Food processing has existed for millennia to ensure food is edible, safe and palatable. This has largely been considered to date based on the physical extent of processing. However, recent approaches have expanded this to consider the purpose (i.e. the reason) for the processing. Most commonly, this has been defined by Nova classification.In this regard, mounting evidence links higher intake of ultra-processed food (UPF) with a range of poor health outcomes. However, the value of classifying food and drink by the extent and particularly the purpose of processing has been debated, with evidence limitations highlighted by scientific advisory committees for both UK and US governments to formulate dietary guidance.Unfortunately, evidence is not perfect and rarely clear cut, particularly so in the world of diet and nutrition. Therefore, when assessing links between nutrients, food and diets with health outcomes, we must the consider the sources and extent of uncertainty in the evidence, and then evaluate whether the uncertainty may meaningfully impact on the conclusions. The evidence regarding UPF and the Nova classification is no different.In this presentation, I outline in detail the Nova classification and what it captures in contrast to other processing classifications, before discussing sources of uncertainty and error when measuring UPF intake, including the latest evidence on validation assessments of diet assessment tools. I then review the evidence of associations in the observational literature between UPF and health outcomes, dissecting methodological aspects and sensitivity analyses to consider the extent of uncertainty and its impact on effect estimates. I consider alignment with experimental evidence, and conclude by summarising strengths and limitations of the evidence base, and key research recommendations to address current limitations.

Fair distribution of limited health funding is a universal challenge for health systems. Decisions about funding new technologies provide a helpful lens on this complex issue. This study examined how two of the world's most mature centralised review processes for health technology funding, namely the Australian Pharmaceutical Benefits and Medical Services Advisory Committees (PBAC and MSAC) have approached fairness over time. Using the Accountability for Reasonableness (A4R) framework, which defines fair priority-setting through four conditions (Relevance, Publicity, Revision, and Enforcement), we conducted (i) a detailed document review of policy changes (2014-2022) and (ii) semi-structured interviews with decision-makers at PBAC and MSAC in 2014 (n = 12) and 2021/22 (n = 11). In both the document review and the interviews, we found increased alignment with A4R principles over time, including enhanced Relevance through increased consumer representation, increased Publicity of decision rationales, and greater Enforcement through broader committee deliberation. However, Revision was not a pressing concern of committee members at either time point despite notable policy changes that improved Revision. Persistent barriers to Publicity were identified, particularly the redaction of decision rationales in public summary documents due to sponsor confidentiality requirements and challenges of explaining nuanced deliberations rather than formulaic criteria. Our findings illustrate how A4R principles are applied in practice and highlight the challenge of balancing procedural fairness with substantive ethical considerations, such as equity and cost effectiveness, that underlie the criterion of Relevance.

To systematically review empirical evidence on the prevalence and influence of conflicts of interest (COIs) among members and public speakers of US Food and Drug Administration (FDA) advisory committees. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched MEDLINE, PubMed, and Cochrane Library from inception to November 2024 for peer-reviewed studies reporting quantitative data on COIs in FDA advisory committees. Eligible studies examined prevalence, type, or impact of COIs among voting members or public speakers. Data extraction and quality assessment were conducted independently by 2 reviewers using the Joanna Briggs Institute checklist for cross-sectional studies. Eighteen studies published between 2006 and 2022 were included, covering committee activity from 1997 to 2022. COIs among voting members ranged from 15% to over 70% of meetings, whereas 25% of public speakers disclosed financial COIs, most commonly consulting fees, research funding, and stock ownership. Evidence linking member COIs to voting outcomes was mixed, with some studies finding no significant association. In contrast, public speakers with financial COIs were consistently more likely to deliver favorable testimony, with odds ratios ranging from 3.0 to 6.1. Several studies suggested a decline in member COI prevalence after the 2007 FDA Amendments Act, but no similar trend was observed among public speakers. COIs remain prevalent in FDA advisory committees, particularly among public speakers, for which they are strongly associated with favorable testimony. These findings underscore the need for stronger and more consistent COI disclosure and management policies that include both committee members and public speakers to protect decision-making integrity.

