The Sprint Goal is an objective that will be met within the Sprint through the implementation of the Product Backlog, and it provides guidance to the Development Team on why it is building the Increment. Having set the Sprint Goal and selected the Product Backlog items for the Sprint, the Development Team decides how it will build this functionality into a "Done" product Increment during the Sprint. The Product Backlog items selected for this Sprint plus the plan for delivering them is called the Sprint Backlog.
The Development Team usually starts by designing the system and the work needed to convert the Product Backlog into a working product Increment. Work may be of varying size, or estimated effort. However, enough work is planned during Sprint Planning for the Development Team to forecast what it believes it can do in the upcoming Sprint. Work planned for the first days of the Sprint by the Development Team is decomposed by the end of this meeting, often to units of one day or less.
The Development Team self-organizes to undertake the work in the Sprint Backlog, both during Sprint Planning and as needed throughout the Sprint. The Product Owner can help to clarify the selected Product Backlog items and make trade-offs. If the Development Team determines it has too much or too little work, it may renegotiate the selected Product Backlog items with the Product Owner. The Development Team may also invite other people to attend to provide technical or domain advice.
By the end of the Sprint Planning, the Development Team should be able to explain to the Product Owner and Scrum Master how it intends to work as a self-organizing team to accomplish the Sprint Goal and create the anticipated Increment. The Sprint Goal is an objective set for the Sprint that can be met through the implementation of Product Backlog. It provides guidance to the Development Team on why it is building the Increment. It is created during the Sprint Planning meeting. The Sprint Goal gives the Development Team some flexibility regarding the functionality implemented within the Sprint.
The selected Product Backlog items deliver one coherent function, which can be the Sprint Goal. The Sprint Goal can be any other coherence that causes the Development Team to work together rather than on separate initiatives. As the Development Team works, it keeps the Sprint Goal in mind.
In order to satisfy the Sprint Goal, it implements functionality and technology. If the work turns out to be different than the Development Team expected, they collaborate with the Product Owner to negotiate the scope of Sprint Backlog within the Sprint. The Daily Scrum is a minute time-boxed event for the Development Team. The Daily Scrum is held every day of the Sprint. At it, the Development Team plans work for the next 24 hours. This optimizes team collaboration and performance by inspecting the work since the last Daily Scrum and forecasting upcoming Sprint work.
The Daily Scrum is held at the same time and place each day to reduce complexity. The Development Team uses the Daily Scrum to inspect progress toward the Sprint Goal and to inspect how progress is trending toward completing the work in the Sprint Backlog. Every day, the Development Team should understand how it intends to work together as a self-organizing team to accomplish the Sprint Goal and create the anticipated Increment by the end of the Sprint. The structure of the meeting is set by the Development Team and can be conducted in different ways if it focuses on progress toward the Sprint Goal.
Some Development Teams will use questions, some will be more discussion based. Here is an example of what might be used:. The Daily Scrum is an internal meeting for the Development Team. If others are present, the Scrum Master ensures that they do not disrupt the meeting. This is a key inspect and adapt meeting. During the Sprint Review, the Scrum Team and stakeholders collaborate about what was done in the Sprint. Based on that and any changes to the Product Backlog during the Sprint, attendees collaborate on the next things that could be done to optimize value.
This is an informal meeting, not a status meeting, and the presentation of the Increment is intended to elicit feedback and foster collaboration. This is at most a four-hour meeting for one-month Sprints. The Scrum Master ensures that the event takes place and that attendees understand its purpose. The Scrum Master teaches everyone involved to keep it within the time-box.
The Product Backlog may also be adjusted overall to meet new opportunities. The Sprint Retrospective is an opportunity for the Scrum Team to inspect itself and create a plan for improvements to be enacted during the next Sprint. This is at most a three-hour meeting for one-month Sprints. The Scrum Master ensures that the meeting is positive and productive. The Scrum Master teaches all to keep it within the time-box.
