Effectiveness evaluation of different steel fibers on the shear strength of reinforced SFRC slender beams without web rebars.

Current studies have mainly focused on the effect of specific steel fibers on the shear performance of steel fiber-reinforced concrete (SFRC) slender beams. However, there has been a lack of in-depth research evaluating the effectiveness of different steel fibers through a statistically comparative analysis of experimental data from various researchers. Existing design methods do not fully account for the impact of all types of steel fibers on the shear capacity of SFRC slender beams, providing very limited guidance on selecting appropriate steel fibers. This highlights the need for research to verify the strengthening effectiveness of different steel fibers. This paper establishes databases comprising 232 shear-failed reinforced SFRC beams with four other types of steel fibers straight wire, deformed wire, deformed cut-sheet and ingot mill, based on a comprehensive review of published literature. These databases complement an existing database of 280 reinforced SFRC beams using hook-end wire steel fibers as shear reinforcement. The databases are used to evaluate the validity of several well-known existing formulas for predicting the shear capacity of beams and to determine the fiber bond factor values that reflect the diverse strengthening effects of different steel fibers. Utilizing a simi-empirical synergetic prediction model for the shear strength of reinforced SFRC slender beams with hook-end wire steel fibers, the shear resistances of test beams in databases with the other four types of steel fiber are analyzed. The primary contributors to shear capacity are identified as the uncracked shear-compression SFRC and the dowel action of longitudinal tensile steel bars. The contribution of steel fibers is linked to the shear resistance of uncracked shear-compression SFRC. From a practical design perspective, a conservative prediction formula is verified, aligning with the lower boundary of the tested shear strength obtained from the database of beams. Finally, suitable steel fibers for s enhancing the shear strength of reinforced SFRC beams without web rebars are suggested based on their effectiveness.

Evaluating the Capabilities of Generative AI Tools in Understanding Medical Papers: Qualitative Study.

BACKGROUND: Reading medical papers is a challenging and time-consuming task for doctors, especially when the papers are long and complex. A tool that can help doctors efficiently process and understand medical papers is needed. OBJECTIVE: This study aims to critically assess and compare the comprehension capabilities of large language models (LLMs) in accurately and efficiently understanding medical research papers using the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist, which provides a standardized framework for evaluating key elements of observational study. METHODS: The study is a methodological type of research. The study aims to evaluate the understanding capabilities of new generative artificial intelligence tools in medical papers. A novel benchmark pipeline processed 50 medical research papers from PubMed, comparing the answers of 6 LLMs (GPT-3.5-Turbo, GPT-4-0613, GPT-4-1106, PaLM 2, Claude v1, and Gemini Pro) to the benchmark established by expert medical professors. Fifteen questions, derived from the STROBE checklist, assessed LLMs' understanding of different sections of a research paper. RESULTS: LLMs exhibited varying performance, with GPT-3.5-Turbo achieving the highest percentage of correct answers (n=3916, 66.9%), followed by GPT-4-1106 (n=3837, 65.6%), PaLM 2 (n=3632, 62.1%), Claude v1 (n=2887, 58.3%), Gemini Pro (n=2878, 49.2%), and GPT-4-0613 (n=2580, 44.1%). Statistical analysis revealed statistically significant differences between LLMs (P<.001), with older models showing inconsistent performance compared to newer versions. LLMs showcased distinct performances for each question across different parts of a scholarly paper-with certain models like PaLM 2 and GPT-3.5 showing remarkable versatility and depth in understanding. CONCLUSIONS: This study is the first to evaluate the performance of different LLMs in understanding medical papers using the retrieval augmented generation method. The findings highlight the potential of LLMs to enhance medical research by improving efficiency and facilitating evidence-based decision-making. Further research is needed to address limitations such as the influence of question formats, potential biases, and the rapid evolution of LLM models.

Strengthening the planning and design of Objective Structured Clinical Examinations.

