanning approximately five to eight perch generations. Using the PMRN approach, we show that warming has substantial effects on maturation size independent of warming‐induced changes in body growth. We found that young fish mature at a smaller size and invest more in developing their gonads in the heated population than in the unheated population. Our findings suggest that warming effects on reproductive investment may initially compensate for the cost of warming‐induced decrease in maturation size caused by the trade‐off between early maturation and size‐dependent fecundity. After multiple additional generations of warming, maturation and reproduction traits in perch differed from those in the first generations following the onset of warming, which suggests that warming‐induced evolution may have occurred. Our study is particularly relevant in the context of climate change because of the unusually large temperature difference between the areas and the fact that the heating occurred on an ecosystem level. We call for experimental studies resolving mechanisms of trait responses to warming across generations, complemented with genomic analyses, to aid understanding of organisms' long‐term responses to climate change.

Major Depressive Disorder (MDD) is one of the common depressive disorder. MDD has high comorbidity and has greater implications on quality of life. Whole system Ayurveda management protocol (WSAP) is explored for it's possible role in management of MDD. To evaluate the efficacy of Whole system Ayurveda management protocol on Major Depressive Disorder. Study was a randomized controlled trial. Total 50 patients of MDD meeting the DSM V criteria, age group 20–70 years of either sex participated in the study. They were randomly divided into two groups, control group received Escitalopram 10 mg twice a day and Ayurveda group was on WSAP. Interventions were for 60 days. Assessments were done through various clinical parameters like Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Brief psychiatric rating scale (BPRS), Pittsburgh Sleep Quality Index (PSQI), WHO Quality of Life- BREF (WHOQOL-BREF), Clinical Global Improvement scale (CGI), UKU Side effect scale. Assessments during intervention was on every 15th day. Study showed that Ayurveda group produced significant outcome improvement compared to control group in HDRS (p = 0.01), HARS (p = 0.03), PSQI (p = 0.03), WHOQOL-Bref (p < 0.001) and UKU side effect scale (p = 0.02). Both the group showed improvements in all the parameters except in WHOQOL-Bref where Ayurveda group only showed improvements (p < 0.001). Effect size showed large effect in WHOQOL-Bref. Mild side effects were reported in control group and none in Ayurveda group. WSAP was effective in management of MDD and had better side effect profile. Further studies needed. •One of the major Ayurveda interventional study on Depression.•Randomized controlled trial, whole system research design and Escitalopram as control.•Major Depressive disorder diagnosed as per DSM V.•Assessing through standard assessment scales of depression, anxiety, sleep, quality of life, clinical global impression.•Additional advantages with Ayurveda protocol were in depression, anxiety, sleep, quality of life and side effects profile.

Context: The long-term sustainability of whole-system change programs is rarely studied, and when it is, it is inevitably undertaken in a shifting context, thereby raising epistemological and methodological questions. This article describes a transferable methodology that was developed to guide the evaluation of a three-year follow-up of a large health care change program in London, which took place during a period of economic turbulence and rapid policy change. Method: Using a mixed-method organizational case study design, we studied three services (stroke, kidney, and sexual health) across primary and secondary care. Each had received £5 million (US$7.8 million) in modernization funding in 2004. In 2010/2011, we gathered data on the services and compared them with data from 2004 to 2008. The new data set contained quantitative statistics (access, process, and outcome metrics), qualitative interviews with staff and patients, documents, and field notes. Our data analysis was informed by two complementary models of sustainability: intervention-focused (guided by the question, What, if anything, of the original program has been sustained?) and system-dynamic (guided by the question, How and why did change unfold as it did in this complex system?). Findings: Some but not all services introduced in the original transformation effort of 2004—2008 were still running; others had ceased or been altered substantially to accommodate contextual changes (e.g., in case mix, commissioning priorities, or national policies). Key cultural changes (e.g., quality improvement, patient centeredness) largely persisted, and innovative ideas and practices had spread elsewhere. To draw causal links between the original program and current activities and outcomes, it was necessary to weave a narrative thread with multiple intervening influences. In particular, against a background of continuous change in the local health system, the sustainability of the original vision and capacity for quality improvement was strongly influenced by (1) stakeholders' conflicting and changing interpretations of the targeted health need; (2) changes in how the quality cycle was implemented and monitored; and (3) conflicts in stakeholders' values and what each stood to gain or lose. Conclusions: The sustainability of whole-system change embodies a tension between the persistence of past practice and the adaptation to a changing context. Although the intervention-focused question, What has persisted from the original program? (addressed via a conventional logic model), may be appropriate, evaluators should qualify their findings by also considering the system-dynamic question, What has changed, and why? (addressed by producing a meaningful narrative).

