From PERFORM to PERFORM2Scale: Lessons from scaling-up a health management strengthening intervention to support Universal Health Coverage in three African countries.

Strengthening management and leadership competencies among district and local health managers has emerged as a common approach for health systems strengthening and to achieve Universal Health Coverage (UHC). While the literature is rich with localised examples of initiatives that aim to strengthen the capacity of district or local health managers, particularly in sub-Saharan Africa, considerably less attention is paid to the science of how to scale-up these initiatives. The aim of this paper is thus to examine the process of scaling-up a management strengthening intervention (MSI) and identify new knowledge and key lessons learned that can be used to inform the scale-up process of other complex health interventions, in support of UHC. Qualitative methods were used to identify lessons learned from scaling-up the MSI in Ghana, Malawi and Uganda. We conducted 14 interviews with district health management team members, three scale-up assessments with 20 scale-up stakeholders, and three reflection discussions with 11 research team members. We also kept records of activities throughout MSI and scale-up implementation. Data was recorded, transcribed, and analysed against the Theory of Change to identify both scale-up outcomes and the factors affecting these outcomes. The MSI was ultimately scaled-up across 27 districts. Repeated MSI cycles over time were found to foster greater feelings of autonomy among district health management teams (DHMTs) to address longstanding local problems, a more innovative use of existing resources without relying on additional funding, and improved teamwork. The use of 'resource teams' and the emergence of MSI 'champions', were both instrumental in supporting scale-up efforts. Challenges to the sustainability of the MSI include limited government buy-in and lack of sustained financial investment.

The effect of an intervention to promote isoniazid preventive therapy on leadership and management abilities.

BACKGROUND: Across sub-Saharan Africa, mid-level healthcare managers oversee implementation of national guidelines. It remains unclear whether leadership and management training can improve population health outcomes. METHODS: We sought to evaluate leadership/management skills among district-level health managers in Uganda participating in the SEARCH-IPT randomised trial to promote isoniazid preventive therapy (IPT) for persons with HIV (PWH). The intervention, which led to higher IPT rates, included annual leadership/management training of managers. We conducted a cross-sectional survey assessing leadership/management skills among managers at trial completion. The survey evaluated self-reported use of leadership/management tools and general leadership/management. We conducted a survey among a sample of providers to understand the intervention's impact. Targeted minimum loss-based estimation (TMLE) was used to compare responses between trial arms. RESULTS: Of 163 managers participating in the SEARCH-IPT trial, 119 (73%) completed the survey. Intervention managers reported more frequent use of leadership/management tools taught in the intervention curriculum than control managers (+3.64, 95% CI 1.98-5.30, P < 0.001). There were no significant differences in self-reported leadership skills in the intervention as compared to the control group. Among providers, the average reported quality of guidance and supervision was significantly higher in intervention vs control districts (+1.08, 95% CI 0.63-1.53, P = 0.001). CONCLUSIONS: A leadership and management training intervention increased the use of leadership/management tools among mid-level managers and resulted in higher perceived quality of supervision among providers in intervention vs control districts in Uganda. These findings suggest improved leadership/management among managers contributed to increased IPT use among PWH in the intervention districts of the SEARCH-IPT trial.