Background: Although Objective Structured Clinical Examinations (OSCEs) offer innovative, objective, and fair methods of clinical assessment, their quality is compromised by poor planning and design. Aim: This study aimed to describe the development and present evidence-based recommendations on strengthening the planning and design of OSCEs for a South African public College of Nursing. Setting: A South African public College of Nursing. Methods: Recommendations were developed based on synthesising two sets of qualitative data. Set 1 included two main themes with each of the four sub-themes related to barriers and facilitators towards quality in OSCE designs from 14 nurse educator interviews and 15 external moderator reports. Set 2 included 12 quality measures to be adopted in the quality design of OSCEs derived from an integrative literature review. The draft recommendations were reviewed by eight experts to be finalised. Results: Seven recommendations were developed for strengthening OSCEs' planning and design, related to: (1) policy framework, standard operating procedures and stakeholder code of conduct; (2) blueprinting and mapping of the OSCE content; (3) developing a bank of OSCE stations; (4) scoring rubric and standard-setting method selection; (5) examiners and standardised patients' recruitment and training; (6) venue selection; and (7) station piloting. Conclusion: The seven developed recommendations can strengthen the quality of OSCEs in the South African public College of Nursing context. Contribution: The developed recommendations can assist nurse educators in planning and designing to conduct quality OSCEs following piloting and implementation.

Articulating the ultimate objectives of research capacity strengthening programmes: Why this is important and how we might achieve it.

'Research capacity strengthening' (RCS) is an umbrella term that can be used to describe a wide variety of activities conducted in support of diverse objectives premised upon distinct, potentially opposing, views. Despite this, the ultimate objective of RCS activities is rarely made explicit which can be problematic when diverse objectives are possible. By 'ultimate' objective we are referring to the overarching (often long-term) goal an RCS initiative is intended to contribute towards (e.g. better population health) as opposed to the more immediate 'proximate' (often short-term) objectives of any such activity (e.g. improved capacity to undertake infectious disease research). We argue a need for those funding, designing and implementing RCS initiatives to make clear statements as to the ultimate objective that they foresee their respective initiative contributing towards as well as the proposed pathway and associated assumptions that underlie their approach. Examples of distinct ultimate objectives for RCS initiatives are presented alongside fictitious examples of how they may be transparently reported from both a funder and implementor perspective. Such transparency should be routine within the scope of funding calls for RCS activities (even when such activities are only a minor component of the call), subsequent applications to those calls and any description of an applied RCS activity/ies and/or the associated outcomes thereof. The process of determining one's ultimate objective will further cause funders and actors to think through their respective initiatives more thoroughly and make informed choices and better designed RCS projects. Doing so would reduce any ambiguity associated with the use of the term 'research capacity strengthening' and would provide a stronger foundation for robust programme evaluation.

Effects of Yipi Huayu decoction on tumor markers, immune function, and adverse reactions during chemotherapy in gastric cancer patients: a retrospective propensity score-matched study.

OBJECTIVE: To analyze the effects of Yianpi Huayu Decoction on tumor markers, immune function and adverse reactions during chemotherapy in patients with gastric cancer. METHOD: The clinical data of 154 patients with progressive gastric cancer who attended Baoji Maternal and Child Health Hospital (Daijiawan Branch) from January 2020 to March 2022 were retrospectively analyzed. The patients were divided into an observation group (61 cases) and a control group (93 cases) according to the treatment method and were matched using propensity score matching (PSM). The control group was given SOX neoadjuvant chemotherapy regimen (oxaliplatin + tiglio), and the observation group was given spleen-strengthening and blood-stasis-reducing tonics as adjuvant treatment on the basis of the treatment given to the control group. Clinical efficacy in the two groups was observed, as well as Carbohydrate Antigen 19-9 (CA19-9), Carbohydrate Antigen 72-4 (CA72-4), and Carcinoembryonic Antigen (CEA) levels, immune function (IgA, IgM, and IgG), Karnofsky Performance Scale (KPS), and occurrence of adverse reactions. RESULTS: After matching, there was no significant difference in the total clinical efficiency between the two groups (P > 0.05). After matching, there were no differences in CA19-9, CA72-4, and CEA levels between the observation group and the control group before or after treatment (P > 0.05). After matching, the IgA, IgM, and IgG levels in the observation group were significantly better than those in the control group after treatment (P < 0.05). The incidence of leukopenia (P = 0.011) and diarrhea (P = 0.011) during treatment was higher in the control group than in the observation group after matching. The KPS score of the observation group was higher than that of the control group after matching (P < 0.05). After matching, Cox regression analysis found that the treatment regimen (P < 0.001, HR = 2.527), TNM staging (P = 0.001, HR = 0.471), local recurrence (P = 0.001, HR = 2.147), and pretreatment CEA (P = 0.011, HR = 1.131) were independent prognostic factors affecting patients' 2-year survival. CONCLUSION: While the spleen-enhancing and blood-stasis-removing herbal formula combined with the SOX chemotherapy regimen did not improve therapeutic outcomes in gastric cancer patients, it did enhance immune function, reduce adverse reactions, and improve quality of life.