Background Increasing awareness of the complexity of public health problems, including obesity, has led to growing interest in whole systems approaches (WSAs), defined as those that consider the multifactorial drivers of overweight and obesity, involve transformative co-ordinated action across a broad range of disciplines and stakeholders, operate across all levels of governance and throughout the life course. This paper reports a systematic review of WSAs targeting obesity and other complex public health and societal issues, such as healthy lifestyles for prevention of non-communicable disease. Methods Seven electronic databases were searched from 1995 to 2018. Studies were included if there had been an effort to implement a WSA. Study selection was conducted by one reviewer with a random 20% double checked. Data extraction and validity assessment were undertaken by one reviewer and checked by a second reviewer. Narrative synthesis was undertaken. Results Sixty-five articles were included; 33 about obesity. Most examined multicomponent community approaches, and there was substantial clinical and methodological heterogeneity. Nevertheless, a range of positive health outcomes were reported, with some evidence of whole systems thinking. Positive effects were seen on health behaviours, body mass index (BMI), parental and community awareness, community capacity building, nutrition and physical activity environments, underage drinking behaviour and health, safety and wellbeing of community members, self-efficacy, smoking and tobacco-related disease outcomes. Features of successful approaches reported in process evaluations included: full engagement of relevant partners and community; time to build relationships, trust and capacity; good governance; embedding within a broader policy context; local evaluation; finance. Conclusions Systems approaches to tackle obesity can have some benefit, but evidence of how to operationalise a WSA to address public health problems is still in its infancy. Future research should: (a) develop an agreed definition of a WSA in relation to obesity, (b) look across multiple sectors to ensure consistency of language and definition, (c) include detailed descriptions of the approaches, and (d) include process and economic evaluations.

Many global changes take the form of resource enhancements that have potential to transform multiple aspects of ecosystems from slower to faster cycling, including a suite of both above- and belowground variables. We developed a novel analytic approach to measure integrated ecosystem responses to resource-enhancing global changes, and how such whole ecosystem slow-to-fast transitions are linked to diversity and exotic invasions in real-world ecosystems. We asked how 5-yr experimental rainfall and nutrient enhancements in a natural grassland system affected 16 ecosystem functions, pools, and stoichiometry variables considered to indicate slow vs. fast cycling. We combined these metrics into a novel index we termed “slow-fast multifunctionality” and assessed its relationship to plant community diversity and exotic plant dominance. Nutrient and rainfall addition interacted to affect average slow-fast multifunctionality. Nutrient addition alone pushed the system toward faster cycling, but this effect weakened with the joint addition of rainfall and nutrients. Variables associated with soil nutrient pools and cycling most strongly contributed to this antagonistic interaction. Nutrient and water addition together, respectively, had additive or synergistic effects on plant trait composition and productivity, demonstrating divergence of above- and belowground ecosystem responses. Our novel metric of faster cycling was strongly associated with decreased plant species richness and increased exotic species dominance. These results demonstrate the breadth of interacting community and ecosystem changes that ensue when resource limitation is relaxed

A 1.5°C global average target implies that we should no longer focus on merely incremental emissions reductions from the electricity system, but rather on fundamentally re-envisaging a system that, sooner rather than later, becomes carbon free. Many low-carbon technologies are surpassing mainstream predictions for both uptake and cost reduction. Their deployment is beginning to be disruptive within established systems. 'Smart technologies' are being developed to address emerging challenges of system integration, but their rates of future deployment remain uncertain. We argue that transition towards a system that can fully displace carbon generation sources will require expanding the focus of our efforts beyond technical solutions. Recognizing that change has social and technical dimensions, and that these interact strongly, we set out a socio-technical review that covers electricity infrastructure, citizens, business models and governance. It describes some of the socio-technical challenges that need to be addressed for the successful transition of the existing electricity systems. We conclude that a socio-technical understanding of electricity system transitions offers new and better insights into the potential and challenges for rapid decarbonization. This article is part of the theme issue 'The Paris Agreement: understanding the physical and social challenges for a warming world of 1.5°C above pre-industrial levels'.