CONTEXTE: Dans toute l'Afrique subsaharienne, les gestionnaires de soins de santé de niveau intermédiaire supervisent la mise en œuvre des directives nationales. Il n'est toujours pas clair si la formation en leadership et en gestion peut améliorer les résultats en matière de santé de la population. MÉTHODES: Nous avons cherché à évaluer les compétences en leadership et en gestion des responsables de la santé au niveau des districts en Ouganda participant à l'essai randomisé SEARCH-IPT visant à promouvoir le traitement préventif à l'isoniazide (TPI) pour les personnes vivant avec le VIH (PWH, pour l'anglais « people living with HIV ¼). L'intervention, qui a permis d'augmenter les taux de TPI, comprenait une formation annuelle en leadership et en gestion des gestionnaires. Nous avons mené une enquête transversale pour évaluer les compétences en leadership et en gestion des gestionnaires à la fin de l'essai. L'enquête a évalué l'utilisation autodéclarée d'outils de leadership et de gestion et de leadership et de gestion en général. Nous avons mené une enquête auprès d'un échantillon de prestataires pour comprendre l'impact de l'intervention. L'estimation ciblée basée sur les pertes minimales (TMLE, « Targeted minimum loss-based estimation ¼) a été utilisée pour comparer les réponses entre les groupes de l'essai. RÉSULTATS: Sur les 163 gestionnaires qui ont participé à l'essai SEARCH-IPT, 119 (73%) ont répondu au sondage. Les gestionnaires d'intervention ont déclaré utiliser plus fréquemment les outils de leadership/gestion enseignés dans le programme d'intervention que les gestionnaires de contrôle (+3,64 ; IC à 95% 1,98­5,30 ; P < 0,001). Il n'y avait pas de différences significatives dans les compétences de leadership autodéclarées dans l'intervention par rapport au groupe témoin. Parmi les prestataires, la qualité moyenne déclarée de l'orientation et de la supervision était significativement plus élevée dans les districts d'intervention que dans les districts témoins (+1,08 ; IC à 95% 0,63­1,53 ; P = 0,001). CONCLUSIONS: Une intervention de formation au leadership et à la gestion a permis d'accroître l'utilisation d'outils de leadership et de gestion parmi les cadres intermédiaires et d'améliorer la perception de la qualité de la supervision parmi les prestataires dans les districts d'intervention par rapport aux districts de contrôle en Ouganda. Ces résultats suggèrent que l'amélioration du leadership et de la gestion chez les gestionnaires a contribué à l'augmentation de l'utilisation du TPI chez les personnes handicapées dans les districts d'intervention de l'essai SEARCH-IPT.

Rural community-centred co-planning for sustainable rural health systems.

OBJECTIVE: Sustaining rural healthcare services is challenging because of numerous systemic factors. Rural communities can inform the design of sustainable rural health models; however, further evidence of effective co-design is needed to guide implementation. The study aim was to co-design a series of place-based and evidence-informed rural health models, to improve local health system sustainability. SETTING: A rural region (categorised as Modified Monash Model 5) defined by three adjoining Shires in Central and Northwest Victoria, Australia. PARTICIPANTS: A health executive co-planning network led the co-design, with input and oversight from a broader cross-sector group. Healthcare professionals (n = 44) and consumers and carers (n = 21) participated in interviews, and an online survey was completed by healthcare professionals (n = 11) and consumers and carers (n = 7) to provide feedback on the preliminary results. DESIGN: Community-based participatory action research was applied incorporating co-design methods and systems thinking. Data were collected through qualitative interviews followed by an online feedback survey. Mixed method data analysis (QUAL-quant) was conducted with qualitative directed content analysis of interview transcripts and quantitative descriptive analyses of survey responses to aid prioritisation. RESULTS: Healthcare priorities, strengths and challenges, and proposed rural health models are described. A rural health system sustainability strategy was developed with three integrated pillars: 1. Workforce strengthening, 2. Integrated health services and 3. Innovative models of care. CONCLUSION: Community-centred co-design with rural health stakeholders was effective for generating locally tailored ideas and potential health models that emulate community strengths and resources, and provide a foundation for further planning, implementation and evaluation.

