In this systematic review, the antimicrobial effect of ion-substituted calcium phosphate biomaterials was quantitatively assessed.The literature was systematically searched up to the 6th of... Show moreIn this systematic review, the antimicrobial effect of ion-substituted calcium phosphate biomaterials was quantitatively assessed.The literature was systematically searched up to the 6th of December 2021. Study selection and data extraction was performed in duplo by two independent reviewers with a modified version of the OHAT tool for risk of bias assessment. Any differences were resolved by consensus or by a referee. A mixed effects model was used to investigate the relation between the degree of ionic substitution and bacterial reduction.Of 1016 identified studies, 108 were included in the analysis. The methodological quality of included studies ranged from 6 to 16 out of 18 (average 11.4). Selenite, copper, zinc, rubidium, gadolinium, silver and samarium had a clear antimicrobial effect, with a log reduction in bacteria count of 0.23, 1.8, 2.1, 3.6, 5.8, 7.4 and 10 per atomic% of substitution, respectively. There was considerable between-study variation, which could partially be explained by differences in material formulation, study quality and microbial strain. Future research should focus on clinically relevant scenarios in vitro and the translation to in vivo prevention of PJI. Show less
There is an increasing amount of attention on EU and its Member States contributions to implementation of two landmark agreements: the Paris Climate Agreement and the UN Agenda 2030 with... Show moreThere is an increasing amount of attention on EU and its Member States contributions to implementation of two landmark agreements: the Paris Climate Agreement and the UN Agenda 2030 with Sustainable Development Goals (SDGs). Absent from the current literature is an analysis of the political effect of legal competences on coordination between EU and Member State actors. Legal competences will become increasingly important for transformative sustainability policies. By using different case studies focusing on alternative fuel policies, ‘Team EU’ in climate negotiations and SDG implementation, this dissertation attempts to explore the potential of including legal competences as independent variables explaining coordination of EU and Member State actors. The findings nuance some of the theories in which the role of EU Treaties is often neglected. The dissertation also shows, however, that the legal competences are sometimes not used habitually unless clear examples of behaviours ‘contrary to the Treaty-logic’ or ‘contrary to sustainable development objectives’. The dissertation not only serves academic integrative purposes. There is increased societal attention for legal avenues to influence political decision-making. As an example, the Dutch ‘Urgenda’ case demonstrate that Courts can be responsive to the argument that Member States’ policies are ‘unlawful’ to avoid dangerous climate change. Show less
