This article is part of the Research Topic \'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict\'. The COVID-19 pandemic has exposed the vulnerabilities and limitations of many health systems and underscored the need for strengthening health system resilience to make and sustain progress toward Universal Health Coverage (UHC), global health security and healthier populations in tandem. In response to the COVID-19 pandemic, Commonwealth countries have been practicing a combination of innovative integrated approaches and actions to build health systems resilience. This includes utilizing digital tools, improvements in all-hazard emergency risk management, developing multisectoral partnerships, strengthening surveillance and community engagement. These interventions have been instrumental in strengthening national COVID-19 responses and can contribute to the evidence-base for increasing country investment into health systems resilience, particularly as we look toward COVID-19 recovery. This paper gives perspectives of five Commonwealth countries and their overall responses to the pandemic, highlighting practical firsthand experiences in the field. The countries included in this paper are Guyana, Malawi, Rwanda, Sri Lanka, and Tanzania. Given the diversity within the Commonwealth both in terms of geographical location and state of development, this publication can serve as a useful reference for countries as they prepare their health systems to better absorb the shocks that may emerge in future emergencies.

The Western Pacific Region has one of the fastest-growing populations of older adults (≥ 65 years) globally, among whom tuberculosis (TB) poses a particular concern. This study reports country case studies from China, Japan, the Republic of Korea, and Singapore reflecting on their experiences in managing TB among older adults.
Across all four countries, TB case notification and incidence rates were highest among older adults, but clinical and public health guidance focused on this population was limited. Individual country reports illustrated a range of practices and challenges. Passive case finding remains the norm, with limited active case finding (ACF) programs implemented in China, Japan, and the Republic of Korea. Different approaches have been trialled to assist older adults in securing an early diagnosis, as well as adhering to their TB treatment. All countries emphasised the need for person-centred approaches that include the creative application of new technology and tailored incentive programs, as well as reconceptualisation of how we provide treatment support. The use of traditional medicines was found to be culturally entrenched among older adults, with a need for careful consideration of their complementary use. TB infection testing and the provision of TB preventive treatment (TPT) were underutilised with highly variable practice.
Older adults require specific consideration in TB response policies, given the burgeoning aging population and their high TB risk. Policymakers, TB programs and funders must invest in and develop locally contextualised practice guidelines to inform evidence-based TB prevention and care practices for older adults.

Studies of sex chromosome systems at early stages of divergence are key to understanding the initial process and underlying causes of recombination suppression. However, identifying signatures of divergence in homomorphic sex chromosomes can be challenging due to high levels of sequence similarity between the X and the Y. Variations in methodological precision and underlying data can make all the difference between detecting subtle divergence patterns or missing them entirely. Recent efforts to test for X-Y sequence differentiation in the guppy have led to contradictory results. Here, we apply different analytical methodologies to the same data set to test for the accuracy of different approaches in identifying patterns of sex chromosome divergence in the guppy. Our comparative analysis reveals that the most substantial source of variation in the results of the different analyses lies in the reference genome used. Analyses using custom-made genome assemblies for the focal population or species successfully recover a signal of divergence across different methodological approaches. By contrast, using the distantly related Xiphophorus reference genome results in variable patterns, due to both sequence evolution and structural variations on the sex chromosomes between the guppy and Xiphophorus. Changes in mapping and filtering parameters can additionally introduce noise and obscure the signal. Our results illustrate how analytical differences can alter perceived results and we highlight best practices for the study of nascent sex chromosomes.

The slow adoption of innovations is a key challenge that the European sheep sector faces for its sustainability. The future of the sector lies on the adoption of best practices, modern technologies and innovations that can improve its resilience and mitigate its dependence on public support. In this study, the concept of technical efficiency was used to reveal the most efficient sheep meat farms and to identify the best practices and farm innovations that could potentially be adopted by other farms of similar production systems. Data Envelopment Analysis was applied to farm accounting data from 458 sheep meat farms of intensive, semi-intensive and extensive systems from France, Spain and the UK, and the structural and economic characteristics of the most efficient farms were analyzed. These best farmers were indicated through a survey, which was conducted within the Innovation for Sustainable Sheep and Goat Production in the Europe (iSAGE) Horizon 2020 project, the management and production practices and innovations that improve their economic performance and make them better than their peers.

