UNASSIGNED: Antimicrobial drugs form an essential component of medical treatment in human and animal health. Resistance associated with their use has posed a global public health threat. Multiple efforts have been made at the global level directed by the World Health Organization and associated partners to develop policies aimed at combatting antimicrobial resistance.
UNASSIGNED: Whilst the Global Action Plan on antimicrobial resistance and people-centered framework aim to guide countries in implementing successful antimicrobial resistance policies, their adoption and success depend on different implementation contexts. Therefore, this paper highlights the challenges and opportunities for implementing the World Health Organization\'s people-centered approach in sub-Saharan Africa, whilst recognizing antimicrobial resistance as a multifaceted problem rooted in \'complex systems.\'
UNASSIGNED: The people-centered approach provides a solid framework for combating antimicrobial resistance. Countries should build sustainable national action plans, adopt the One Health approach, limit over-the-counter antibiotic consumption, and educate communities on rational antibiotic use. They should also promote inter-country collaborations and innovative solutions, strengthen drug regulatory capacities, invest in infection control, water sanitation, hygiene, diagnostics, and surveillance tools, and promote vaccine uptake to prevent drug-resistant infections.

The Covid-19 pandemic exacerbated pre-existing problems in Latin America and posed unprecedented challenges for Latin American universities (LAU). These challenges can be characterised as complex problems that cannot be understood through reductionist approaches. This paper aims (i) to provide a complex system perspective of the challenges confronting LAUs and (ii) to propose guidelines for managers of LAUs to address them in practice. A multidisciplinary group was formed and conducted an iterative process of research, brainstorming and debate of potential solutions to the following problems considered particularly important by their universities: mental health issues in the university environment, student learning gaps, brain drain, and anti-science movements. Complexity theory and E/HF concepts are integrated to demonstrate that understanding what LAUs are experiencing in a fragmented manner is impossible, and that the interactions between the challenges should be at the centre of the managers\' actions plans. Practitioner summary: Managers of LAUs can benefit from the guidelines proposed to understand the pressing challenges confronting universities and develop systemic approaches to address them.

In general, it is not feasible to collect enough empirical data to capture the entire range of processes that define a complex system, either intrinsically or when viewing the system from a different geographical or temporal perspective. In this context, an alternative approach is to consider model transferability, which is the act of translating a model built for one environment to another less well-known situation. Model transferability and adaptability may be extremely beneficial-approaches that aid in the reuse and adaption of models, particularly for sites with limited data, would benefit from widespread model uptake. Besides the reduced effort required to develop a model, data collection can be simplified when transferring a model to a different application context. The research presented in this paper focused on a case study to identify and implement guidelines for model adaptation. Our study adapted a general Dynamic Bayesian Networks (DBN) of a seagrass ecosystem to a new location where nodes were similar, but the conditional probability tables varied. We focused on two species of seagrass (Zostera noltei and Zostera marina) located in Arcachon Bay, France. Expert knowledge was used to complement peer-reviewed literature to identify which components needed adjustment including parameterization and quantification of the model and desired outcomes. We adopted both linguistic labels and scenario-based elicitation to elicit from experts the conditional probabilities used to quantify the DBN. Following the proposed guidelines, the model structure of the general DBN was retained, but the conditional probability tables were adapted for nodes that characterized the growth dynamics in Zostera spp. population located in Arcachon Bay, as well as the seasonal variation on their reproduction. Particular attention was paid to the light variable as it is a crucial driver of growth and physiology for seagrasses. Our guidelines provide a way to adapt a general DBN to specific ecosystems to maximize model reuse and minimize re-development effort. Especially important from a transferability perspective are guidelines for ecosystems with limited data, and how simulation and prior predictive approaches can be used in these contexts.

Regardless of health issue, health sector, patient condition, or treatment modality, the chances are that provision is supported by \"a guideline\" making professionally endorsed recommendations on best practice. Against this background, research has proliferated seeking to evaluate how effectively such guidance is followed. These investigations paint a gloomy picture with many a guideline prompting lip service, inattention, and even opposition. This predicament has prompted a further literature on how to improve the uptake of guidelines, and this paper considers how to draw together lessons from these inquiries.
This huge body of material presents a considerable challenge for research synthesis, and this paper produces a critical, methodological comparison of 2 types of review attempting to meet that task. Firstly, it provides an overview of the current orthodoxy, namely, \"thematic reviews,\" which aggregate and enumerate the \"barriers and facilitators\" to guideline implementation. It then outlines a \"realist synthesis,\" focussing on testing the \"programme theories\" that practitioners have devised to improve guideline uptake.
Thematic reviews aim to provide a definitive, comprehensive catalogue of the facilitators and barriers to guideline implementation. As such, they present a restatement of the underlying problems rather than an improvement strategy. The realist approach assumes that the incorporation of any guideline into current practice will produce unintended system strains as different stakeholders wrestle over responsibilities. These distortions will prompt supplementary revisions to guidelines, which in turn beget further strains. Realist reviews follow this dynamic understanding of organisational change.
Health care decision makers operate in systems that are awash with guidelines. But guidelines only have paper authority. Managers do not need a checklist of their pros and cons, because the fate of guidelines depends on their reception rather than their production. They do need decision support on how to engineer and reengineer guidelines so they dovetail with evolving systems of health care delivery.