Exploring the sports participation, muscle-strengthening exercise and active commuting with comorbidity of depression and anxiety among Chinese children and adolescents: a cross-sectional study.

Prior research has shown that physical activity (PA) is a crucial element for preserving and enhancing health, particularly among children and adolescents, and consistent engagement in PA offers numerous advantages for sustaining typical physical and mental well-being. Purpose: Hence, the primary objective of this study was to examine the relationship between sport participation, muscle-strengthening exercise (MSE), and active commuting (AC) in the co-occurrence of depression and anxiety in Chinese children and adolescents. Method: This cross-sectional investigation occurred in various cities across the southeastern region of China between March 2021 and October 2021. A convenient sampling method was utilized. We invited children and adolescents to participate in the questionnaire survey. A total of 1,996 participants completed the questionnaires with the endorsement of their parents or guardians under the supervision of schoolteachers and headmasters. Girls comprised 47.5% of the participants, and the average age of participants was 14.8 ± 2.0 years. We conducted a logistic regression analysis, including 95% confidence intervals, to explore the association between sports participation, MSE, AC, and the co-occurrence of depression and anxiety. Results: No significant association was observed between weekday active commuting for travelling to and from school and MSE and the comorbidity of depression and anxiety in children and adolescents. A negative association was only detected for those who engaged in muscle-strengthening exercises 4 days a week (OR = 0.540, 95% CI = 0.345-0.845) compared to those who did not partake in such exercises. Conclusion: The present study has provided evidence of the connection between sports participation and the co-occurrence of depression and anxiety among Chinese children and adolescents. Sports participation is more likely to help adolescents relieve anxiety and depression than AC, MSE. In forthcoming research, it is imperative to delve deeper into strategies that enhance the impact of sports on the mental well-being of children and young individuals. Furthermore, optimizing the magnitude of this effect may be achievable by focusing on neurobiological, behavioral, and psychosocial mechanisms.

Enhancing Strength and Ductility of a Ni-26.6Co-18.4Cr-4.1Mo-2.3Al-0.3Ti-5.4Nb Alloy via Nanosized Precipitations, Stacking Faults, and Nanotwins.

The addition of Co to Ni-based alloys can reduce the stacking fault energy. In this study, a novel Ni-26.6Co-18.4Cr-4.1Mo-2.3Al-0.3Ti-5.4Nb alloy was developed by increasing the Co addition to 26.6 wt.%. A new strategy to break the trade-off between strength and ductility is proposed by introducing dense nanosized precipitations, stacking faults, and nanoscale twins in the as-prepared alloys. The typical characteristics of the deformed alloy include dense dislocations tangles, nanotwins, stacking faults, and Lomer-Cottrell locks. In addition to the pinning effect of the bulky δ precipitates to the grain boundaries, the nanosized γ' particles with a coherent interface with the matrix show significant precipitation strengthening. As a result, the alloy exhibits a superior combination of yield strength of 1093 MPa and ductility of 29%. At 700 °C, the alloy has a high yield strength of 833 MPa and an ultimate tensile strength of 1024 MPa, while retaining a ductility of 6.3%.

