Mental Models

A central principle of the systems thinking perspective is that system structures are supported and held in place by our underlying beliefs, mindsets, and goals (See Brief 1.01 - Systems Thinking Iceberg). Therefore, in order to transform and redesign systems we must also transform our mindsets. The purpose of this brief is to introduce the concept of mental models, and to discuss how system dynamics tools can be used to elicit, negotiate, and transform them

System Archetypes

K-12 education presents an incredibly complex system that makes solving problems challenging. Often, we implement changes with the best of intentions, only to see problems get worse rather than better. Many of the structures that cause these patterns can be found all around us - in schools, in businesses, in non-profit organizations, in health systems, and in communities. By learning about these common structures or system archetypes, we can start to identify and anticipate them. The purpose of this brief is to describe how education stakeholders can use system archetypes as a tool for recognizing, anticipating, and addressing the system dynamics driving the common patterns of problems in their school communities

Systems Thinking Iceberg: Diving Beneath the Surface in Education Systems

The iceberg is a classic metaphor that is applied to many disciplines beyond systems thinking. The metaphor describes a situation in which what you see (the tip of the iceberg) is only a small portion of what you can’t see (a large, hidden mass of ice below the surface). In systems thinking, we use the iceberg metaphor to think about what is “under the surface” driving the individual events that we see: (1) Patterns of events over time, (2) System Structure that give rise to these patterns and, (3) Beliefs, Mindsets and Goals that inform the design of system structures. This purpose of this brief is to unpack the Systems Thinking Iceberg as a way to organize reflection and dialogue about systemic challenges in education

Characteristics of Complex Problems

Many of the social challenges we care about feel like messy, wicked knots (or a pile of tangled headphones). When we pull on a thread in one place, we create new, tighter knots elsewhere. The messy nature of these challenges is due to, among other things, their complexity. Understanding key features of complex problems helps us understand why problems in education can be especially resistant to change. The purpose of this brief is to share (some) characteristics of complex problems, and introduce system dynamics as a set of tools for managing this complexity

Strengthening the Strategic and Operational Response for Reducing COVID-19 Transmission in Indonesia

Indonesia reported the first two cases of COVID-19 from Depok City, West Java, on March 2, 2020. This study aimed to evaluate the strategic response for reducing the COVID-19 transmission which mainly comprised case management, large-scale social restrictions, including micro-scale social restrictions, and the development of drugs and vaccines. The data were collected from the Indonesian Government’s official websites and the latest information from March 2020 to May 2021. Furthermore, a logical framework approach and a theory of change were used to describe, evaluate, and strengthen the strategic response. The current strategic response has not reduce the COVID-19 transmission. As of May 30, 2021, 1,879,730 confirmed cases with 101,639 active cases,1,663,998 recovered, and 50,404 deaths have been reported from 34 provinces. The case management faced a high positive rate and case fatality. Furthermore, the large-scale social restrictions have not increased public awareness and behavior practice on the prevention and control. Currently, there is no cure, and the vaccination needs more time to complete. Therefore, strengthening the current strategic response needs more testing, contact tracing, better quality treatment, community education for behavior change, and effective vaccination

Understanding Systems from a Feedback Perspective

Systems perspectives encourage us to see the world as an interconnected system of causal relationships. A fundamental idea of system dynamics perspective the focus on feedback thinking – looking at cause and effect as not just moving in one direction. The purpose of this brief is to introduce the concept of feedback thinking through the lens of challenges in K-12 education, and present Causal Loop Diagrams as tools to describe feedback relationships between components of a syste

All over the Map: A Systematic Literature Review and State Policy Scan of Medicaid Buy-In Programs for Working Individuals with Disabilities