Combined Aerobic and Resistance Training Improves Body Composition, Alters Cardiometabolic Risk, and Ameliorates Cancer-Related Indicators in Breast Cancer Patients and Survivors with Overweight/Obesity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Breast cancer survivors with obesity are at a high risk of cancer recurrence, comorbidity, and mortality. This review aims to systematically evaluate the effects of combined aerobic and resistance training (CART) on body composition, lipid homeostasis, inflammation, adipokines, cancer-related fatigue, sleep, and quality of life in breast cancer patients and survivors with overweight/obesity. An electronic search was conducted in PubMed, Web of Science, Scopus, Science Direct, Cochrane, and Google Scholar databases from inception up to January 8, 2024. Randomized controlled trials (RCTs) meeting the inclusion criteria were selected for the analysis. The Cochrane risk of bias tool was used to assess eligible studies, and the GRADE method to evaluate the quality of evidence. A random-effects model was used, and data were analyzed using mean (MD) and standardized mean differences (SMD) for continuous variables with 95% confidence intervals (CI). We assessed the data for risk of bias, heterogeneity, sensitivity, reporting bias, and quality of evidence. A total of 17 randomized controlled trials were included in the systematic review involving 1,148 female patients and survivors (mean age: 54.0 ± 3.4 years). The primary outcomes showed significant improvements in body mass index (SMD -0.57 kg/m2, p = 0.04), body fat (SMD -0.50%, p = 0.02), fat mass (SMD -0.63 kg, p = 0.04), hip circumference (MD -3.14 cm, p = 0.02), and fat-free mass (SMD 1.03 kg, p < 0.001). The secondary outcomes indicated significant increases in high-density lipoprotein cholesterol (MD -0.05 mmol/L, p = 0.008), natural killer cells (SMD 0.42%, p = 0.04), reductions in triglycerides (MD -81.90 mg/dL, p < 0.01), total cholesterol (SMD -0.95 mmol/L, p < 0.01), tumor necrosis factor α (SMD -0.89 pg/mL, p = 0.03), and leptin (SMD -0.63 ng/mL, p = 0.03). Also, beneficial alterations were found in cancer-related fatigue (SMD -0.98, p = 0.03), sleep (SMD -1.17, p < 0.001), and quality of life (SMD 2.94, p = 0.02) scores. There was very low to low confidence in the estimated effect of most of the outcomes. The present findings reveal that CART could be considered an adjunct therapy in supporting the conventional clinical approach observed following exercise. However, further high-quality research is needed to evaluate whether CART would be a valuable intervention to lower aggressive pharmacologic use in breast cancer patients with overweight/obesity.

Identifying opportunities for global surgery in Cameroon: an analysis of existing health policies and events.

Introduction: the burden of diseases amenable to surgery, obstetrics, trauma, and anesthesia (SOTA) care is increasing globally but low- and middle-income countries are disproportionately affected. The Lancet Commission on Global Surgery proposed National Surgical, Obstetrics, and Anesthesia Plans as national policies to reduce the global SOTA burden. These plans are dependent on comprehensive stakeholder engagement and health policy analysis. Objective: in this study, we analyzed existing national health policies and events in Cameroon to identify opportunities for SOTA policies. Methods: we searched the Cameroonian Ministry of Health´s health policy database to identify past and current policies. Next, the policies were retrieved and screened for mentions of SOTA-related interventions using relevant keywords in French and English, and analyzed using the 'eight-fold path´ framework for public policy analysis. Results: we identified 136 policies and events and excluded 16 duplicates. The health policies and events included were implemented between 1967 and 2021. Fifty-nine policies and events (49.2%) mentioned SOTA care: governance (n=25), infrastructure (n=21), service delivery (n=11), workforce (n=11), information management (n=10), and funding (n=8). Most policies and events focused on maternal and neonatal health, followed by anesthesia, ophthalmologic surgery, and trauma. National, multinational civil society organizations and private stakeholders supported these policies and events, and the Cameroonian Ministry of Public Health was the largest funder. Conclusion: most Cameroonian SOTA-related policies and events focus on maternal and neonatal care, and health financing is the health system component with the least policies and events. Future SOTA policies should build on existing strengths while improving neglected areas, thus attaining shared global and national goals by 2030.

Hybridizing Shear-Stiffening Gel and Chemically-Strengthened Ultrathin Glass Sheets for Flexible Impact-Resistant Armor.