Addressing the UHC Challenge Using the Disease Control Priorities 3 Approach: Lessons Learned and an Overview of the Pakistan Experience.

BACKGROUND: Pakistan developed its first national Essential Package of Health Services (EPHS) as a key step towards accelerating progress in achieving Universal Health Coverage (UHC). We describe the rationale, aims, the systematic approach followed to EPHS development, methods adopted, outcomes of the process, challenges encountered, and lessons learned. METHODS: EPHS design was led by the Ministry of National Health Services, Regulations & Coordination. The methods adopted were technically guided by the Disease Control Priorities 3 Country Translation project and existing country experience. It followed a participatory and evidence-informed prioritisation and decision-making processes. RESULTS: The full EPHS covers 117 interventions delivered at the community, health centre and first-level hospital platforms at a per capita cost of US$29.7. The EPHS also includes an additional set of 12 population-based interventions at US$0.78 per capita. An immediate implementation package (IIP) of 88 district-level interventions costing US$12.98 per capita will be implemented initially together with the population-based interventions until government health allocations increase to the level required to implement the full EPHS. Interventions delivered at the tertiary care platform were also prioritised and costed at US$6.5 per capita, but they were not included in the district-level package. The national EPHS guided the development of provincial packages using the same evidence-informed process. The government and development partners are in the process of initiating a phased approach to implement the IIP. CONCLUSION: Key ingredients for a successful EPHS design requires a focus on package feasibility and affordability, national ownership and leadership, and solid engagement of national stakeholders and development partners. Major challenges to the transition to implementation are to continue strengthening the national technical capacity, institutionalise priority setting and package design and its revision in ministries of health, address health system gaps and bridge the current gap in financing with the progressive increase in coverage towards 2030.

Research on Microstructure, Mechanical Properties, and High-Temperature Stability of Hot-Rolled Tungsten Hafnium Alloy.

W-(0, 0.1, 0.3, 0.5) wt.% Hf (mass fraction, wt.%) materials were fabricated by the powder metallurgy method and hot rolling. The microstructure, mechanical properties, and high-temperature stability of alloys with varying compositions were systematically studied. The active element Hf can react with the impurity O segregated at the grain boundary to form fine dispersed HfO2 particles, refining the grains and purifies and strengthening the grain boundary. The average size of the sub-grains in the W-0.3 wt.% Hf alloy is 4.32 µm, and the number density of the in situ-formed second phase is 6.4 × 1017 m-3. The W-0.3 wt.% Hf alloy has excellent mechanical properties in all compositions of alloys. The ultimate tensile strength (UTS) is 1048 ± 17.02 MPa at 100 °C, the ductile fracture occurs at 150 °C, and the total elongation (TE) is 5.91 ± 0.41%. The UTS of the tensile test at 500 °C is 614 ± 7.55 MPa, and the elongation is as high as 43.77 ± 1.54%. However, more Hf addition will increase the size of the second-phase particles and reduce the number density of the second-phase particles, resulting in a decrease in the mechanical properties of the tungsten alloy. The isochronal annealing test shows that the recrystallization temperature of W-Hf alloy is 1400 °C, which is 200 °C higher than rolling pure tungsten.

Study on the Aging Precipitation Behavior and Kinetics of Al-10.0Zn-3.0Mg-2.8Cu Alloy by Pre-Deformation Treatment.

