Unsustainable production patterns and disease emergence: The paradigmatic case of Highly Pathogenic Avian Influenza H5N1.

Current food production systems are causing severe environmental damage, including the emergence of dangerous pathogens that put humans and wildlife at risk. Several dangerous pathogens (e.g., the 2009 A(H1N1) Influenza Virus, Nipah virus) have emerged associated with the dominant intensive food production systems. In this article, we use the case of the emergence and spillover of the Highly Pathogenic Avian Influenza virus H5N1 (hereafter, H5N1) to illustrate how intensive food production methods provide a breeding ground for dangerous pathogens. We also discuss how emerging pathogens, such as H5N1, may affect not only ecosystem health but also human well-being and the economy. The current H5N1 panzootic (2020-2024) is producing a catastrophic impact: the millions of domestic birds affected by this virus have led to significant economic losses globally, and wild birds and mammals have suffered alarming mortalities, with the associated loss of their material and non-material ecosystem services. Transformative actions are required to reduce the emergence and impact of pathogens such as H5N1; we particularly need to reconsider the ways we are producing food. Governments should redirect funds to the promotion of alternative production systems that reduce the risk of new emerging pathogens and produce environmentally healthy food. These systems need to have a positive relationship with nature rather than being systems based on business as usual to the detriment of the environment. Sustainable food production systems may save many lives, economies, and biodiversity, together with the ecosystem services species provide.

Negotiating discord in sustainability transformations.

Policy action for sustainability transformation faces inherent and ever-present sources of conflict, pushback, and resistance (i.e., discord). However, conceptual frameworks and policy prescriptions for sustainability transformations often reflect an undue image of accord. This involves simplified assumptions about consensus, steering, friction, discreteness, and additiveness of policy action, conferring an unrealistic view of the potential to deliberately realize transformation. Instead, negotiating discord through continuously finding partial political settlements among divided actors needs to become a key focus of policy action for sustainability transformations. Doing so can help to navigate deeply political settings through imperfect but workable steps that loosen deadlock, generate momentum for further policy action, and avoid complete derailment of transformation agendas when discord arises.

Development and implementation of a pregnancy heart team at a Southeastern United States tertiary hospital: a qualitative study.

BACKGROUND: The United States has seen a significant rise in maternal mortality and morbidity associated with cardiovascular disease over the past 4 decades. Contributing factors may include an increasing number of parturients with comorbid conditions, a higher rate of pregnancy among women of advanced maternal age, and more patients with congenital heart disease who survive into childbearing age and experiencing pregnancy. In response, national medical organizations have recommended the creation of multidisciplinary obstetric-cardiac teams, also known as pregnancy heart teams, to provide comprehensive preconception counseling and coordinated pregnancy management that extend through the postpartum period. OBJECTIVE: We sought to describe the development and implementation of a pregnancy heart team for parturients with cardiac disease at a southeastern United States tertiary hospital. STUDY DESIGN: This was a qualitative study that was conducted among healthcare team members involved during the pregnancy heart team formation. Semi-structured interviews were conducted between April and May 2022, professionally transcribed, and the responses were thematically coded for categories and themes using constructs from The Consolidated Framework for Implementation Research. RESULTS: Themes identified included intentional collaboration to improve outpatient and inpatient coordination through earlier awareness of patients who meet the criteria and via documented care planning. The pregnancy heart team united clinicians around best practices and coordination to promote the success and safety of pregnancies and not only to minimize maternal health risks. Developing longitudinal care plans was critical among the pathway team to build on collective expertise and to provide clarity for those on shift to reduce hesitancy and achieve timely, vetted practices without additional consults. Establishing a proactive approach of specialists offering their perspectives was viewed as positively contributing to a culture of speaking up. Barriers to the successful development and sustainability of the pregnancy heart team included unmet administrative needs and clinician turnover within a context of shortages in staffing and high workload. CONCLUSION: This study described the process of developing and implementing a pregnancy heart team at 1 institution, thereby offering insights for future multidisciplinary care for maternal cardiac patients. Establishing pregnancy heart teams can enhance quality care for high-risk patients, foster learning and collaboration among physician and nursing specialties, and improve coordination to manage complex maternal cardiac cases.