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The Scrum Master participates as a peer team member in the meeting from the accountability over the Scrum process. The Scrum Master encourages the Scrum Team to improve, within the Scrum process framework, its development process and practices to make it more effective and enjoyable for the next Sprint. During each Sprint Retrospective, the Scrum Team plans ways to increase product quality by improving work processes or adapting the definition of "Done", if appropriate and not in conflict with product or organizational standards.
By the end of the Sprint Retrospective, the Scrum Team should have identified improvements that it will implement in the next Sprint. Implementing these improvements in the next Sprint is the adaptation to the inspection of the Scrum Team itself. Although improvements may be implemented at any time, the Sprint Retrospective provides a formal opportunity to focus on inspection and adaptation.
Artifacts defined by Scrum are specifically designed to maximize transparency of key information so that everybody has the same understanding of the artifact. The Product Backlog is an ordered list of everything that is known to be needed in the product. It is the single source of requirements for any changes to be made to the product.
The Product Owner is responsible for the Product Backlog, including its content, availability, and ordering. A Product Backlog is never complete. The earliest development of it lays out the initially known and best-understood requirements. The Product Backlog evolves as the product and the environment in which it will be used evolves. The Product Backlog is dynamic; it constantly changes to identify what the product needs to be appropriate, competitive, and useful. If a product exists, its Product Backlog also exists. The Product Backlog lists all features, functions, requirements, enhancements, and fixes that constitute the changes to be made to the product in future releases.
Product Backlog items have the attributes of a description, order, estimate, and value. Product Backlog items often include test descriptions that will prove its completeness when "Done". As a product is used and gains value, and the marketplace provides feedback, the Product Backlog becomes a larger and more exhaustive list. Requirements never stop changing, so a Product Backlog is a living artifact.
Changes in business requirements, market conditions, or technology may cause changes in the Product Backlog. Multiple Scrum Teams often work together on the same product. One Product Backlog is used to describe the upcoming work on the product. A Product Backlog attribute that groups items may then be employed. Product Backlog refinement is the act of adding detail, estimates, and order to items in the Product Backlog. This is an ongoing process in which the Product Owner and the Development Team collaborate on the details of Product Backlog items.
During Product Backlog refinement, items are reviewed and revised. The Scrum Team decides how and when refinement is done. Higher ordered Product Backlog items are usually clearer and more detailed than lower ordered ones. More precise estimates are made based on the greater clarity and increased detail; the lower the order, the less detail.
Product Backlog items that will occupy the Development Team for the upcoming Sprint are refined so that any one item can reasonably be "Done" within the Sprint time-box. Product Backlog items usually acquire this degree of transparency through the above described refining activities. The Development Team is responsible for all estimates. The Product Owner may influence the Development Team by helping it understand and select trade-offs, but the people who will perform the work make the final estimate. At any point in time, the total work remaining to reach a goal can be summed.
The Product Owner tracks this total work remaining at least every Sprint Review. The Product Owner compares this amount with work remaining at previous Sprint Reviews to assess progress toward completing projected work by the desired time for the goal. According to the HE 2 Diagram, a key factor affecting the adequacy of the welfare system and of the minimum wage is the consideration of the real cost of healthy eating in the design of these social protection mechanisms.
The group also acknowledged the informal supports that can help improve equity in healthy eating, including factors such as kinship and community groups, which provide financial or meals based support to people in need. The group also identified a number of individual level variables, notably in the health literacy and food preference sub-systems. Nutrition knowledge was noted by the group as being a key equity concern, whereby people from low socioeconomic groups typically report lower levels of nutrition knowledge.
Nutrition knowledge can act as an antecedent to healthy food choices, however many other intersecting factors often influence health literacy, as illustrated in the Health Literacy sub-system. Food preferences were noted by participants as being important individual level factors that affect food choices. Preferences and levels of acceptance for new foods can be altered via repeat exposures to disliked or unfamiliar foods. Within the current obesogenic food environment, the group felt that it is often difficult for communities to avoid the heavily marketed highly palatable foods that are often high in fat, salt, and sugar.
Fig 5 is a structural level depiction of the HE 2 diagram that shows the feedback between different sub-systems as they relate to inequity in healthy eating. The direction of the arrows connecting each sub-system are derived from the direction of the arrows in the full HE 2 CLD Fig 2. The structural level diagram gives insight into the feedback between policy sub-systems at a structural level.