In this paper, the effect of thermomechanical treatment process on the hardening behavior, grain microstructure, precipitated phase, and tensile mechanical properties of the new high-strength and high-ductility Al-10.0Zn-3.0Mg-2.8Cu alloy was studied, and the optimal thermomechanical treatment process was established. The strengthening and toughening mechanisms were revealed, which provided technical and theoretical guidance for the engineering application of this kind of high strength-ductility aluminum alloy. Al-10.0Zn-3.0Mg-2.8Cu alloy cylindrical parts with external longitudinal reinforcement were prepared by a composite extrusion deformation process (reciprocal upsetting + counter-extrusion) with a true strain up to 2.56, and the organizational evolution of the alloys during the extrusion deformation process and the influence of pre-stretching treatments on the subsequent aging precipitation behaviors and mechanical properties were investigated. The results show that firstly, the large plastic deformation promotes the fragmentation of coarse insoluble phases and the occurrence of dynamic recrystallization, which results in the elongation of the grains along the extrusion direction, and the volume fraction of recrystallization reaches 42.4%. Secondly, the kinetic study showed that the decrease in the activation energy of precipitation increased the nucleation sites, which further promoted the diffuse distribution of the second phase in the alloy and a higher number of nucleation sites, while limiting the coarsening of the precipitated phase. When the amount of pre-deformation was increased from 0% to 2%, the size of the matrix precipitated phase decreased from 5.11 µm to 4.1 µm, and when the amount of pre-deformation was increased from 2% to 7%, the coarsening of the matrix precipitated phase took place, and the size of the phase increased from 4.1 µm to 7.24 µm. The finalized heat treatment process for the deformation of the aluminum alloy tailframe was as follows: solution (475 °C/3 h) + 2% pre-stretching + aging (120 °C/24 h), at which the comprehensive performance of the alloy was optimized, with a tensile strength of 634.2 MPa, a yield strength of 571.0 MPa, and an elongation of 15.2%. The alloy was strengthened by both precipitation strengthening and dislocation strengthening. After 2% pre-stretching, the fracture surface starts to be dominated by dense tough nest structure, and most of them are small tough nests, and small and dense tough nests are the main reason for the increase in alloy toughness after 2% pre-stretching deformation.

Developing a roadmap to reach and sustain 90% full immunization coverage through a cross-sectoral system strengthening strategy in Bihar, India.

INTRODUCTION: Reducing childhood mortality by curtailing the incidence of vaccine preventable diseases is contingent upon a robust and high-performing routine immunization system. According to the available data, the full immunization coverage (FIC) in the state of Bihar (India) has reached ~ 71%. While the government aspires to reach 90% FIC, a systematic evidence-based investigation of the reasons behind underimmunization as well as the identification of drivers and enablers to reach and sustain 90% FIC is critical. This study aimed to review the factors leading to underimmunized children in the state of Bihar and develop a forward-looking roadmap to reach and sustain 90% FIC by adopting a system strengthening approach. METHOD: We conducted a desk review, followed by extensive stakeholder interviews and field visits to document and analyze the data and evidence relevant to routine immunization system performance in the state of Bihar. The stakeholders included the State Immunization Officer, District Immunization Officers, Block-level health officials, representatives from development agencies, healthcare workers, and caregivers. A total of eighty-six structured interviews were conducted, which included qualitative and quantitative parameters. RESULT: While positive results were observed from the assessment of Bihar's immunization system, the implementation of targeted strategies for supply, service delivery and demand can provide a means to achieve FIC of 90%. The roadmap developed by the Government of Bihar enlists 40 + interventions across key thematic areas and has been prioritized over a 5-year time horizon as short, medium, and long-term milestones to achieve 90% FIC. These interventions include strengthening the data availability and quality, improving the governance and review mechanism, augmenting the capacity of health workers involve with immunization programme, and initiatives to increase demand for immunization services. CONCLUSION: The Bihar's Immunization Roadmap development project work follows a methodical approach to assess and identify intervention to improve immunization coverage and can provide information and reference to other states and countries that are aiming to formulate similar action plans.

The GIBACHT fellowship: a multilateral initiative for strengthening capacity in biosafety and biosecurity towards pandemic preparedness.

The German Biosecurity Programme was launched in 2013 with the aim to support partner countries overcome biological threats including natural outbreaks or the intentional misuse of highly pathogenic agents. As part of this programme, this paper describes the development and implementation of a multilateral biosafety and biosecurity training initiative, called 'Global Partnership Initiated Biosecurity Academia for Controlling Health Threats' (GIBACHT). To achieve its objectives, GIBACHT implemented a blended-learning approach with self-directed, distance-based learning phases and three training-of-trainer workshops. The programme follows Kirkpatrick's model of learning to guarantee sustainable effects of improved knowledge and skills. One hundred nine fellows from 26 countries have been trained in seven cohorts. Many GIBACHT alumni have established additional biosafety/biosecurity trainings in their home countries. The knowledge exchange is strengthened by the implementation of a Moodle-based alumni network. GIBACHT has the potential to contribute to strengthening the capacities of partner countries in Africa, the Middle East, and South and Central Asia to respond and build resilience to biological threats.

