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The effects of quality improvement interventions in healthcare are mixed, and the mechanisms through which they mediate their effect remain poorly understood. Quality improvement methods often rest on implicit assumptions of predictability, linear causality, and standardisation. Health systems are increasingly recognised as complex adaptive systems, where outcomes emerge through adaptation, self-o
Background Trauma is the leading cause of quality-related mortality in low- and middle-income countries, with an estimated two million preventable deaths each year. Although trauma quality improvement programmes have been utilised in high-income countries for more than three decades, there is no high-level evidence of their effect on patient outcomes. We aimed to assess whether implementing a cont
The intersectional nature of gender-based violence (GBV) makes it unlikely that survivors can escape the socio-economic precarity that perpetuates this social ill. Current conceptualizations of the entrepreneurial process do not sufficiently account for the material constraints GBV survivors face in developing countries and/or in contexts of poverty, and as such, may not fully grasp their capaciti
This paper explores how entrepreneurial legacies can have broader social impact beyond the identity of founders, the organization that they created, or their own philanthropic activity. Thus, we illustrate how, in the South African context, social entrepreneuring may be understood as the values-driven, relational brokering of societal legacies amongst a variety of entrepreneurs. At the heart of th
AIMS: The COVID-19 pandemic had substantial impacts on mortality and morbidity, even after the rollout of vaccinations. These impacts however, varied considerably across regions. We examined regional disparities in COVID-19 mortality and hospitalizations among older people in Sweden from January 2021 to August 2023 and assessed the role of vaccination coverage in shaping these disparities.METHODS:
Aim: This paper aims to describe what constitutes good-quality, accessible, affordable and acceptable primary care for migrants. This includes identifying system adaptations and offering evidence- and practice-based recommendations and guidance for primary care organizations and professionals on how to deliver such care.Background: Migration has significantly diversified European populations. Migr
This study evaluates the performance and biofilm-mediated flux stabilization of a coupled up-flow anaerobic sludge blanket (UASB) reactor and gravity-driven membrane (GDM) system equipped with electrospun nanofiber membranes (ESN) for decentralized wastewater treatment. The system was operated under fully anaerobic conditions at 37 °C over three different hydraulic retention times (HRTs: 24, 16, a
Horizontal gene transfer by conjugative plasmids plays a critical role in the evolution of antibiotic resistance. Interactions between bacteria and other organisms can affect the persistence and spread of conjugative plasmids. Here we show that protozoan predation increased the persistence and spread of the antibiotic resistance plasmid RP4 in populations of the opportunist bacterial pathogen Serr
Sub-minimum inhibiting concentrations (sub-MICs) of antibiotics frequently occur in natural environments owing to wide-spread antibiotic leakage by human action. Even though the concentrations are very low, these sub-MICs have recently been shown to alter bacterial populations by selecting for antibiotic resistance and increasing the rate of adaptive evolution. However, studies are lacking on how
Bacteria live in dynamic systems where selection pressures can alter rapidly, forcing adaptation to the prevailing conditions. In particular, bacteriophages and antibiotics of anthropogenic origin are major bacterial stressors in many environments. We previously observed that populations of the bacterium Pseudomonas fluorescens SBW25 exposed to the lytic bacteriophage SBW25Φ2 and a noninhibitive c
Interactions between nitrogen-fixing (i.e. diazotrophic) cyanobacteria and their viruses, cyanophages, can have large-scale ecosystem effects. These effects are mediated by temporal alterations in nutrient availability in aquatic systems owing to the release of nitrogen and carbon sources from cells lysed by phages, as well as by ecologically important changes in the diversity and fitness of cyano
Wastewater treatment plants (WWTPs) collect wastewater from various sources for a multi-step treatment process. By mixing a large variety of bacteria and promoting their proximity, WWTPs constitute potential hotspots for the emergence of antibiotic resistant bacteria. Concerns have been expressed regarding the potential of WWTPs to spread antibiotic resistance genes (ARGs) from environmental reser
Experimental microbial ecology and evolution have yielded foundational insights into ecological and evolutionary processes using simple microcosm setups and phenotypic assays with one- or two-species model systems. The fields are now increasingly incorporating more complex systems and exploration of the molecular basis of observations. For this purpose, simplified, manageable and well-defined mult
Low concentrations of antibiotics have numerous effects on bacteria. However, it is unknown whether ecological factors such as trophic interactions and spatial structuring influence the effects of low concentrations of antibiotics on multispecies microbial communities. Here, we address this question by investigating the effects of low antibiotic concentration on community composition and horizonta
Mobile genetic elements such as conjugative plasmids are responsible for antibiotic resistance phenotypes in many bacterial pathogens. The ability to conjugate, the presence of antibiotics, and ecological interactions all have a notable role in the persistence of plasmids in bacterial populations. Here, we set out to investigate the contribution of these factors when the conjugation network was di
Recognizing when and how rapid evolution drives ecological change is fundamental for our understanding of almost all ecological and evolutionary processes such as community assembly, genetic diversification and the stability of communities and ecosystems. Generally, rapid evolutionary change is driven through selection on genetic variation and is affected by evolutionary constraints, such as trade
Predation is one of the key ecological mechanisms allowing species coexistence and influencing biological diversity. However, ecological processes are subject to contemporary evolutionary change, and the degree to which predation affects diversity ultimately depends on the interplay between evolution and ecology. Furthermore, ecological interactions that influence species coexistence can be altere
A tumour grows when the total division (birth) rate of its cells exceeds their total mortality (death) rate. The capability for uncontrolled growth within the host tissue is acquired via the accumulation of driver mutations which enable the tumour to progress through various hallmarks of cancer. We present a mathematical model of the penultimate stage in such a progression. We assume the tumour ha