The ILC Maine statement: Time for the fundamental care [r]evolution.

AIM: The aim of this study was to present the third position statement from the International Learning Collaborative (ILC). The ILC is the foremost global organization dedicated to transforming fundamental care. Internationally, fundamental care is reported to be poorly delivered, delayed or missed, negatively impacting patients, their families/carers and healthcare staff and systems. Overcoming this global challenge requires profound transformation in how our healthcare systems value, deliver and evaluate fundamental care. This transformation will take both evolutionary and revolutionary guises. In this position statement, we argue how this [r]evolutionary transformation for fundamental care can and must be created within clinical practice. DESIGN: Position paper. METHODS: This position statement stems from the ILC's annual conference and Leadership Program held in Portland, Maine, USA, in June 2023. The statement draws on the discussions between participants and the authors' subsequent reflections and synthesis of these discussions and ideas. The conference and Leadership Program involved participants (n = 209) from 13 countries working primarily within clinical practice. RESULTS: The statement focuses on what must occur to transform how fundamental care is valued, prioritized and delivered within clinical practice settings globally. To ensure demonstrable change, the statement comprises four action-oriented strategies that must be systematically owned by healthcare staff and leaders and embedded in our healthcare organizations and systems: Address non-nursing tasks: reclaim and protect time to provide high-value fundamental care. Accentuate the positive: change from deficit-based to affirmative language when describing fundamental care. Access evidence and assess impact: demonstrate transformation in fundamental care by generating relevant indicators and impact measures and rigorously synthesizing existing research. Advocate for interprofessional collaboration: support high-quality, transdisciplinary fundamental care delivery via strong nursing leadership. CONCLUSION: The ILC Maine Statement calls for ongoing action - [r]evolution - from healthcare leaders and staff within clinical practice to prioritize fundamental care throughout healthcare systems globally. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: We outline four action-oriented strategies that can be embedded within clinical practice to substantially transform how fundamental care is delivered. Specific actions to support these strategies are outlined, providing healthcare leaders and staff a road map to continue the transformation of fundamental care within our healthcare systems. IMPACT: Fundamental care affects everyone across their life course, regardless of care context, clinical condition, age and/or the presence of disability. This position statement represents a call to action to healthcare leaders and staff working specifically in clinical practice, urging them to take up the leadership challenge of transforming how fundamental care is delivered and experience globally. PATIENT OR PUBLIC CONTRIBUTION: Patients, service users and caregivers were involved in the ILC annual conference, thus contributing to the discussions that shaped this position statement. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: The strategies and actions outlined in this position statement are relevant to all clinical settings globally, providing practical strategies and actions that can be employed to enhance fundamental care for all patients and their families/carers. By outlining the importance of both evolutionary and revolutionary change, we identify ways in which healthcare systems globally can begin making the necessary steps towards radical fundamental care transformation, regardless of where they are in the change journey.

The resilience-sustainability-quality of life nexus.

Social-ecological resilience (SER), sustainability (SUS) and quality of life including wellbeing (QOL) are distinct but highly interconnected goals that are essential for human survival, development, and adaptation to environmental and socioeconomic changes. However, these goals are often addressed in silos or pairs, and a framework explicitly linking all three is currently lacking. In this paper, we present the SER-SUS-QOL nexus framework and discuss how social and ecological changes affect these goals. The main thrust of this nexus is that efforts toward SER and SUS need to be explicitly framed in terms of the ultimate goal, which has to be the QOL of the present and future generations. We contend that critically assessing the dynamic interplay between SER, SUS and QOL, as well as the factors impacting them, can help promote transformative governance and planning in the contemporary era. Understanding the multifaceted interrelationship between these goals is crucial to empower planners and decision-makers to navigate the complexities of our rapidly changing world and address the challenges brought by interrelated social and ecological changes. To deepen our understanding of this nexus, more research is needed on various issues, including, but not limited to, trade-offs and synergies, cascading effects, spatiotemporal dynamics of SER, SUS and QOL outcomes, potential inconsistencies between SER and transformative changes toward SUS, and the role of local/indigenous/traditional ecological knowledge in transformative governance and planning.