From this diagram it can be observed that the distribution of healthy eating is influenced by all sub-systems. Further, this diagram indicates that the state of variables within a certain sub-system, for example Housing, influence the distribution of healthy eating directly, but also go on to influence the state of variables in other sub-systems, such as Transport, Employment and, Food Supply and Environment.
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The state of variables in these sub-systems can then go on to influence variables in the Housing sub-system, and so on. Such feedback based interactions between sub-systems add to the complexity of the HE 2 system overall. In this paper we present the results of research conducted with an expert group of policy actors policy makers, practitioners and researchers. A systems approach, using group model building of a causal loop diagram, has made it possible to organise and analyse complex information with an emphasis on the whole picture.
While the healthy eating literature has paid a lot of attention to food systems, this project expands the thinking in two ways: it brings an equity lens to healthy eating, and it considers a much wider system that is inclusive of societal and individual level factors that cross multiple sectors—the food supply and environment; housing and the built environment; transport; employment; social protection; health literacy, and food preferences. This articulation of the interconnections within the wider system highlights the need, within policy development and implementation, to consider the ways in which actions in one sector can reinforce or undermine actions in other sectors.
Members of the policy actor group were able to identify multiple level determinants of inequities in healthy eating and capture the interactions between the different factors. They were also able to identify feedback loops within the system that drive inequities in healthy eating. Through participating in the workshops and constructing the CLD, the policy actors were able to discuss deeply the whole system and begin to identify key points in the system in which there are opportunities to intervene to address inequities in healthy eating.
This study framed the emergence of inequity in healthy eating as arising from a complex adaptive system and successfully used an expert group collaborative modelling process to build a causal loop diagram for understanding drivers, major feedback loops, and the system structure of inequity in healthy eating. This has not been done as far as we are aware. Previous nutrition related systems research has focussed on the food environment rather than to draw together all of the relevant drivers of diet and nutrition as a complex adaptive system, and has not included an equity focus [ 51 , 52 ].
www.hiphopenation.com/mu-plugins/eastland/dyqu-dating-a.php By using a collaborative group model building method in the development of the causal loop diagram, the study demonstrated that such a systematic approach was a useful way of engaging key policy actors in developing a broad understanding of systems that affect inequities in healthy eating and ultimately inequities in NCDs. The study was very participatory, and enabled a diverse group of stakeholders to share knowledge and insights about a whole variety of issues relating to healthy eating, in a way that was informative and respectful of differences in views and knowledge.
The involvement of senior government officials, key non-government agencies and prominent academics has the potential to enhance the leadership and workforce readiness to push for a comprehensive policy and practice response to inequities in healthy eating. This participatory approach of involving key stakeholders in the process of developing the CLD has been observed by others to help create ownership of the issues raised and help move towards action and solutions [ 11 , 15 , 53 ].
Almost none of the participants had used systems science approaches previously, and in a relatively short period of time, using the CCM method, deepened their understanding of the wide range of determinants of inequities in healthy eating, and started to think about policies and interventions that they might otherwise not have. Indeed, the complexity of the HE 2 diagram demonstrates that bringing together the range of experts in the field of healthy eating enabled the identification of many connections between many factors that influence equity in healthy eating.
As a group, the experts identified seven sub-systems that are important to address inequities in healthy eating: food supply and environment; housing and the built environment; transport; employment; social protection; health literacy, and food preferences. Housing, Social Protection, Employment , which is a critical first step in tackling this complex systems-wide issue of inequities in healthy eating. Using a systems approach to understand the drivers of inequities in healthy eating has enabled us to produce a new conceptual model of HE 2.
This visual product, plus the method used to develop it, is likely to be of value to others concerned with complex health and social issues. Not only does the CLD help visualise the different drivers of complex problems, in this case inequities in healthy eating, it also demonstrates the interconnections and feedback loops, which ultimately can help the users identify key points in the system in which to intervene.