Traditional anti-impact armors and shields are normally made of stiff and hard materials and therefore deficient in flexibility. This greatly limits their applications in protecting objects with complex geometries or significant deformability. Flexible armors can be developed with the application of hard platelets and soft materials, but the lower rigidity of the flexible armors renders them incapable of providing sufficient resistance against impact attacks. To address the inherent conflict between flexibility and impact resistance in traditional armors, here, a composite is developed by hybridizing a shear-stiffening gel as the matrix and chemically-strengthened ultrathin glass sheets (CSGS) as the reinforcement. The resulting laminate, termed PCCL, exhibits both high flexibility and high impact resistance. Specifically, at low strain rates, the high ductility of the gel combined with the high flexural strength of the CSGS enables the PCCL to undergo considerable deformation; at high strain rates, on the other hand, the shear stiffening behavior of the gel matrix endows the PCCL with excellent impact resistance manifested by its high performance in energy absorption and high rigidity. With the combination of high flexibility and high impact resistance, the PCCL is demonstrated to be an ideal armor for protecting curved vulnerable objects from impact attacks.

Strengthening Reinforced Concrete Beams through Integration of CFRP Bars, Mechanical Anchorage System, and Concrete Jacketing.

The demand for strengthening reinforced concrete (RC) structures has increased considerably. Implementing carbon-fiber-reinforced polymer (CFRP) bars and concrete jacketing are the most effective techniques for RC beam retrofitting. Using the mechanical anchorage system (MAS) to attach CFRP bars to old concrete is highly recommended to avoid any debonding when it is applied to cyclic loads. However, the design of strengthening details is the most challenging issue because it involves many effective parameters. In this study, a design process for strengthening beams using CFRP bars with new MASs and concrete jacketing is proposed, and various design schemes are studied. The number of applied MASs and the thickness and grade of the concrete jacket were investigated through experimental testing and finite element (FE) simulations to define strengthening design details, such as the number and size of employed CFRP bars. Accordingly, an analytical technique was formulated to predict the performance of the strengthened beam in terms of the nominal ultimate load. The results demonstrated the high performance of the proposed system in preventing premature debonding. The proposed system enhances the beam capacity from 44 kN to 83 kN, representing an increase of more than 90%. In contrast, the conventional near-surface mounted (NSM) system exhibits a lower percentage increase at less than 37%. Both FE simulations and analytical approaches can be effectively employed to predict the behavior and capacity of the strengthened beam while considering various design parameters.

Enhancing the Strength and Ductility Synergy of Lightweight Ti-Rich Medium-Entropy Alloys through Ni Microalloying.

Medium-entropy alloys (MEAs) have attracted considerable attention in recent decades due to their exceptional material properties and design flexibility. In this study, lightweight and non-equiatomic MEAs with low density (~5 g/cm3), high strength (yield strength: 1200 MPa), and high ductility (plastic deformation: ≧10%) were explored. We fine-tuned a previously developed Ti-rich MEA by microalloying it with small amounts of Ni (reducing the atomic radius and increasing the elastic modulus) through solid solution strengthening to achieve a series of MEAs with enhanced mechanical properties. Among the prepared MEAs, Ti65Ni1 and Ti65Ni3 exhibited optimal properties in terms of the balance between strength and ductility. Furthermore, the Ti65Ni3 MEA was subjected to thermo-mechanical treatment (TMT) followed by cold rolling 70% (CR70) and cold rolling 85% (CR85). Subsequently, the processed samples were rapidly annealed at 743 °C, 770 °C, 817 °C, and 889 °C at a heating rate of 15 °C/s. X-ray diffraction analysis revealed that the MEA could retain its single-body-centered cubic solid solution structure after TMT. Additionally, the tensile testing results revealed that increasing the annealing temperature led to a decrease in yield strength and an increase in ductility. Notably, the Ti65Ni3 MEA sample that was subjected to CR70 and CR85 processing and annealed for 30 s exhibited high yield strength (>1250 MPa) and ductility (>13%). In particular, the Ti65Ni3 MEA subjected to CR85 exhibited a specific yield strength of 264 MPa·cm3/g, specific tensile strength of 300 MPa·cm3/g, and ductility of >13%.