Four System Enablers of Large-System Transformation in Health Care: A Mixed Methods Realist Evaluation.

Policy Points The implementation of large-scale health care interventions relies on a shared vision, commitment to change, coordination across sites, and a spanning of siloed knowledge. Enablers of the system should include building an authorizing environment; providing relevant, meaningful, transparent, and timely data; designating and distributing leadership and decision making; and fostering the emergence of a learning culture. Attention to these four enablers can set up a positive feedback loop to foster positive change that can protect against the loss of key staff, the presence of lone disruptors, and the enervating effects of uncertainty. CONTEXT: Large-scale transformative initiatives have the potential to improve the quality, efficiency, and safety of health care. However, change is expensive, complex, and difficult to implement and sustain. This paper advances system enablers, which will help to guide large-scale transformation in health care systems. METHODS: A realist study of the implementation of a value-based health care program between 2017 and 2021 was undertaken in every public hospital (n = 221) in New South Wales (NSW), Australia. Four data sources were used to elucidate initial program theories beginning with a set of literature reviews, a program document review, and informal discussions with key stakeholders. Semistructured interviews were then conducted with 56 stakeholders to confirm, refute, or refine the theories. A retroductive analysis produced a series of context-mechanism-outcome (CMO) statements. Next, the CMOs were validated with three health care quality expert panels (n = 51). Synthesized data were interrogated to distill the overarching system enablers. FINDINGS: Forty-two CMO statements from the eight initial program theory areas were developed, refined, and validated. Four system enablers were identified: (1) build an authorizing environment; (2) provide relevant, authentic, timely, and meaningful data; (3) designate and distribute leadership and decision making; and (4) support the emergence of a learning culture. The system enablers provide a nuanced understanding of large-system transformation that illustrates when, for whom, and in what circumstances large-system transformation worked well or worked poorly. CONCLUSIONS: System enablers offer nuanced guidance for the implementation of large-scale health care interventions. The four enablers may be portable to similar contexts and provide the empirical basis for an implementation model of large-system value-based health care initiatives. With concerted application, these findings can pave the way not just for a better understanding of greater or lesser success in intervening in health care settings but ultimately to contribute higher quality, higher value, and safer care.

How policies and actor strategies affect electric vehicle diffusion and wider sustainability transitions.

Implementing electromobility is a central component in the de-carbonization of personal mobility. In recent years, the absolute number of electric vehicles (EVs) and their market share has increased sharply in many countries. This paper focuses on Norway, a pioneer market for EVs that other countries can learn from. The analysis highlights how a combination of local and national policies over a 30-y period, which targeted both industry development and vehicle demand, were important drivers of this development. It also highlights the importance of advocacy groups and strong networks in promoting EVs, as well as changes in user preferences. The paper demonstrates how the EV diffusion has been driven by alignments of multiple processes across different levels, involving interactions between multiple actors and social groups with different interests and views about desirable futures as described by the multi-level perspective (MLP). Building on the MLP, the study of EV diffusion in Norway illustrates how niches are often sustained through demonstrations, experimentation, strategic alliances, and actors securing favorable political and economic conditions. Further, it shows how local or national niches may depend on international regime actors, such as the car manufacturing industry and policies developed abroad. The paper also explores how the introduction of EVs has opened for wider effects, including innovation within production-consumption systems beyond mobility. Based on this analysis, we argue for a nuanced perspective on the relationship between incremental, regime-internal innovation, and wider transformative changes, where the merits of societal learning and experience with battery electricity for transportation are highlighted.

Transformative potential of conservation actions.