As with other studies that have used systems science to investigate health issues [ 14 ], the resulting CLD is complex, messy and potentially overwhelming. As is the case for all causal loop diagrams [ 48 ], the HE 2 diagram cannot visually represent the distributional effects of the different variables on healthy eating.
The HE 2 diagram represents important variables that impact on inequities in health eating, the structure of these variables, and their relationships, but not the specific degree that these affect an individual or group. However, the diagram can be used in an interpretive manner, noting that while the depicted policy areas and determinants matter for all people, different groups are affected to different degrees. For example, access to affordable public transport is relevant for accessing food for all people, however the degree to which different individuals or groups experience transport as a barrier to healthy eating varies.
Another limitation of the study is the positioning of the boundaries around the system. The boundaries were determined by the interests and knowledge of the expert group and may have differed if the composition of the group was less health prevention focussed and more inclusive of a business perspective or directly involved community organizations engaged in promoting or preserving healthy eating alternatives. The CLD may therefore not be generalizable to other policy actor groups and communities.
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However, the purpose of this study was to provide a way by which policy actors could begin to engage with, and apply, systems thinking. While study participants were encouraged to think in an analytical manner about a complex system, the study must be considered descriptive in nature rather than analytical. As a descriptive study, the results are however valuable as a first step in understanding and appreciating the processes that were undertaken to address the research question and provide a platform from which to continue such a body of work.
The method used in this study relies on the knowledge of an assembled group of experts. This brings with it some potential biases and knowledge gaps. Complementing this method could be meta-narrative synthesis mapping exercises, which characterise the literature in complex issues e.
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For example, Weiler et al [ 54 ] undertook such an exercise to examine literature exploring the relationships between food sovereignty, food security, and health equity. Iteration between experts and literature would help overcome knowledge gaps and group biases. This conceptualisation of the drivers of inequities in healthy eating helps demonstrate to a range of policy actors the importance of policy action that tackles the systemic drivers of the availability, affordability, accessibility and acceptability of healthy food compared to unhealthy foods, and that these actions are not confined to the food system or food environment.
The identification of seven broad policy domains that affect inequity in healthy eating suggests that whole of government action is needed. Further work is needed to elicit different stakeholder perspectives, including food industry, social policy and consumer groups, on the issues that affect healthy eating. The group model building methods used in this study provide a relatively straightforward technique that could be used by policy actors to engage communities. A quantitative system dynamics model based on the HE 2 diagram could generate further insight into the utility of the model, and enable policy makers to identify the relative impact of different policy actions at various intervention points in the model.
Similar work has been done in modelling diabetes [ 55 ] and obesity more broadly [ 56 ], which could provide examples of data driven models that could be adapted to the social distribution of healthy eating. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract Introduction Systems thinking has emerged in recent years as a promising approach to understanding and acting on the prevention and amelioration of non-communicable disease. Methods Collaborative conceptual modelling workshops were held in with an expert group of representatives from government, non-government health organisations and academia in Australia.
Results The work of the expert stakeholders generated a comprehensive causal loop diagram of the determinants of inequity in healthy eating the HE 2 Diagram. Discussion The HE 2 causal loop diagram illustrates the complexity of determinants of inequities in healthy eating. Data Availability: All relevant data are within the paper. Introduction Systems thinking has emerged in recent years as a promising approach to understanding and acting on the prevention and amelioration of non-communicable disease NCDs.
Methods This study used qualitative methods. Research team and reflexivity The study was designed and conducted by a core team SF, EM, MP who consulted with a larger project team consisting of public health academics and health practitioners through the design, data collection and analysis steps.
Study design Systems methods can be both qualitative and quantitative in nature, including the formation of dynamic systems models, causal loop diagrams, agent-based models, network analyses and time series analyses [ 37 ]. Download: PPT. Data collection and analysis. Individual mental models. Pair blending.
Results The group of experts identified multiple determinants of inequities in healthy eating. Fig 1. An example of a policy actor mind map of the determinants of inequities in healthy eating. The HE 2 causal loop diagram After much clarification of variables, relationships between variables and direction of connections, via email and telephone following the first workshop, and after review at the second workshop, the final CLD was completed.
