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Background: Complex interactions between political economy factors and corporate power are increasingly recognized to prevent transformative policy action on non-communicable disease (NCD) prevention. System science offers promising methods for analysing such causal complexity. This study uses qualitative system dynamics methods to map the political economy of diet-related NCD (DR-NCD) prevention policy-making aiming to better understand the policy inertia observed in this area globally.Methods We interviewed 25 key policy actors. We analysed the interviews using purposive text analysis (PTA). We developed individual then combined casual loop diagrams to generate a shared model representing the DR-NCD prevention policy-making system. Key variables/linkages identified from the literature were also included in the model. We validated the model in several steps including through stakeholder validation interviews.Results We identified several inter-linked feedback processes related to political economy factors that may entrench different forms of corporate power (instrumental, structural, and discursive) in DR-NCD prevention policy-making in South Africa over time. We also identified a number of feedback processes that have the potential to limit corporate power in this setting.Conclusion Using complex system methods can be useful for more deeply understanding DR-NCD policy inertia. It is also useful for identifying potential leverage points within the system which may shift the existing power dynamics to facilitate greater political commitment for healthy, equitable, and sustainable food system transformation.

Introduction Despite rapidly growing academic and policy interest in health system resilience, the empirical literature on this topic remains small and focused on macrolevel effects arising from single shocks. To better understand health system responses to multiple shocks, we conducted an in-depth case study using qualitative system dynamics. We focused on routine childhood vaccination delivery in Lebanon in the context of at least three shocks overlapping to varying degrees in space and time: large-scale refugee arrivals from neighbouring Syria; COVID-19; and an economic crisis.Methods Semistructured interviews were performed with 38 stakeholders working at different levels in the system. Interview transcripts were analysed using purposive text analysis to generate individual stakeholder causal loop diagrams (CLDs) mapping out relationships between system variables contributing to changes in coverage for routine antigens over time. These were then combined using a stepwise process to produce an aggregated CLD. The aggregated CLD was validated using a reserve set of interview transcripts.Results Various system responses to shocks were identified, including demand promotion measures such as scaling-up community engagement activities and policy changes to reduce the cost of vaccination to service users, and supply side responses including donor funding mobilisation, diversification of service delivery models and cold chain strengthening. Some systemic changes were introduced—particularly in response to refugee arrivals—including task-shifting to nurse-led vaccine administration. Potentially transformative change was seen in the integration of private sector clinics to support vaccination delivery and depended on both demand side and supply side changes. Some resilience-promoting measures introduced following earlier shocks paradoxically increased vulnerability to later ones.Conclusion Flexibility in financing and human resource allocation appear key for system resilience regardless of the shock. System dynamics offers a promising method for ex ante modelling of ostensibly resilience-strengthening interventions under different shock scenarios, to identify—and safeguard against—unintended consequences.

To address tooth enamel demineralization resulting from factors such as acid erosion, abrasion, and chronic illness treatments, it is important to develop effective daily dental care products promoting enamel preservation and surface remineralization. This study focused on formulating four toothpastes, each containing calcined synthetic hydroxyapatite (HAP) in distinct compositions, each at 4%, along with 1.3% birch extract. Substitution elements were introduced within the HAP structure to enhance enamel remineralization. The efficacy of each toothpaste formulation was evaluated for repairing enamel and for establishing the dynamic of the remineralization. This was performed by using an in vitro assessment of artificially demineralized enamel slices. The structural HAP features explored by XRD and enamel surface quality by AFM revealed notable restorative properties of these toothpastes. Topographic images and the self-assembly of HAP nanoparticles into thin films on enamel surfaces showcased the formulations’ effectiveness. Surface roughness was evaluated through statistical analysis using one-way ANOVA followed by post-test Bonferroni’s multiple comparison test with a p value < 0.05 significance setting. Remarkably, enamel nanostructure normalization was observed within a short 10-day period of toothpaste treatment. Optimal remineralization for all toothpastes was reached after about 30 days of treatment. These toothpastes containing birch extract also have a dual function of mineralizing enamel while simultaneously promoting enamel health and restoration.