Transformative change can help achieve the 2050 vision of biodiversity, but concrete ways to achieve it are only being discovered. To contribute to the understanding of the practical options for concrete action to foster, accelerate and maintain the transformative change, we assessed the leverage potential of existing conservation actions using the Meadows' Leverage points framework. We took the actions from the Conservation Actions Classification by the Conservation Measures Partnership. The outcome is a scheme that evaluates at which leverage points, from simple parameters to paradigms, the different conservation actions have potential to make an impact, and thus impact systemic change. We found that all conservation actions have potential to leverage systemic transformative change, with varying coverage of the leverage points. All leverage points were addressed by several actions. The scheme could be used both as an interim tool for evaluating transformative potential in different broad datasets, but also help with planning of new conservation policies, interventions and projects. We hope our work could be a first step toward standardization and broader adoption of assessing leverage in conservation research and practice, achieving broader socio-ecological system leverage with conservation tools. Supplementary Information: The online version contains supplementary material available at 10.1007/s10531-023-02600-3.

The Therapeutic Relationship: Intrapsychic and Behavioral Changes in Both Patient and Analyst.

This article explores how the therapeutic relationship facilitates intrapsychic and behavioral changes in both the patient and the analyst. Key elements of the therapeutic relationship are reviewed, including transference, countertransference, introjective and projective identification, as well as the "real relationship." Special attention is paid to the "transformative relationship," which is a special kind of bond that develops between analyst and patient that is unique and transformative. It consists of mutual respect, emotional intimacy, trust, understanding, and affection. Empathic attunement is a key element in the evolution of a transformative relationship. This attunement optimally promotes intrapsychic and behavioral changes in both the patient and the analyst. This process is illustrated by a case presentation.

An Urgent Call to Integrate the Health Sector into the Post-2020 Global Biodiversity Framework.

There is a rapidly closing window of opportunity to stop biodiversity loss and secure the resilience of all life on Earth. In December 2022, Parties to the United Nations (UN) Convention on Biological Diversity (CBD) will meet in Montreal, Canada, to finalize the language and terms of the Post-2020 Global Biodiversity Framework (Post-2020 GBF). The Post-2020 GBF aims to address the shortcomings of the previous Strategic Plan on Biodiversity 2011-2020, by introducing a Theory of Change, that states that biodiversity protection will only be successful if unprecedented, transformative changes are implemented effectively by Parties to the CBD. In this policy perspective, we explore the implications of the Theory of Change chosen to underpin the Post-2020 GBF, specifically that broad social transformation is an outcome that requires actors to be specified. We detail how the health sector is uniquely positioned to be an effective actor and ally in support of the implementation of the Post-2020 GBF. Specifically, we highlight how the core competencies and financial and human resources available in the health sector (including unique knowledge, skill sets, experiences, and established trust) provide a compelling, yet mostly untapped opportunity to help create and sustain the enabling conditions necessary to achieve the goals and targets of the framework. While by no means a panacea for the world's biodiversity problems, we posit that explicitly omitting the health sector from the Post-2020 GBF substantially weakens the global, collective effort to catalyze the transformative changes required to safeguard biodiversity.

Green building standards and the United Nations' Sustainable Development Goals.

Sustainable practices in the building industry are strongly influenced by published green and sustainable building and real-estate standards (GSBRES). Therefore, it is crucial to assess how these standards contribute to achieving the United Nations' Sustainable Development Goals (SDGs). This paper evaluates the extent to which GSBRESs align with the 2030 Agenda for Sustainable Development, lending a particular focus to the call for transformative change implicit in the SDGs. To this end, we develop a methodology that combines qualitative and quantitative analysis to assess the overlap between the content of three GSBRESs (LEED for design, BOMA BEST for operation, and GRESB for investment) and the SDGs. Despite the overlaps between the attributes of the GSBRESs and the general topics of the SDGs, we find that less than 20% of GSBRES attributes address the specific targets of the 2030 Agenda. Most importantly, the qualitative analysis shows that less than 10% of the standards' scores is attributed to transformative change. We conclude that claims that the GSBRESs are effective in advancing the SDGs are overstated and, without further empirical evidence, caution that they increase the risk of sustainable development greenwashing. We recommend that the standards be repositioned to adopt transformation-focused indicators related to a project's long-term impacts.