Fig 2. HE 2 causal loop diagram of the determinants of inequities in healthy eating. Sub-systems The HE 2 diagram comprises 67 variables and connecting arrows, highlighting the perception among the expert group of a high degree of complexity, interconnectedness and feedback between variables in the system. Fig 4. CLD for determinants of inequities in healthy eating, showing sub-systems.
Food supply and environment. Housing and the built environment sub-system. Transport sub-system. Employment sub-system. Social protection sub-system. Health literacy sub-system. Food preferences sub-system. Dynamics of the HE 2 system as a whole Fig 5 is a structural level depiction of the HE 2 diagram that shows the feedback between different sub-systems as they relate to inequity in healthy eating. Fig 5.
Feedback between sub-systems and the social distribution of healthy eating. Discussion In this paper we present the results of research conducted with an expert group of policy actors policy makers, practitioners and researchers. Strengths of the study A new way of thinking. Participatory processes. Crossing sectors. A model for complex problems. Weaknesses of the study As with other studies that have used systems science to investigate health issues [ 14 ], the resulting CLD is complex, messy and potentially overwhelming.
Implications of the study This conceptualisation of the drivers of inequities in healthy eating helps demonstrate to a range of policy actors the importance of policy action that tackles the systemic drivers of the availability, affordability, accessibility and acceptability of healthy food compared to unhealthy foods, and that these actions are not confined to the food system or food environment.
References 1. A simple guide to chaos and complexity. Journal of epidemiology and community health. Simulation models of obesity: a review of the literature and implications for research and policy.
Obesity reviews: an official journal of the International Association for the Study of Obesity. View Article Google Scholar 3. Bar-Yam Y. Improving the effectiveness of health care and public health: a multiscale complex systems analysis. American Journal of Public Health. The global obesity pandemic: shaped by global drivers and local environments. Other examples include tissues of the eyes, such as the lens, which is almost totally devoid of mitochondria; and the outer segment of the retina, which contains the photosensitive pigment.
You may have already guessed that these cells and tissues then must produce ATP by metabolizing glucose only. In these situations, glucose is degraded to pyruvate, which is then promptly converted to lactate Figure 2. This process is called lactic acid fermentation. Although not highly metabolically active, red blood cells are abundant, resulting in the continual uptake of glucose molecules from the bloodstream. Additionally, there are cells that, despite having mitochondria, rely almost exclusively on lactic acid fermentation for ATP production. This is the case for renal medulla cells, whose oxygenated blood supply is not adequate to accomplish oxidative phosphorylation.
Finally, what if the availability of fatty acids to cells changes? The blood-brain barrier provides a good example. In most physiological situations, the blood-brain barrier prevents the access of lipids to the cells of the central nervous system CNS. Therefore, CNS cells also rely solely on glucose as fuel molecules Figure 2. In prolonged fasting, however, ketone bodies released in the blood by liver cells as part of the continual metabolization of fatty acids are used as fuels for ATP production by CNS cells.
In both situations and unlike red blood cells, however, CNS cells are extremely metabolically active and do have mitochondria. Thus, they are able to fully oxidize glucose, generating greater amounts of ATP. Indeed, the daily consumption of nerve cells is about g of glucose equivalent, which corresponds to an input of about kilocalories 1, kilojoules. However, most remaining cell types in the human body have mitochondria, adequate oxygen supply, and access to all three fuel molecules. Which fuel, then, is preferentially used by each of these cells?
Virtually all cells are able to take up and utilize glucose. What regulates the rate of glucose uptake is primarily the concentration of glucose in the blood. Glucose enters cells via specific transporters GLUTs located in the cell membrane. There are several types of GLUTs, varying in their location tissue specificity and in their affinity for glucose.
Adipose and skeletal muscle tissues have GLUT4, a type of GLUT which is present in the plasma membrane only when blood glucose concentration is high e. The presence of this type of transporter in the membrane increases the rate of glucose uptake by twenty- to thirtyfold in both tissues, increasing the amount of glucose available for oxidation. Therefore, after meals glucose is the primary source of energy for adipose tissue and skeletal muscle. The breakdown of glucose, in addition to contributing to ATP synthesis, generates compounds that can be used for biosynthetic purposes.