IHR-PVS National Bridging Workshop for Somalia: An interactive and participatory approach for operationalizing the One Health roadmap.

Background: National Bridging Workshops (NBW) are a tool for reviewing collaboration gaps between line ministries relevant to the One Health framework. Methods: The NBW for Somalia was held on November 11-13, 2023 in Nairobi, Kenya with support from WHO and WOAH. Participants included representatives from the Somali government both national and sub-national (including Ministry of Health; Ministry of Livestock, Forestry and Range; Ministry of Agriculture and Irrigation; and Ministry of Environment and Climate Change). Other participants included representatives from non-governmental organizations, academia and the quadripartite. Structured sessions guided participants through a step-by-step process, starting from identifying gaps to collectively developing solutions. The design of these sessions aimed to foster active engagement and collaboration with the outcomes of each session contributing to the subsequent one. Results: A total of 60 participants partook in the exercise, representing human health (35%), animal health (27%), agriculture (13%), environmental health (7%) and other relevant sectors (18%). Eighty-three percent of participants represented the national level and 17% the sub-national level. The collaborative effort yielded a joint roadmap comprising 36 activities and 11 objectives. Priority objectives included: development of national joint surveillance systems for selected One Health threats (41/47 votes, or 87% of the total votes); establishment of a high-level ministerial system to govern and coordinate One Health activities (30/47; 64%); and establishment of emergency funding structures for priority zoonotic diseases along with development of a 5-year national investment plan for One Health (27/47; 57%). A total of 94% of activities required low or moderate cost to be implemented, and 90% of activities were identified to have a likely high impact on multisectoral collaboration. The timeline for implementing the activities is projected to span one to two years. Conclusion: The workshop promoted high-level engagement, national ownership, and leadership in addressing health threats at the human-animal-environment interface. The resulting co-created roadmap will be integrated into the National Action Plan for Health Security, supporting ongoing One Health efforts in Somalia.

Exploring the West African forest island phenomenon: scientific insights gained, successes achieved and capacities strengthened.

Anthropogenic activities around local villages in mesic savanna landscapes of West Africa have resulted in soil improvement and forest establishment outside their climatic zones. Such unique 'forest islands' have been reported to provide ecosystem services including biodiversity conservation. However, the science underpinning their formations is limitedly studied. In 2015 and with funding support from the Royal Society-DFID (now FCDO), we set out to investigate the biogeochemistry of the forest islands in comparison with adjacent natural savanna and farmlands across 11 locations in Burkina Faso, Ghana and Nigeria. Our results showed that the forest islands do not differ significantly from the adjoining ecosystems in soil mineralogy implying that their formation was anthropogenically driven. We observed greater soil organic carbon and nutrient distributions in the forest islands, which also had more stable macro (>500 µm) and meso-aggregates (500-250 µm) than the adjoining agricultural lands. We found that soil micro-aggregate (250-53 µm) stability was climate (precipitation) driven in the West African ecosystems while meso- and macro-aggregate stability was land-use driven. In one of the unique forest islands we studied in the Mole National Park of Ghana, we found its mineral-associated organic carbon over 40% greater than the adjoining natural savanna with potential implications for the achievement of the global initiative of the '4p1000' in West Africa. We conclude that the North-South-South research collaboration has established clearly, the science underlying the age-long West African forest island phenomenon and has, among many successes, led to capacity building of young scientists driving cutting-edge research in climate change adaptation and food systems transformation in the sub-region.

An evaluation of a multi-partner approach to increase routine immunization coverage in six northern Nigerian States.