Rethinking authentic assessment: work, well-being, and society.

This article seeks a deeper understanding of the concept of authentic assessment which ensures it does not become another educational buzzword, slowly diminishing in real meaning. I consider the origins of the term in the US schooling sector, and how it has developed over time, and in different countries, to today focus in higher education largely on real world tasks. There is, however, I argue, a common conflation of real world with the world of work. Little of this literature actually engages with the rich philosophical debates on authenticity, and in this article, I suggest that this deeper understanding of authenticity can enable us to build on existing work on authentic assessment to develop a more holistic and richer concept that will be more beneficial to individual students and to the larger society of which they are part. I argue that we should move from thinking in terms of either the so-called real world, or the world of work, to focus our justification for authentic assessment on its social value (which encompasses but is not limited to its economic value). To achieve this aim, I suggest we move from simply focusing on the authentic task to considering why that task matters? This then enables a shift from the student in isolation to the student as a member of society. Senses of achievement can become richer, thus enhancing the students' sense of self, self-worth, and well-being.

Recognizing reflexivity among conservation practitioners.

When deciding how to conserve biodiversity, practitioners navigate diverse missions, sometimes conflicting approaches, and uncertain trade-offs. These choices are based not only on evidence, funders' priorities, stakeholders' interests, and policies, but also on practitioners' personal experiences, backgrounds, and values. Calls for greater reflexivity-an individual or group's ability to examine themselves in relation to their actions and interactions with others-have appeared in the conservation science literature. But what role does reflexivity play in conservation practice? We explored how self-reflection can shape how individuals and groups conserve nature. To provide examples of reflexivity in conservation practice, we conducted a year-long series of workshop discussions and online exchanges. During these, we examined cases from the peer-reviewed and gray literature, our own experiences, and conversations with 10 experts. Reflexivity among practitioners spanned individual and collective levels and informal and formal settings. Reflexivity also encompassed diverse themes, including practitioners' values, emotional struggles, social identities, training, cultural backgrounds, and experiences of success and failure. Reflexive processes also have limitations, dangers, and costs. Informal and institutionalized reflexivity requires allocation of limited time and resources, can be hard to put into practice, and alone cannot solve conservation challenges. Yet, when intentionally undertaken, reflexive processes might be integrated into adaptive management cycles at multiple points, helping conservation practitioners better reach their goals. Reflexivity could also play a more transformative role in conservation by motivating practitioners to reevaluate their goals and methods entirely. Reflexivity might help the conservation movement imagine and thus work toward a better world for wildlife, people, and the conservation sector itself.

Reconocimiento de la reflexividad entre los practicantes de la conservación Resumen Cuando se decide cómo conservar la biodiversidad, quienes la practican sortean varias misiones, algunas veces con enfoques contrastantes y compensaciones inciertas. Estas elecciones no se basan solamente en las evidencias, prioridades de los financiadores, los intereses de los actores y las políticas, sino también en las experiencias personales, formación y valores de los practicantes. En la literatura sobre las ciencias de la conservación han surgido llamados para una mayor reflexividad - la habilidad individual o grupal para examinarse a sí mismo en relación con sus acciones e interacciones con otros. Pero ¿cuál es el papel de la reflexividad en la práctica de la conservación? Para responder esto, exploramos cómo la autorreflexión puede determinar cómo ocurre la conservación individual y grupal de la naturaleza. Realizamos una serie de talleres de discusión e intercambios virtuales durante un año para ejemplificar la reflexividad en la práctica de la conservación. Durante estas sesiones examinamos casos de la literatura gris y revisada por pares, nuestras propias experiencias y conversaciones con diez expertos. La reflexividad de los practicantes abarcó niveles individuales y colectivos y escenarios formales e informales. La reflexividad también comprendió diferentes aspectos de los practicantes, como los valores, conflictos emocionales, identidad social, preparación, contexto cultural y experiencias exitosas y fallidas. Los procesos reflexivos también tienen limitaciones, riesgos y costos. La reflexividad informal e institucionalizada requiere la distribución de tiempo y recursos limitados, puede ser difícil de poner en práctica y no puede resolver los retos de conservación por sí sola. Aun así, cuando se realizan intencionalmente, los procesos reflexivos pueden integrarse a los ciclos de manejo adaptativo en varios puntos, lo que ayuda a quienes practican la conservación a lograr sus metas de mejor manera. La reflexividad también podría tener un papel transformador en la conservación al motivar a los practicantes a reevaluar completamente sus metas y métodos. La reflexividad podría ayudar al movimiento de conservación a imaginar, y por lo tanto trabajar para tener, un mundo mejor para la vida silvestre, las personas y el propio sector de la conservación.