High-Entropy Alloy Activating Laves-Phase Network for Multi-Component Metallic Coatings with High Hardness.

The low hardness and poor wear resistance of laser-cladding 316L stainless steel impose significant constraints on its practical applications. In this study, a strategy for strengthening laser-cladding 316L stainless steel with WMoTaNb refractory high-entropy alloy as a reinforcement material is proposed. The results confirm that the coating primarily comprises a body-centered cubic (BCC) Fe-based solid solution, a network-distributed hexagonal Fe2X (X = W, Mo, Ta, and Nb) Laves phase, and a diffusely distributed face-centered cubic (FCC) (Ta, Nb)C phase. The Fe-based solid solution distributes along columnar and fine dendrites, while the Laves phase and (Ta, Nb)C phase are in the inter-dendrites. The presence of a significant number of network Laves phases exhibiting high strength and hardness is the primary factor contributing to the enhancement of coating microhardness. The hardness of the composite coating is increased by nearly twice compared to that of the 316L coating, resulting in an improved wear resistance. The present work can shed light on designing and fabricating 316L stainless steel coating with enhanced hardness and wear resistance.

Strengthening and Toughening of ZG25SiMn2CrB Steel without Tempering Brittleness via Electropulsing Treatment.

High-strength low-alloy steels are widely used, but their traditional heat-treatment process is complex, energy-intensive, and makes it difficult to fully exploit the material's potential. In this paper, the electropulsing processing technology was applied to the quenching and tempering process of ZG25SiMn2CrB steel. Through microstructural characterization and mechanical property testing, the influence of electropulsing on the solid-state phase transition process of annealing steel was systematically studied. The heating process of the specimen with the annealing state (initial state) is the diffusion-type transition. As the discharge time increased, the microstructure gradually transformed from ferrite/pearlitic to slate martensite. Optimal mechanical properties and fine microstructure were achieved after quenching at 500 ms. The steel subjected to rapid tempering with 160 ms electropulsing exhibited good, comprehensive mechanical properties (tensile strength 1609 MPa, yield strength 1401.27 MPa, elongation 11.63%, and hardness 48.68 HRC). These favorable mechanical properties are attributed to the coupled impact of thermal and non-thermal effects induced by high-density pulse current. Specifically, the thermal effect provides the thermodynamic conditions for phase transformation, while the non-thermal effect reduces the nucleation barrier of austenite, which increases the nucleation rate during instantaneous heating, and the following rapid cooling suppresses the growth of austenite grains. Additionally, the fine microstructure prevents the occurrence of temper brittleness.

Theoretical Prediction of Strengthening in Nanocrystalline Cu with Multi-Element Grain Boundary Segregation Decoration.

The composition of grain boundaries (GBs) determines their mechanical behavior, which in turn affects the mechanical properties of nanocrystalline materials. Inspired by GB segregation and the concept of high-entropy alloys (HEAs), we investigated, respectively, the mechanical responses of nanocrystalline Cu samples with and without multi-element GBs, as well as the grain size effects, aiming to explore the effects of GB composition decoration on mechanical properties. Our results show that introducing multi-element segregation GBs can significantly improve the mechanical properties of nanocrystalline Cu by effectively inhibiting GB migration and sliding. Additionally, we proposed an improved a theoretical model that can reasonably describe the strengths of the materials with multi-element or single-element segregation GBs. Notably, the introduction of multi-element segregation GBs inhibits both migration and sliding behavior, with migration being more effectively suppressed than sliding. These results present a novel approach for designing high-performance nanometallic materials and offer valuable insights into the role of GB composition decoration in enhancing mechanical properties.

Effect of Partial Substitution of Zr for Ti Solvent on Young's Modulus, Strength, and Biocompatibility in Beta Ti Alloy.