While supports for people with disabilities have increased, significant healthcare and financial barriers persist. State-administered Medicaid Buy-In programs for working people with disabilities, distinct from broader buy-in discussions that have emerged as some states consider expanding access to health insurance, are intended to incentivize employment and protect against a loss of Long-Term Services and Supports. Loss of these services would be detrimental to a person’s ability to access daily living and workforce participation supporting services. This paper explores identified drivers of and barriers to participation, outcomes, and the current state of programs that are currently in place. Authors conducted a systematic literature search to identify evidence published in peer-review journals. Additionally, a policy scan using information from government sources for the 45 state-administered buy-in programs was completed. The results indicate that state Medicaid Buy-In programs vary dramatically in their construction and presentation, with eligibility and administration information or lack thereof having the potential to significantly affect a person’s decision making around benefit enrollment and employment. Findings are discussed in the context of additional recent state and federal policy efforts to improve outcomes around employment, income, and asset generation for people with disabilities

High-Dose-Rate Brachytherapy for the Treatment of Basal and Squamous Cell Carcinomas on Sensitive Areas of the Face: A Report of Clinical Outcomes and Acute and Subacute Toxicities

Purpose Basal cell and cutaneous squamous cell carcinoma are common malignancies (keratinocyte carcinomas [KCs]). Surgical resection is the standard of care. Radiation using high-dose rate brachytherapy (HDR-BT) may serve as a superior alternative where surgical scars may be of cosmetic concern or in elderly patients with significant comorbidity. We aim to describe the clinical and cosmetic outcomes as well as posttreatment radiation toxicities associated with HDR-BT in patients who were treated for KCs of the face. Methods and Materials Patients with KCs treated with HDR-BT from 2015 to 2018 were included in the study. Patient medical records and clinical photos were reviewed at multiple time points: start of treatment, end of treatment, short-term (2 week) follow-up, 3-month follow-up, and if needed at 6 months. Radiation toxicity was graded using the Radiation Therapy Oncology Grading (RTOG) acute toxicity scale. Median (range) toxicity grades at follow-up intervals were calculated. Clinical outcomes including local recurrence were evaluated for all patients. Results The study included 19 patients and 20 KCs. The median radiation dose was 42 Gy (39-42 Gy) over 6 fractions. The median toxicity at completion of treatment was RTOG grade 2 (85% of patients). At short-term follow-up, 50% of patients (n = 10) improved to RTOG grade 1 (0-2). At 3 months, 70% of patients (n = 14) had RTOG grade 0, and by 6 months, 100% of patients (n = 18) had RTOG grade 0. No RTOG grade 3 or higher skin toxicity was observed. With a median follow-up of 7.2 months (range, 1.3-54.4 months), the local recurrence-free survival was 95%. Conclusions We demonstrate that HDR-BT can be used as definitive treatment of KCs of the face with excellent cosmetic outcomes and local control. Acute and subacute skin toxicities were most commonly RTOG grade 2 or less with resolution of patient’s skin toxicity by 3 months

Molecular pedomorphism underlies craniofacial skeletal evolution in Antarctic notothenioid fishes

Background Pedomorphism is the retention of ancestrally juvenile traits by adults in a descendant taxon. Despite its importance for evolutionary change, there are few examples of a molecular basis for this phenomenon. Notothenioids represent one of the best described species flocks among marine fishes, but their diversity is currently threatened by the rapidly changing Antarctic climate. Notothenioid evolutionary history is characterized by parallel radiations from a benthic ancestor to pelagic predators, which was accompanied by the appearance of several pedomorphic traits, including the reduction of skeletal mineralization that resulted in increased buoyancy. Results We compared craniofacial skeletal development in two pelagic notothenioids, Chaenocephalus aceratus and Pleuragramma antarcticum, to that in a benthic species, Notothenia coriiceps, and two outgroups, the threespine stickleback and the zebrafish. Relative to these other species, pelagic notothenioids exhibited a delay in pharyngeal bone development, which was associated with discrete heterochronic shifts in skeletal gene expression that were consistent with persistence of the chondrogenic program and a delay in the osteogenic program during larval development. Morphological analysis also revealed a bias toward the development of anterior and ventral elements of the notothenioid pharyngeal skeleton relative to dorsal and posterior elements. Conclusions Our data support the hypothesis that early shifts in the relative timing of craniofacial skeletal gene expression may have had a significant impact on the adaptive radiation of Antarctic notothenioids into pelagic habitats