Carrying out bibliometric reports is one of the common tasks performed by librarians and practitioners within the framework of their professional duties. The emergence of novel data sources, the need to measure new research activities and the growing demand for fairer and more equitable evaluation within the framework of the Responsible Metrics movement has led to calls for a review of the traditional approaches to these types of reports. The main goal of this study is to outline a series of recommendations for bibliometricians, consultants and research support librarians when drafting bibliometric reports in their institutions. These best practices can significantly enhance the quality and utility of bibliometric reports, posing their practitioners as key players in the science management process.

Practical methods for facilitating process improvement are needed to support high quality, safe care. How best to specify (identify and define) process improvements - the changes that need to be made in a healthcare process - remains a key question. Methods for doing so collaboratively, rapidly and remotely offer much potential, but are under-developed. We propose an approach for engaging diverse stakeholders remotely in a consensus-building exercise to help specify improvements in a healthcare process, and we illustrate the approach in a case study.
Organised in a five-step framework, our proposed approach is informed by a participatory ethos, crowdsourcing and consensus-building methods: (1) define scope and objective of the process improvement; (2) produce a draft or prototype of the proposed process improvement specification; (3) identify participant recruitment strategy; (4) design and conduct a remote consensus-building exercise; (5) produce a final specification of the process improvement in light of learning from the exercise. We tested the approach in a case study that sought to specify process improvements for the management of obstetric emergencies during the COVID-19 pandemic. We used a brief video showing a process for managing a post-partum haemorrhage in women with COVID-19 to elicit recommendations on how the process could be improved. Two Delphi rounds were then conducted to reach consensus.
We gathered views from 105 participants, with a background in maternity care (n = 36), infection prevention and control (n = 17), or human factors (n = 52). The participants initially generated 818 recommendations for how to improve the process illustrated in the video, which we synthesised into a set of 22 recommendations. The consensus-building exercise yielded a final set of 16 recommendations. These were used to inform the specification of process improvements for managing the obstetric emergency and develop supporting resources, including an updated video.
The proposed methodological approach enabled the expertise and ingenuity of diverse stakeholders to be captured and mobilised to specify process improvements in an area of pressing service need. This approach has the potential to address current challenges in process improvement, but will require further evaluation.

Research that was undertaken to identify and evaluate best practices that can effectively minimise the amount of marine litter in European Seas is presented. Best practices were approached in a novel way that aimed to maximise the impact and added value of the FP7-funded project MARLISCO. The practices served as a tool to enhance the active participation and build capacity in key actors through the implementation of the innovative, dedicatedly-developed decision support tool, DeCyDe-4-Marlisco. This paper also presents the key \'preference\' attributes of successful marine litter management practices and provides a snapshot of the key characteristics of the recorded best practices as a means of helping the reader, and particularly decision makers, recognise what would make their marine litter management efforts more successful.

Group B Streptococcus (GBS) is the most frequent cause of neonatal invasive disease. Two forms of GBS are recognized: early-onset and late-onset disease. The average incidence of late-onset disease is 0.24 per 1000, a figure that has remained substantially unchanged over time. Exposure to breast milk represents a potential source of infection, especially in late-onset and/or recurrent GBS disease. As a result, both breastfeeding and the use of breast milk have been questioned. We report for the first time the case of both simultaneous and recurrent infection in newborn preterm twins, born 3 weeks apart, resulting from ingestion of GBS positive breast milk. A genetically identical strain was found in both breast milk and her newborn infants. Transmission of GBS through breast milk should be considered in late-onset GBS sepsis. An eradicating antibiotic treatment of GBS positive mothers with ampicillin plus rifampin and temporary discontinuation of breastfeeding and/or the use of heat processed breast milk may represent preventive measures, although outcomes are inconsistent, for recurrent GBS disease. Guidelines on breastfeeding and prevention of recurrent neonatal GBS disease are needed. It is unfortunate that existing scientific literature is scarce and there is no general consensus. As a consequence, we propose a best practice approach on the topic.