In orthopedics and dentistry, there is an urgent need to obtain low-stiffness implants that suppress the stress shielding caused by the use of metallic implants. In this study, we aimed to fabricate alloys that can reduce the stiffness by increasing the strength while maintaining a low Young's modulus based on the metastable ß-Ti alloy. We designed alloys in which Ti was partially replaced by Zr based on the ISO-approved metastable ß-Ti alloy Ti-15Mo-5Zr-3Al. All alloys prepared by arc melting and subsequent solution treatment showed a single ß-phase solid solution, with no formation of the ω-phase. The alloys exhibited a low Young's modulus equivalent to that of Ti-15Mo-5Zr-3Al and a high strength superior to that of Ti-15Mo-5Zr-3Al and Ti-6Al-4V. This strengthening was presumed to be due to solid-solution strengthening. The biocompatibility of the alloys was as good as or better than that of Ti-6Al-4V. These alloys have potential as metallic materials suitable for biomedical applications.

Research on the Influence of Cold Drawing and Aging Heat Treatment on the Structure and Mechanical Properties of GH3625 Alloy.

With the development of the petroleum industry, the demand for materials for oilfield equipment is becoming increasingly stringent. The strength increase brought about by time strengthening is limited in meeting the needs of equipment development. The GH3625 alloy with different strength levels can be obtained through cold deformation and heat treatment processes. A study should be carried out to further develop the potential mechanical properties of GH3625. In this study, the GH3625 alloy was cold drawn with different reductions in area (0-30%) and heat treated, and its mechanical properties were tested. The microstructure of the alloy during deformation and heat treatment was characterized by methods such as optical microscopy (OM), scanning electron microscopy (SEM), and transmission electron microscopy (TEM) based on the principles of physical metallurgy. The strength increase caused by dislocation strengthening was calculated from the dislocation density, tested by X-ray diffraction (XRD). The calculated value was compared to the measured value, elucidating the strengthening effect of cold deformation and heat treatment. The results showed that the yield strength and yield ratio of the cold-drawn alloy significantly reduced after aging at 650 °C and 760 °C. Heat treatment can make a cold-deformed material recover, ablate dislocations, and greatly reduce the dislocation density in the microstructure of the GH3625 alloy, which was the main factor in the decrease in yield strength. The work-hardening gradient of the cold-drawn material varied greatly with different reductions in area. When the reduction in area was small (10%), the hardness gradient was obvious. When it increased to 30%, the alloy was uniformly strengthened as the deformation was transmitted to the axis. This study can provide more mechanical performance options for GH3625 alloy structural components in the petrochemical industry.

Weight training and risk of all-cause, cardiovascular disease and cancer mortality among older adults.

BACKGROUND: While previous studies indicate muscle-strengthening exercises may reduce mortality risk, further research is needed to increase certainty of the evidence. We investigated overall and dose-response associations between weight training and the risks of all-cause, cardiovascular disease (CVD) and cancer mortality in a large cohort of older adults with long follow-up time and a large number of deaths. We also investigated the joint associations of weight training and aerobic exercise with mortality risk. METHODS: Weight training was assessed via self-report in 2004-05 in the National Institutes of Health-American Association of Retired Persons (NIH-AARP) Diet and Health Study (USA; n = 216 339), with follow-up to 2019. Cox regression estimated the hazard ratios (HR) and 95% confidence intervals (CI) for the associations between weight training and mortality, after adjusting for confounders including aerobic exercise. RESULTS: Around 25% of participants [mean age = 69.9 years (standard deviation = 5.4), 58% men] reported engaging in weight training over the past year, and there were 79 107 (37%) deaths. Engaging in any weight training (vs none) was associated with lower risks of all-cause (HR = 0.94; 95% CI = 0.93-0.96), CVD (HR = 0.92; 95% CI = 0.90-0.95) and cancer mortality (HR = 0.95; 95% CI = 0.92-0.98). More time spent in weight training was associated with only marginally greater risk reductions. Larger risk reductions were observed among women than men. Performing both aerobic exercise and weight training conferred the greatest mortality risk reduction; weight training was not associated with mortality risk among participants who did no aerobic exercise. CONCLUSION: Performing any amount of weight training lowered mortality risk.