This research work aims to develop functional toothpastes with combined enamel remineralization and antibacterial effects using nano-hydroxyapatites (nHAPs) and birch extract. Eleven toothpastes (notated as P1–P11) were designed featuring different concentrations of birch extract and a constant concentration of pure nHAPs or substituted nHAPs (HAP-5%Zn, HAP-0.23%Mg-3.9%Zn-2%Si-10%Sr, and HAP-2.5%Mg-2.9%Si-1.34%Zn). In vitro assessments involved treating artificially demineralized enamel slices and analyzing surface repair and remineralization using Atomic Force Microscopy (AFM). The Agar Disk Diffusion method was used to measure antibacterial activity against Enterococcus faecalis, Escherichia coli, Porphyromonas gingivalis, Streptococcus mutans, and Staphylococcus aureus. Topographic images of enamel structure and surface roughness, as well as the ability of nHAP nanoparticles to form self-assembled layers, revealed excellent restorative properties of the tested toothpastes, with enamel nanostructure normalization occurring as soon as 10 days after treatment. The outcomes highlighted enamel morphology improvements due to the toothpaste treatment also having various efficacious antibacterial effects. Promising results were obtained using P5 toothpaste, containing HAP-5%Zn (3.4%) and birch extract (1.3%), indicating notable remineralization and good antibacterial properties. This study represents a significant advancement in oral care by introducing toothpaste formulations that simultaneously promote enamel health through effective remineralization and bacterial inhibition.

This work aimed to compare the effect of four new toothpastes (P1–P4) based on pure and biomimetic substituted nano-hydroxyapatites (HAPs) on remineralization of human enamel. Artificially demineralized enamel slices were daily treated for ten days with different toothpastes according to the experimental design. Tooth enamel surfaces were investigated using atomic force microscope (AFM) images and surface roughness (Ra) determined before and after treatment. The surface roughness of enamel slices was statistically analyzed by one-way ANOVA and Bonferroni’s multiple comparison test. X-ray diffraction (XRD) and Fourier transform infrared (FTIR) data revealed the HAP structure with crystal sizes between 28 and 33 nm and crystallinity between 29 and 37%. The average size of HAP particles was found to be between 30 and 40 nm. The Ra values indicated that P3 (HAP-Mg-Zn-Sr-Si) toothpaste was the most effective after 10 days of treatment, leading to the lowest mean roughness. The P3 and P2 (HAP) toothpastes were found to be effective in promoting remineralization. Specifically, their effectiveness can be ranked as follows: P3 = P2 > P4 (HAP-Mg-Zn-Si) > P1 (HAP-Zn), considering both the chemical composition and the size of their constitutive nanoparticles. The proposed toothpastes might be used successfully to treat early tooth decay.

Care management (CM) is a promising team-based, patient-centered approach "designed to assist patients and their support systems in managing medical conditions more effectively." As little is known about its implementation, this article describes CM implementation and associated lessons from 12 Agency for Healthcare Research and Quality-sponsored projects. Two rounds of data collection resulted in project-specific narratives that were analyzed using an iterative approach analogous to framework analysis. Informants also participated as coauthors. Variation emerged across practices and over time regarding CM services provided, personnel delivering these services, target populations, and setting(s). Successful implementation was characterized by resource availability (both monetary and nonmonetary), identifying as well as training employees with the right technical expertise and interpersonal skills, and embedding CM within practices. Our findings facilitate future context-specific implementation of CM within medical homes. They also inform the development of medical home recognition programs that anticipate and allow for contextual variation.

Health systems worldwide face major challenges in anticipating, planning for and responding to shocks from infectious disease epidemics, armed conflict, climatic and other crises. Although the literature on health system resilience has grown substantially in recent years, major uncertainties remain concerning approaches to resilience conceptualisation and measurement. This narrative review revisits literatures from a range of fields outside health to identify lessons relevant to health systems. Four key insights emerge. Firstly, shocks can only be understood by clarifying how, where and over what timescale they interact with a system of interest, and the dynamic effects they produce within it. Shock effects are contingent on historical path-dependencies, and on the presence of factors or system pathways (e.g. financing models, health workforce capabilities or supply chain designs) that may amplify or dampen impact in unexpected ways. Secondly, shocks often produce cascading effects across multiple scales, whereas the focus of much of the health resilience literature has been on macro-level, national systems. In reality, health systems bring together interconnected sub-systems across sectors and geographies, with different components, behaviours and sometimes even objectives – all influencing how a system responds to a shock. Thirdly, transformability is an integral feature of resilient social systems: cross-scale interactions help explain how systems can show both resilience and transformational capability at the same time. We illustrate these first three findings by extending the socioecological concept of adaptive cycles in social systems to health, using the example of maternal and child health service delivery. Finally, we argue that dynamic modelling approaches, under-utilised in research on health system resilience to date, have significant promise for identification of shock-moderating or shock-amplifying pathways, for understanding effects at multiple levels and ultimately for building resilience.