BACKGROUND: Global health partnerships are increasingly being used to improve coordination, strengthen health systems, and incentivize government commitment for public health programs. From 2012 to 2022, the Bill & Melinda Gates Foundation (BMGF) and Aliko Dangote Foundation (ADF) forged Memorandum of Understanding (MoU) partnership agreements with six northern state governments to strengthen routine immunization (RI) systems and sustainably increase immunization coverage. This mixed methods evaluation describes the RI MoUs contribution to improving program performance, strengthening capacity and government financial commitment as well as towards increasing immunization coverage. METHODS: Drawing from stakeholder interviews and a desk review, we describe the MoU inputs and processes and adherence to design. We assess the extent to which the program achieved its objectives as well as the benefits and challenges by drawing from a health facility assessment, client exit interview and qualitative interviews with service providers, community leaders and program participants. Finally, we assess the overall impact of the MoU by evaluating trends in immunization coverage rates. RESULTS: We found the RI MoUs across the six states to be mostly successful in strengthening health systems, improving accountability and coordination, and increasing the utilization of services and financing for RI. Across all six states, pentavalent 3 vaccine coverage increased from 2011 to 2021 and in some states, the gains were substantial. For example, in Yobe, vaccination coverage increased from 10% in 2011 to nearly 60% in 2021. However, in Sokoto, the change was minimal increasing from only 4% in 2011 to nearly 8% in 2021. However, evaluation findings indicate that issues pertaining to human resources for health, insecurity that inhibits supportive supervision and vaccine logistics as well as harmful socio-cultural norms remain a persistent challenge in the states. There is also a need for a rigorous monitoring and evaluation plan with well-defined measures collected prior to and throughout implementation. CONCLUSION: Introducing a multi-partner approach grounded in a MoU agreement provides a promising approach to addressing health system challenges that confront RI programs.

Self-Growing Hydrogel Bioadhesives for Chronic Wound Management.

Hydrogel bioadhesives have emerged as a promising alternative to wound dressings for chronic wound management. However, many existing bioadhesives do not meet the functional requirements for efficient wound management through dynamically mechanical modulation, due to the reduced wound contractibility, frequent wound recurrence, incapability to actively adapt to external microenvironment variation, especially for those gradually-expanded chronic wounds. Here, a self-growing hydrogel bioadhesive (sGHB) patch that exhibits instant adhesion to biological tissues but also a gradual increase in mechanical strength and interfacial adhesive strength within a 120-h application is presented. The gradually increased mechanics of the sGHB patch could effectively mitigate the stress concentration at the wound edge, and also resist the wound expansion at various stages, thus mechanically contracting the chronic wounds in a programmable manner. The self-growing hydrogel patch demonstrated enhanced wound healing efficacy in a mouse diabetic wound model, by regulating the inflammatory response, promoting the faster re-epithelialization and angiogenesis through mechanical modulation. Such kind of self-growing hydrogel bioadhesives have potential clinical utility for a variety of wound management where dynamic mechanical modulation is indispensable.

Isokinetic Knee Strengthening Impact on Physical and Functional Performance, Pain Tolerance, and Quality of Life in Overweight/Obese Women with Patellofemoral Pain Syndrome.

Background/Objectives: Patellofemoral syndrome is a common osteoarticular condition that affects many individuals. Various treatment options are available, with a significant emphasis on targeted muscle-strengthening exercises. The purpose of this study was to investigate the effect of isokinetic muscle strengthening on muscle strength, joint range of motion, quality of life, physical performance, and pain tolerance in overweight/obese women with patellofemoral syndrome. Methods: Twenty-four overweight or obese women with patellofemoral syndrome participated in the study during September and October 2023 in a private medical facility for physical medicine and functional rehabilitation. They were randomly assigned to one of two groups for six weeks of isokinetic muscle strengthening. The first group (ISO.G) followed a rehabilitation program combined with isokinetic muscle strengthening. A second group (PCM.G) followed a rehabilitation program that includes an isokinetic protocol in passive compensation movement. The extensors' peak torque was measured before and after training. Results: The flexors' peak torque, stair climbing test, 10 m walk, chair lift, monopodal support, goniometric knee flexion test, heel-buttock distance measurement, pain, and quality of life scores improved significantly in both groups. The ISO.G, on the other hand, benefited from a significant increase in quadriceps muscle strength revealed by the extensors' peak torque. Conclusions: For the treatment of patellofemoral syndrome, isokinetic muscle strengthening in concentric mode appears to have a significant advantage over the classic rehabilitation program with isokinetic passive compensation, particularly in muscle strength gain, in addition to the improvement of joint range of motion, quality of life, physical performance, and pain tolerance. Isokinetic training may be recommended as a beneficial approach for the rehabilitative treatment of patellofemoral pain syndrome in overweight/obese women.