Effects of Stretching or Strengthening Exercise on Spinal and Lumbopelvic Posture: A Systematic Review with Meta-Analysis.

BACKGROUND: Abnormal posture (e.g. loss of lordosis) has been associated with the occurrence of musculoskeletal pain. Stretching tight muscles while strengthening the antagonists represents the most common method to treat the assumed muscle imbalance. However, despite its high popularity, there is no quantitative synthesis of the available evidence examining the effectiveness of the stretch-and-strengthen approach. METHODS: A systematic review with meta-analysis was conducted, searching PubMed, Web of Science and Google Scholar. We included controlled clinical trials investigating the effects of stretching or strengthening on spinal and lumbopelvic posture (e.g., pelvic tilt, lumbar lordosis, thoracic kyphosis, head tilt) in healthy individuals. Effect sizes were pooled using robust variance estimation. To rate the certainty about the evidence, the GRADE approach was applied. RESULTS: A total of 23 studies with 969 participants were identified. Neither acute (d = 0.01, p = 0.97) nor chronic stretching (d=-0.19, p = 0.16) had an impact on posture. Chronic strengthening was associated with large improvements (d=-0.83, p = 0.01), but no study examined acute effects. Strengthening was superior (d = 0.81, p = 0.004) to stretching. Sub-analyses found strengthening to be effective in the thoracic and cervical spine (d=-1.04, p = 0.005) but not in the lumbar and lumbopelvic region (d=-0.23, p = 0.25). Stretching was ineffective in all locations (p > 0.05). CONCLUSION: Moderate-certainty evidence does not support the use of stretching as a treatment of muscle imbalance. In contrast, therapists should focus on strengthening programs targeting weakened muscles.

How an international research programme can contribute to improvements in the research environment: the perspective of doctoral students in sub-Saharan Africa.

Background: The Africa Capacity Building Initiative (ACBI) programme aimed to 'strengthen the research and training capacity of higher education institutions and support the development of individual scientists in sub-Saharan Africa through UK-Africa research collaborations' including by funding PhD studentships. We conducted research to understand students' experiences and to see how consortia-based programmes such as ACBI and their own institutions can enhance PhD students' research environment and progress. Methods: In-depth interviews with 35 ACBI-funded PhD students explored their perspectives about how their research and personal development benefitted from belonging to a research consortium. Questionnaires were used to corroborate interview findings. Results: Students recognised that membership of a research consortium provided many benefits compared to less well-resourced peers. By drawing on the programme and consortiums' resources, they were often able to overcome some limitations in their own institution's systems and facilities. Through their consortia they could access a wide range of international expertise and support from mentors and colleagues for their technical and psychosocial needs. Multiple consortia opportunities for engaging with the international scientific community and for networking, gave them confidence and motivation and enhanced their career prospects. Conclusion: Our study and its recommendations highlight how the breadth and diversity of resources available to PhD students through research consortia can be harnessed to facilitate students' progress and to create a supportive and conducive research environment. It also underlines how, through a multi-level approach, consortia can contribute to longer-term improvements in institutional research environments for PhD students.