Bone regeneration has gained attention in the biomedical field, which has led to the development of materials and synthesis methods meant to improve osseointegration and cellular bone activity. The properties of hydroxyapatite, a type of calcium phosphate, have been researched to determine its advantages for bone tissue engineering, particularly its biocompatibility and ability to interact with bone cells. Recently, the advantages of utilizing nanomolecules of hydroxyapatite, combined with various substances, in order to enhance and combine their characteristics, have been reported in the literature. This review will outline the cellular and molecular roles of hydroxypatite, its interactions with bone cells, and its nano-combinations with various ions and natural products and their effects on bone growth, development, and bone repair.

Communicating dynamic insights to a wide audience constitutes a long‐standing challenge among system dynamics modelers. We propose that telling stories is a compelling way of introducing feedback insights, as well as an understanding of how our individual decisions are linked to social behaviors in our day‐to‐day living. These decisions often involve moral and ethical trade‐offs. In this article, we use examples and heuristics to illustrate how the process of building a system dynamics model can drive a storytelling project. In a complimentary manner, the process of storytelling supports and enriches a model building project by exploring new dynamic hypotheses. © 2024 The Authors. System Dynamics Review published by John Wiley & Sons Ltd on behalf of System Dynamics Society. [ABSTRACT FROM AUTHOR]

Abstract Introduction: The Clinical and Translational Science Awards (CTSA) Consortium, a network of academic health care institutions with CTSA hubs, is charged with improving the national clinical and translational research enterprise. The CTSA Consortium and the NIH National Center for Advancing Translational Sciences implemented the Common Metrics Initiative comprised of standardized metrics and a shared performance improvement framework. This article summarizes hubs’ perspectives on its value during the initial implementation. Methods: The value was assessed across 58 hubs. Survey items assessed change in perceived ability to manage performance and advance clinical and translational science. Semi-structured interviews elicited hubs’ perspectives on meaningfulness and value-added of the Common Metrics Initiative and hubs’ recommendations. Results: Hubs considered their abilities to manage performance to have improved, but there was no change in perceived ability to advance clinical and translational science. The initiative added value by providing a formal structured process, enabling strategic conversations, facilitating improvements in processes, providing an external impetus for improvement, and providing justification for funds invested. Hubs were concerned about the usefulness of the metrics chosen and whether the value-added was sufficient relative to the effort required. Hubs recommended useful benchmarking, disseminating best practices and promoting peer-to-peer learning, and expanding the use of data to inform the initiative. Conclusions: Implementing Common Metrics and a performance improvement framework yielded concrete short-term benefits, but concerns about usefulness remained, particularly considering the effort required. The Common Metrics Initiative should focus on facilitating cross-hub collaboration around metrics that address high-priority impact areas for individual hubs and the Consortium.

Abstract Introduction: The Clinical and Translational Science Awards (CTSA) Consortium, about 60 National Institutes of Health (NIH)-supported CTSA hubs at academic health care institutions nationwide, is charged with improving the clinical and translational research enterprise. Together with the NIH National Center for Advancing Translational Sciences (NCATS), the Consortium implemented Common Metrics and a shared performance improvement framework. Methods: Initial implementation across hubs was assessed using quantitative and qualitative methods over a 19-month period. The primary outcome was implementation of three Common Metrics and the performance improvement framework. Challenges and facilitators were elicited. Results: Among 59 hubs with data, all began implementing Common Metrics, but about one-third had completed all activities for three metrics within the study period. The vast majority of hubs computed metric results and undertook activities to understand performance. Differences in completion appeared in developing and carrying out performance improvement plans. Seven key factors affected progress: hub size and resources, hub prior experience with performance management, alignment of local context with needs of the Common Metrics implementation, hub authority in the local institutional structure, hub engagement (including CTSA Principal Investigator involvement), stakeholder engagement, and attending training and coaching. Conclusions: Implementing Common Metrics and performance improvement in a large network of research-focused organizations proved feasible but required substantial time and resources. Considerable heterogeneity across hubs in data systems, existing processes and personnel, organizational structures, and local priorities of home institutions created disparate experiences across hubs. Future metric-based performance management initiatives across heterogeneous local contexts should anticipate and account for these types of differences.