Large quantities of weather-dependent renewable energy generation are expected in power systems under climate change mitigation policies, yet little attention has been given to the impact of long term climate variability. By combining state-of-the-art multi-decadal meteorological records with a parsimonious representation of a power system, this study characterises the impact of year-to-year climate variability on multiple aspects of the power system of Great Britain (including coal, gas and nuclear generation), demonstrating why multi-decadal approaches are necessary. All aspects of the example system are impacted by inter-annual climate variability, with the impacts being most pronounced for baseload generation. The impacts of inter-annual climate variability increase in a 2025 wind-power scenario, with a 4-fold increase in the inter-annual range of operating hours for baseload such as nuclear. The impacts on peak load and peaking-plant are comparably small. Less than 10 years of power supply and demand data are shown to be insufficient for providing robust power system planning guidance. This suggests renewable integration studies-widely used in policy, investment and system design-should adopt a more robust approach to climate characterisation.

Background UK and global policies recommend whole-school approaches to improve childrens’ inadequate physical activity (PA) levels. Yet, recent meta-analyses establish current interventions as ineffective due to suboptimal implementation rates and poor sustainability. To create effective interventions, which recognise schools as complex adaptive sub-systems, multi-stakeholder input is necessary. Further, to ensure ‘systems’ change, a framework is required that identifies all components of a whole-school PA approach. The study’s aim was to co-develop a whole-school PA framework using the double diamond design approach (DDDA). Methodology Fifty stakeholders engaged in a six-phase DDDA workshop undertaking tasks within same stakeholder ( n = 9; UK researchers, public health specialists, active schools coordinators, headteachers, teachers, active partner schools specialists, national organisations, Sport England local delivery pilot representatives and international researchers) and mixed ( n = 6) stakeholder groupings. Six draft frameworks were created before stakeholders voted for one ‘initial’ framework. Next, stakeholders reviewed the ‘initial’ framework, proposing modifications. Following the workshop, stakeholders voted on eight modifications using an online questionnaire. Results Following voting, the Creating Active Schools Framework (CAS) was designed. At the centre, ethos and practice drive school policy and vision, creating the physical and social environments in which five key stakeholder groups operate to deliver PA through seven opportunities both within and beyond school. At the top of the model, initial and in-service teacher training foster teachers’ capability, opportunity and motivation (COM-B) to deliver whole-school PA. National policy and organisations drive top-down initiatives that support or hinder whole-school PA. Summary To the authors’ knowledge, this is the first time practitioners, policymakers and researchers have co-designed a whole-school PA framework from initial conception. The novelty of CAS resides in identifying the multitude of interconnecting components of a whole-school adaptive sub-system; exposing the complexity required to create systems change. The framework can be used to shape future policy, research and practice to embed sustainable PA interventions within schools. To enact such change, CAS presents a potential paradigm shift, providing a map and method to guide future co-production by multiple experts of PA initiatives ‘with’ schools, while abandoning outdated traditional approaches of implementing interventions ‘on’ schools.

Background Inadequate sleep among Dutch adolescents is a complex public health issue with detrimental effects on physical and mental well-being. Previous interventions have shown limited or no lasting effects. While systems approaches help to understand and address such challenges, effective prevention efforts require theory- and evidence-based intervention design using behavior change techniques. This study outlines the systematic development of a ‘whole systems action program’ , named Charge Your Brainzzz (CYB), to promote healthy sleep in Dutch adolescents aged 12–15, by integrating theory- and evidence-based behavior change methods using the Intervention Mapping Protocol within a systems science approach, combined with stakeholder engagement. Methods The CYB program was developed based on previously identified key system dynamics influencing adolescent sleep and a detailed action plan targeting these dynamics. The development was guided by a procedure of which several sub-steps from the Intervention Mapping protocol were applied: defining the program goal and prioritizing system dynamics outcomes across various interconnected subsystems, specifying performance objectives, constructing matrices of change objectives, developing program components while selecting theoretical methods and practical applications, and program production and formative testing. Adolescents, parents, teachers, school boards, school care coordinators, youth healthcare professionals, and Healthy School advisors were actively involved. Results The theory- and evidence based whole systems action program CYB consists of eight program components and includes: 1) an educational component, 2) a step-by-step guide for implementing school sleep health policies, 3) a parent information evening, 4) an online magazine, 5) Teen Sleep Check, 6) Sleep Guide, 7) Tool for monitoring and early detection for sleep (behavior) problems, and 8) implementation materials including a website. Conclusions The CYB program is the first whole systems action program designed to promote adolescent sleep health. Using a Systems Science approach, the Intervention Mapping (IM) protocol, and stakeholder engagement, the program addresses the complexity of the health issue, ensures a solid theoretical foundation for behavior change, and incorporates the lived experiences of the target groups. Beyond presenting the program’s components, this study offers a replicable roadmap for addressing complex public health challenges, paving the way for innovative, system-oriented solutions in health promotion.