A landscape analysis of clinical trials and infant clinical trials in Kenya, Ethiopia, and Nigeria.

Introduction: Global inequality in clinical research capacity and service delivery can be indicated simply by the proportion of clinical trials that a country or region has registered in clinical trial registry databases. The proportion of clinical trials registered in Africa is very low at 0.02%, even though the region accounts for approximately 15% of the world's population. Despite the economic challenges in most African countries, they have shown potential for growth and change in recent years. Methods: We conducted desk reviews on the interventional clinical trials done in Kenya, Ethiopia, and Nigeria between 2015 to May 2023. The search was done in clinical trials repositories, and journal repositories. The search focused on intervention clinical trials. Data was extracted by screening through the publications and clinical trial platforms. The data extracted from the publications included the type of clinical trial, clinical trial phase, diseases, etc. The data extracted from the reports included: challenges in conducting clinical trials, capacity-building efforts, and the impact of the clinical trial. Results: The number of clinical trial studies identified in Kenya was 113 (28 were on infant clinical trials). The study identified 97 clinical trials in Nigeria, of which 11 studies were on infant clinical trials. In Ethiopia, there were 28 clinical trials and only five were on infant clinical trials. The landscape review also expanded to capacity and gaps in clinical trials in the three countries. The largest proportion of clinical trials carried out in Kenya was on injury, occupational disease, and poisoning, 30.5% (n = 18) and the smallest proportion was on kidney disease, neonatal disease, obstetrics, and gynecology. Most Infant clinical trials were carried out in the area of infections and infestations 33.3% (n = 7). Most of the challenges faced by clinical trials in the three countries include a lack of infrastructure, a lack of human resources, and a lack of financial resources. Implications: There is a need to map clinical trials done by African researchers based in Africa to exclude the trials done by non-African researchers based in Africa. Opportunities for clinical trials should be supported and challenges addressed.

Combined association of aerobic and muscle strengthening activity with mortality in individuals with hypertension.

Evidence on the association between meeting both aerobic physical activity (PA) and muscle-strengthening activity (MSA) guidelines with mortality in individuals with hypertension is scarce. We included 34,990 adults from the 2007 to 2013 Korea National Health and Nutrition Examination Survey, linking mortality follow-up data until 2019. Adherence to PA guidelines was assessed based on the current PA guidelines using a self-reported questionnaire and categorized as follows: meeting MSA only, aerobic PA only, both MSA and aerobic PA, or neither. Associations of hypertension and adherence to PA guidelines with all-cause and cardiovascular disease (CVD) mortality were examined using Cox proportional hazard models. Over 9.2 years, 1948 participants died from any cause and 419 from CVD. Meeting both PA guidelines was associated with the lowest risk of all-cause and CVD mortalities in the total sample regardless of hypertension status. In individuals with hypertension, meeting aerobic PA guidelines only had a 24% lower risk of both all-cause and CVD mortality, and meeting both PA guidelines further reduced risks by 40% and 43%, respectively; however, meeting MSA guidelines only was not associated with either all-cause or CVD mortality. In individuals without hypertension, only meeting both MSA and aerobic PA guidelines, but not meeting either MSA or aerobic PA guidelines, showed reduced risk of CVD mortality. In Korean population, non-hypertensive individuals who met both guidelines had a lower risk of CVD mortality. However, hypertensive individuals showed a reduced risk of both all-cause and CVD mortality when meeting aerobic PA or both guidelines, but not MSA alone.