PurposeWe aimed to advance the internal and external validity of research by sharing our empirical experience and recommendations for systematically reporting contextual factors.MethodsFourteen teams conducting research on primary care practice transformation retrospectively considered contextual factors important to interpreting their findings (internal validity) and transporting or reinventing their findings in other settings/situations (external validity). Each team provided a table or list of important contextual factors and interpretive text included as appendices to the articles in this supplement. Team members identified the most important contextual factors for their studies. We grouped the findings thematically and developed recommendations for reporting context.ResultsThe most important contextual factors sorted into 5 domains: (1) the practice setting, (2) the larger organization, (3) the external environment, (4) implementation pathway, and (5) the motivation for implementation. To understand context, investigators recommend (1) engaging diverse perspectives and data sources, (2) considering multiple levels, (3) evaluating history and evolution over time, (4) looking at formal and informal systems and culture, and (5) assessing the (often nonlinear) interactions between contextual factors and both the process and outcome of studies. We include a template with tabular and interpretive elements to help study teams engage research participants in reporting relevant context.ConclusionsThese findings demonstrate the feasibility and potential utility of identifying and reporting contextual factors. Involving diverse stakeholders in assessing context at multiple stages of the research process, examining their association with outcomes, and consistently reporting critical contextual factors are important challenges for a field interested in improving the internal and external validity and impact of health care research.

ABSTRACT Introduction: The preparations based on hydroxyquinoline, in various combinations, are used in medicine, being shown to have an inhibitory effect against bacteria, molds, fungi, parasites, and viruses, but also having other beneficial effects mentioned in other medical conditions (anti-cancer, anti-degenerative, anti-inflammatory). Aims: In vitro susceptibility testing of microorganisms: bacteria (Gram positive and Gram negative), yeast (Candida spp.,) and unicellular algae (Prototheca spp.) at the preparations based on hydroxyquinoline (HQ) and its cupric derivatives deposited on hydroxyapatite (HAP). Materials and methods: There were tested microbial strains of the following genera: Escherichia, Staphylococcus, Micrococcus, Bacillus, Candida, and Prototheca. The tested products (developed in the Laboratory for Nanobiomaterials Synthesis, Center of Physical Chemistry, Faculty of Chemistry and Chemical Engineering, UBB Cluj-Napoca) were developed in three versions: 1) HQ–Cu2+–HAP1; 2) HQ–Cu2+–HAP2; and 3) NHQ–Cu2+–HAP2, where NHQ stands for nitro hydroxyquinoline. Determination of the inhibitory effect was conducted by diffusion technique in nutrient agar, according to CLSI 2013 standards, with necessary adaptations for testing of products made in the form of suspensions. Results: Following interpretation, it was found that the inhibition zones, arising from the antimicrobial effect of the tested products showed variability in size, depending on the test product and the microbial strain: Escherichia coli (8-10 mm), Staphylococcus sp. (17.6 - 23.2 mm), Micrococcus spp. (24.4 - 27.6 mm), Bacillus spp. (14.0 - 16.0 mm), Candida spp. (20.4 - 25.2 mm), Prototheca spp. (20.8 - 30.0 mm). From the three tested products, the best efficacy was found at the product no. 3 (NHQ – Cu2+ – HAP2), followed by no. 1 (HQ– Cu2+–HAP1) and no. 2 (HQ–Cu2+–HAP2). Conclusions: The inhibitory effect was bactericidal, manifested more intensively against Gram-positive bacteria, yeasts, and prototheca. Such products, prepared in the form of suspensions, may have practical application in the prevention and treatment of skin or hooves disorders. No resistance phenomena are recorded. Keywords: copper, hydroxyapatite, hydroxyquinoline, microorganisms, sensitivity.

A nanocomposite made from hydroxyapatite (HAP) and silver nanoparticles (AgNPs), namely HAP-4.5 wt% AgNPs, is reported. HAP was prepared using a wet precipitation technique, and AgNPs were made by reducing silver nitrate with glucose in basic medium. HAP, AgNPs and HAP-4.5 wt% AgNPs composite were characterized by X-ray diffraction (XRD), SEM - energy dispersive X-ray spectroscopy (EDS) and different imagistic methods: TEM and AFM. The antibacterial effect of the HAP-4.5 wt% AgNPs nanocomposite was tested using diffusion technique in nutritive agar on two pathogenic species, one Gram-negative (Salmonella typhimurium) and one Gram-positive (Bacillus cereus) and promising results were obtained. This hydroxyapatite-silver nanocomposite can be employed as a potential antimicrobial coating for dental and orthopedic implants, or they can be utilized such as bone cements in clinical procedures. [ABSTRACT FROM AUTHOR]