Transforming Intensive Animal Production: Challenges and Opportunities for Farm Animal Welfare in the European Union.

Since the 1960s, the European Union (EU) has made efforts to ensure the welfare of farm animals. The system of EU minimum standards has contributed to improved conditions; however, it has not been able to address the deeper factors that lead to the intensification of animal farming and the consolidation of the processing sector. These issues, along with major competitive pressures and imbalances in economic power, have led to a conflict of interest between animal industries, reformers, and regulators. While the priorities of the European Green Deal and the End the Cage Age initiatives are to induce a rapid phasing out of large-scale cage-based farming systems, the industry faces the need to operate on a highly competitive global market. Animal farmers are also under pressure to decrease input costs, severely limiting their ability to put positive animal-care values into practice. To ensure a truly effective transition, efforts need to go beyond new regulations on farm animal welfare and address drivers that push production toward a level of confinement and cost-cutting. Given the right socio-economic and policy incentives, a transition away from intensive farming methods could be facilitated by incentives supporting farm diversification, alternative technologies, and marketing strategies.

The SARS-CoV-2 Pandemic and Cancer Trials Ireland: Impact, Resolution and Legacy.

BACKGROUND: Cancer Trials Ireland (CTI) is the national cooperative group in Ireland. The SARS-CoV-2 pandemic led to significant ongoing disruptive change in healthcare from March 2020 to the present day. Its impact and legacy on a national clinical trials organisation was assessed. METHODS: A review was conducted of prospectively acquired communications, team logs and time sheets, trial activation, closure and accrual, for the period 2019 to September 2021. An online survey of the impact of the pandemic on clinical investigators and of clinical trials units was performed. A National Cancer Retreat was organised on 21 May 2021 to identify and address pandemic related disruption and develop adaptive strategies. RESULTS: In the weeks after the pandemic was declared, remote working was initiated by all central office staff. Nationally, clinical trial accrual fell by 54% compared to the same period in 2019, radiotherapy trial accrual by 90%, and translational studies by 36%. Staff reassignment of research nurse staff occurred in 60% of units, trial monitoring was reduced in 42%, and trial initiations fell by 67%. Extreme fluctuations in monitoring hours were noted paralleling lockdown measures. Significant impact on all clinical trials units was noted including staff reassignments, reduced access to diagnostic imaging and reduced institutional supports. Remote clinic visits and remote monitoring was widely adopted. The National Cancer Retreat identified flexibility in trial conduct, staff recruitment and retention, the need for harmonisation of processes, and research staff support in the context of remote working as priorities. CONCLUSION: The pandemic has had a significant ongoing negative impact on cancer clinical trial activity in Ireland. Adaptive strategies including trial flexibility, expanded telehealth and remote monitoring, harmonisation of processes and staff support have been identified as priorities to ameliorate this impact, and develop a more sustainable clinical trial ecosystem.

Beyond "blah blah blah": exploring the "how" of transformation.