Efficacy of specific exercises in general population with non-specific low back pain: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: Localized exercises are employed to activate, train, or restore the function of particular muscles and they are usually considered as part of treating individuals suffering low back pain. So, this systematic review and meta-analysis aimed to assess the efficacy of specific exercises in general population with non-specific low back pain (LBP). METHODS: We conducted electronic searches in MEDLINE/PubMed, Scopus, Web of Science (WoS), and Google scholar from January 1990 to June 2021. Initially, 47,740 records were identified. Following the removal of duplicates, 32,138 records were left. After reviewing titles and abstracts, 262 papers were chosen for thorough assessment. Among these, 208 studies were excluded, resulting in 54 trials meeting the inclusion criteria for this study. Additionally, 46 of these trials were randomized controlled trials and were further evaluated for the meta-analysis. We included trials investigating the effectiveness of exercise therapy, including isometric activation of deep trunk muscles, strengthening exercises, stabilization exercises, stretching exercises, and proprioceptive neuromuscular facilitation exercises (PNF) in LBP patients. The primary outcome was pain intensity, measured using tools such as the visual analogue scale (VAS) and numeric pain rating scale (NPRS). The secondary outcome was disability, assessed through instruments such as the Roland Morris Disability Questionnaire (RMDQ) and Oswestry Disability Index (ODI). The quality of the eligible studies was assessed using the Verhagen tool, and the level of evidence was evaluated using the GRADE approach. RESULTS: Based on the Verhagen tool, 46 trials (85.2%) were categorized as having low methodological quality, while 8 studies (14.8%) were considered to have medium methodological quality. The meta-analysis indicated a small efficacy in favor of isometric activation of deep trunk muscles (-0.37, 95% CI: -0.88 to 0.13), a moderate efficacy in favor of stabilization exercises (-0.53, 95% CI: -1.13 to 0.08), and a large efficacy in favor of PNF exercises (-0.91, 95% CI: -1.62 to -0.2) for reducing pain intensity as assessed by VAS or NPRS tools. Moreover, the meta-analysis revealed a moderate efficacy for isometric activation of deep trunk muscles (-0.61, CI: -1.02 to -0.19), and a large efficacy for PNF exercises (-1.26, 95% CI: -1.81 to -0.72) in improving disability, assessed using RMDQ or ODI questionnaires. The level of certainty in the evidence, as determined by the GRADE approach, was very low to low. CONCLUSION: These findings emphasize the importance of incorporating localized therapeutic exercises as a fundamental aspect of managing non-specific LBP. Clinicians should consider utilizing localized therapeutic exercise tailored to individual patient needs. Furthermore, further research investigating optimal exercise therapy, optimal dose of the exercises, durations, and long-term adherence is warranted to enhance the precision and efficacy of exercise-based interventions for non-specific LBP.

The social lives of point-of-care tests in low- and middle-income countries: A meta-ethnography.

Point-of-care tests (POCTs) have become technological solutions for many global health challenges. This meta-ethnography examines what in-depth qualitative research reveals about the "social lives" of POCTs from, highlighting key social considerations for policymakers, funders, developers and users in the design, development and deployment of POCTs. We screened qualitative research examining POCTs in low- and middle-income countries (LMICs) and selected 13 papers for synthesis. Findings illuminate five value-based logics-technological autonomy, care, scalability, rapidity and certainty-shaping global health innovation ecosystems and their entanglement with health systems. Our meta-ethnography suggests POCTs never achieve the technological autonomy often anticipated during design and development processes. Instead, they are both embedded in and constitutive of the dynamic relationships that make up health systems in practice. POCTs are often imagined as caring commodities; however, in use, notions of care inscribed in these devices are constantly negotiated and transformed in relation to multiple understandings of care. POCTs promise to standardize care across scale, yet our analysis indicates non-standard processes, diagnoses and treatment pathways as essential to "fluid technologies" rather than dangerous aberrations. The rapidity of POCTs is constructed and negotiated within multiple distinct temporal registers and POCTs operate as temporal objects that can either speed up or slow down experiences of diagnosis and innovation. Finally, while often valued as epistemic tools that can dispel diagnostic uncertainty, these papers demonstrate that POCTs contribute to new forms of uncertainty. Together, these papers point to knowledge practices as multiple, and POCTs as contributing to, rather than reducing, multiplicity. The values embedded in POCTs are fluid and contested, with important implications for the kind of care these tools can deliver. These findings can contribute to more reflexive approaches to global health innovation, which take into account limitations of established global health logics, and recognise the socio-technical complexity of health systems.