Nanocrystalline forsterite (Mg2SiO4) was synthesized by the precipitation method using Mg(NO3)2∙6H2O, C8H20O4Si (TEOS) and sodium hydroxide as pH regulator as starting materials. The thermal behaviour of the mixture was investigated by a MOM derivatograh. According to DTA results the initial crystallization temperature of the forsterite is about 800oC. The powder calcined at 900oC was characterized by X ray diffraction (XRD). The forsterite was noticed as the main crystalline phase besides of small amounts of periclase (MgO). Polycrystalline forsterite with uniform sized particles and spherical shape is evidenced by electronic microscopy (TEM, SEM). Grain size of forsterite powder according to Counter Coulter-type laser granulometer results is in the range of 10 - 42 nm.

The use of toothpastes is the best way to combat enamel loss and degradation. When they also contain hydroxyapatite nanoparticles, HAP NPs, the tooth enamel can be restored by remineralization. In this study, we developed two types of toothpastes, one with nano sized HAP, noted P1, and the other with nano multi-substituted hydroxyapatite (ms-HAP, HAP-Mg-Zn-Si), noted P2, which were used to treat the artificially demineralized teeth enamel surface. The remineralization efficacy of the two toothpastes was determined on artificially created enamel lesions by suspending healthy enamel slices in demineralizing solution, made of orthophosphoric acid of 37.5% for 90 s. For this purpose, six extracted third molars were collected and twenty-four enamel slices were cut and arbitrarily allocated to the four groups, namely n = 6 enamel slices for each group. One group served as untreated (natural) enamel control, and another group comprised demineralized enamel and two test groups, firstly demineralized, and then, they were treated with toothpastes P1 and P2, respectively, each of them for ten days, and finally were noted P1 and P2 enamel surfaces. The surface morphology and roughness of all enamel specimens were studied by atomic force microscopy (AFM) before and after applying the treatment with the toothpastes. The toothpastes effect was evidenced by the average diameter of ceramic nanoparticles deposited within the superficial smooth layer on enamel surface having, at the completion of 10 days treatment, a low surface roughness close to that of natural enamel. This in vitro comparative study demonstrated that both toothpastes P1 and P2 can promote surface enamel repair by remineralization and the formation of a protective hydroxyapatite coating layer on the enamel surface treated with these toothpastes. [ABSTRACT FROM AUTHOR]

Due to the ions in its structure, that have a variety of important roles in bone metabolism, forsterite (FS, Mg2SiO4) is a promising candidate for orthopedic and dental applications. This paper studies forsterite synthesized through two methods, namely sol-gel (FSsg) and precipitation (FSpp), based on a thermodynamic approach. Therefore, the precursor gel and precipitate were analyzed through thermal gravimetric (TG), differential thermal gravimetric (DTG) and differential scanning calorimetric (DSC) analysis. The FSsg and FSpp powders were characterized by X-ray powder diffraction (XRD) and atomic force microscopy (AFM). XRD reveals that the synthesized forsterite is of high crystallinity. As is evidenced by AFM, the average size of the nanoparticles is around 40 nm for FSsg and 30 nm for FSpp. The potential reaction mechanisms for the two synthesis routes were also established. [ABSTRACT FROM AUTHOR]

Forsterite (Mg2SiO4) powder has been synthesized from talc (Mg3Si4O10(OH)2) and magnesium carbonate (MgCO3) by applying solid state reactions method. The raw materials mixture has been milled for 10 hours until nano powders have been obtained. This mixture was then thermally treated at various temperatures. The synthesized material was structurally characterized by X-ray diffraction. Forsterite represented the main crystalline phase in the samples fired to 1100 and 1200°C, while at 1000°C small amounts of enstatite and periclase were still identified. The particles size and morphology were investigated by TEM, SEM and AFM, and the grain size distribution with a Counter Coulter-type laser granulometer. A ratio of 75 % of the particles in the samples fired to 1000, and respectively 1100°C were less than 25 nm, while the maximum size was 42 nm. For the samples fired at 1200°C, most of the particles (74 %) were larger, about 6.8 μm, with a maximum of 70 μm. In order to evaluate its bioactivity, we have immersed the forsterite powder into simulating body fluids (SBF). Following 28 days of experiment, the FTIR spectra collected on the forsterite nanopowder contained the specific hydroxylapatite bands, while in the case of the micro powder these bands are hardly visible.