Calls for transformations are clear and multiple pathways and alternative visions for the future have been defined. Yet, there is very little shared understanding of how such transformations come about and how knowledge-action gaps will be filled. This Special Feature focuses on how we can go beyond talking about transformation-the "blah blah blah"-and moving toward action for results. It does so by distinguishing between the means of transformation and the manner of transformation, two key dimensions to answering the question of "how." The means can be understood as the many solutions, technical and practical methods, or actions that are presented as significant to transformative change. The manner, in contrast, represents the ways in which something is done, i.e., ways of acting. It describes the core values, principles, qualities, and relationships that not only underpin and motivate transformative change, but shape the process. Integrating rather than conflating the means and the manner is important to better understand how transformations come about. We then present insights from the collection of papers that focus on the "how" of transformation. The papers describe different ways of integrating the means and the manner in transformation processes. We have organized them thematically as follows: papers that draw on the integration of meaning making, the integration of learning and listening, and the integration of different ways of being and becoming. Drawing on both science and alternative ways of knowing, they weave together new narratives and stories about nature, society, and the future, inviting us to embark on the journey of creating sustainability pathways.

An integrative framework for transformative social change: a case in global wildlife trade.

To achieve a sustainable future, it is imperative to transform human actions collectively and underlying social structures. Decades of research in social sciences have offered complementary insights into how such transformations might occur. However, these insights largely remain disjunct and of limited scope, such that strategies for solving global environmental challenges remain elusive. There is a need to integrate approaches focusing on individuals and social structures to understand how individual actions influence and are in turn influenced by social structures and norms. In this paper, we synthesize a range of insights across different schools of thought and integrate them in a novel framework for transformative social change. Our framework explains the relationships among individual behaviors, collective actions, and social structures and helps change agents guide societal transitions toward environmental sustainability. We apply this framework to the global wildlife trade-which presents several distinct challenges of human actions, especially amidst the Covid-19 pandemic-and identify pathways toward transformative change. One key distinction we make is between different individual actions that comprise the practice itself (e.g., buying wildlife products; private action) and those that push for a broader system change in practice (e.g., signaling (dis)approval for wildlife consumption; social-signaling action, and campaigning for policies that end unsustainable wildlife trade; system-changing action). In general, transformative change will require an integrative approach that includes both structural reforms and all three classes of individual action.

Hopeful adaptation after acquired brain injury: The case of late referrals in the Netherlands.

A substantial number of people with 'mild' acquired brain injury (ABI) suffer from cognitive impairments that are not immediately acknowledged as such. Some are eventually referred to multidisciplinary rehabilitation care after months or years of suffering, which is why we have labelled them 'late referrals'. The aim of this paper is to add to the discussion on hopeful adaptation by focussing on the diverse adaptive strategies of late referrals. Hope is typically discussed as a positive emotion that can contribute to transformative processes, but that is also mirrored by despair. We conducted in-depth interviews with ten late referrals in the Netherlands. Our findings demonstrate that the trajectories of late referrals are characterised by wandering and navigating. Wandering is predominantly associated with feeling lost, and not knowing where one is going. While navigating is more purposeful, we found that our participants sometimes navigated in directions that turned out to be dead-end streets. We conclude that hopeful adaptation encompasses a circuitous way of trying and adapting and trying again. As a key recommendation for practice, we suggest that people with cognitive problems due to mild ABI should be supported in reducing the complexities of their everyday lives by taking up challenges one place at a time.

Funding Diversity: A Case Study of A State-initiated, Funding-driven Program to Diversify Mental Health Service Provision in Minnesota.

Human service organizations are reconfiguring to address diversifying populations and widening inequality. However, institutional change is challenging to implement and fund; resource scarcity and stakeholder buy-in are barriers. In this case study, we analyze a funding-driven, state-initiated program that supports mental health professionals who are people of color in order to decrease health disparities. Analyses of interviews and documents depict how the program struggled with high turnover and uninspired, halfhearted messaging, but was nevertheless well loved. Findings illustrate how the 'pitch' and leadership matter in programming for institutional change and its contested nature, a contestation that funding alone cannot temper.

The eighth plenary of the Intergovernmental Science-Policy Platform for Biodiversity and Ecosystem Services (IPBES-8): online, nexus, and transformative change.

The Intergovernmental Science-Policy Platform for Biodiversity and Ecosystem Services held its 8th plenary session online in June 2021, during which a new budget was approved up to 2023, continuing work plans were agreed, and scoping documents for two new assessments, the nexus and transformative change assessments, were accepted.