So the choice of glucose as the primary oxidized substrate is very important for cells that can grow and divide fast. Examples of these cell types include white blood cells, stem cells , and some epithelial cells. A similar phenomenon occurs in cancer cells, where increased glucose utilization is required as a source of energy and to support the increased rate of cell proliferation.
Interestingly, across a tumor mass, interior cells may experience fluctuations in oxygen tension that in turn limit nutrient oxidation and become an important aspect for tumor survival. In addition, the increased glucose utilization generates high amounts of lactate, which creates an acidic environment and facilitates tumor invasion. Another factor that dramatically affects the metabolism is the nutritional status of the individual — for instance, during fasting or fed states. After a carbohydrate-rich meal, blood glucose concentration rises sharply and a massive amount of glucose is taken up by hepatocytes by means of GLUT2.
This type of transporter has very low affinity for glucose and is effective only when glucose concentration is high. Thus, during the fed state the liver responds directly to blood glucose levels by increasing its rate of glucose uptake. In addition to being the main source of energy, glucose is utilized in other pathways, such as glycogen and lipid synthesis by hepatocytes.
The whole picture becomes far more complex when we consider how hormones influence our energy metabolism. Fluctuations in blood levels of glucose trigger secretion of the hormones insulin and glucagon. How do such hormones influence the use of fuel molecules by the various tissues?
Demands by one cell type can be met by the consumption of its own reserves and by the uptake of fuel molecules released in the bloodstream by other cells. Energy use is tightly regulated so that the energy demands of all cells are met simultaneously. Virtually all cells respond to insulin; thus, during the fed state cell metabolism is coordinated by insulin signaling. An extraordinary example is how insulin signaling rapidly stimulates glucose uptake in skeletal muscle and adipose tissue and is accomplished by the activity of GLUT4.
In the absence of insulin, these transporters are located inside vesicles and thus do not contribute to glucose uptake in skeletal muscle and adipose tissue. Insulin, however, induces the movement of these transporters to the plasma membrane, increasing glucose uptake and consumption.
As different tissues continue to use glucose, the blood glucose concentration tends to reach the pre-meal concentration Figure 3. Therefore, during fasting, cell metabolism is coordinated by glucagon signaling and the lack of insulin signaling. As a consequence, GLUT4 stays inside vesicles, and glucose uptake by both skeletal muscle cells and adipocytes is reduced. Now, with the low availability of glucose and the signals from glucagon, those cells increase their use of fatty acids as fuel molecules. Therefore, the use of fatty acids during fasting clearly contributes to the maintenance of adequate blood glucose concentration to meet the demands of cells that exclusively or primarily rely on glucose as a fuel.
But, mentioned above, glucose is used at an apparently high rate by the brain and constantly by red blood cells. And, under physiological conditions, blood glucose is maintained at a constant level, even during fasting. How, then, is that delicate balance achieved? The liver is a very active organ that performs different vital functions. In Greek mythology, Prometheus steals fire from Zeus and gives it to mortals. As a punishment, Zeus has part of Prometheus's liver fed to an eagle every day. Since the liver grows back, it is eaten repeatedly. This story illustrates the high proliferative rate of liver cells and the vital role of this organ for human life.
One of its most important functions is the maintenance of blood glucose.
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The liver releases glucose by degrading its glycogen stores. This reserve is not large, and during overnight fasting glycogen reserves fall severely. However, only the liver supplies the blood with glucose since it has an enzyme that make it possible for glucose molecules to be transported across cell membranes. Since glycogen stores are limited and are reduced within hours of fasting, and blood glucose concentration is kept within narrow limits under most physiological conditions, another mechanism must exist to supply blood glucose.
Indeed, glucose can be synthesized from amino acid molecules. This process is called de novo synthesis of glucose, or gluconeogenesis. Amino acids, while being degraded, generate several intermediates that are used by the liver to synthesize glucose Figure 2. Alanine and glutamine are the two amino acids whose main function is to contribute to glucose synthesis by the liver.