Background: Cancer registry programs depend on strong organisational, procedural, and regulatory foundations. International standards, such as the International Agency for Research on Cancer (IARC)'s Technical Publication No. 43 (TP43) and guidelines from the International Association of Cancer Registries, provide guidance for low- and middle-income countries (LMICs). Nevertheless, adoption remains inconsistent, and many LMICs face structural, legal, and financial barriers. Objective: This scoping review aimed to synthesise and categorise essential criteria and standards that underpin effective cancer registries, and to propose an integrated framework that combines international guidelines (e.g. IARC) with context-specific adaptations for application in resource-limited settings. In addition, the review mapped the implementation status of IARC standards across identified cancer registries, revealing varying levels of adoption and contextual adaptation in LMICs. Method: Using Arksey and O'Malley's framework and PRISMA-ScR guidelines, English and Persian literature in international and national databases up to September 2025 were systematically searched. Eligible documents included peer-reviewed articles, official reports, and guidelines. Extracted data were thematically analysed and mapped to the 10 domains of the IARC framework, with additional elements identified beyond these domains to capture implementation gaps and context-specific adaptations. Results: Fifty-four sources were reviewed. We identified a comprehensive set of criteria and standards aligned with the 10 domains of the IARC framework, encompassing advisory committees, registry type, population denominators, legal aspects, population size, physical location, finance, personnel, equipment, and data management. Additionally, several supplementary domains beyond the IARC framework-including access to cancer cases, reporting and dissemination, and policymaking-were identified, highlighting context-specific challenges and adaptations, particularly in LMICs. Conclusion: By integrating global criteria and standards within a structured and context-sensitive framework, this review provides practical guidance for strengthening cancer registries, particularly in LMICs. Implications for health information management practice: Health information managers can use these findings to develop resilient, sustainable cancer registry systems, improve data quality, and support evidence-based policymaking-particularly in LMICs, where registry infrastructures remain underdeveloped, and system strengthening is a priority.

The pilot implementation of the RTSS/AS01E (RTS,S) malaria vaccine in Ghana, Kenya, and Malawi marked a significant step in the fight against malaria. Given the scale of the rollout, which far exceeded the controlled environment of clinical trials, establishing a robust pharmacovigilance (PV) system to monitor rare but potentially serious adverse events following immunization (AEFIs) was a critical component of the program's design. In collaboration with technical partners, national health authorities monitored the safety of the RTS,S/AS01E vaccine through strengthened existing routine pharmacovigilance systems and strategies in the three participating countries. Causality assessment of serious AEFIs by national expert advisory committees did not reveal any new safety concerns associated with the RTS,S/AS01E vaccine or confirm the safety signals observed in the Phase 3 clinical trials. The PV efforts successfully supported the safe rollout of the vaccine, contributing to substantial public health benefits in these endemic regions. Challenges encountered included underreporting of AEFIs, delays in data submission and in investigating serious AEFIs, and poor report quality despite targeted investments to strengthen the systems. The pilot program highlighted PV challenges in resource-limited settings and provided useful insights for future vaccine rollouts. The lessons learned from these challenges emphasize the importance of sustained investment, particularly for AEFI investigations, and the need for innovations to improve health worker reporting. Research is needed to identify effective strategies for increasing reporting. Key recommendations include training and capacity building, resource allocation, surveillance and reporting, raising and maintaining public awareness, and collaboration and information sharing to ensure sustained PV efforts and robust safety surveillance in similar contexts.

Can artificial intelligence help with the development of generic clinical skills when breaking bad news? A quantitative evaluation

ABSTRACT The organisational practices, status and role of policy-focussed ethics advisory committees are significant in relation to scientific advances, societal transformations and crisis situations. Existing research has explored the effectiveness, de/politicisation and deliberative aspects of national ethics bodies, but their role in wider ecosystems of policy advice is neglected. It is sometimes argued that ethics committees have little impact on practices on the ground, but this is empirically untested. Our key concern is to examine the governance cultures and practices of ethics advice and ethics expertise in specific relation to policymaking. Qualitative interviews with 60 ethics advisors and civil servants in Australia, Germany and the UK are analysed to identify critical factors which shape the operative, discursive and adaptive capacity of ethics-policy advisory ecosystems. Based on our findings, we present a novel framework to inform future comparative analysis of national ethics-policy advisory ecosystems. We argue that a focus on governance capacities would help to enhance how governments use ethics committees and ethics expertise within the wider science/technology/policy nexus. We show how social science and humanities scholarship is responding to new demands to navigate the normative and descriptive with regards to its engagement with ethics advice.

This Viewpoint discusses the lawfulness and credibility of the US Food and Drug Administration’s recent move to using expert panels rather than advisory committees for decision-making.

Several systematic and scoping reviews have focused on the impact of patient and public involvement (PPI) in child health research. The aim of this research was to examine the data sources and analytic approaches used by researchers to evaluate the impact of PPI in child health research. A comprehensive literature search identified published reviews focused on PPI impact in child health research. Titles, abstracts, and full texts were screened to determine eligibility. Individual studies from eligible reviews created the sampling frame, from which 100 individual studies were randomly selected. Information was extracted on primary study characteristics, type of PPI, data sources and analytic approaches used to evaluate PPI impact, and reported PPI impact. Frequency distributions were used to summarise the findings. The initial search yielded 5868 citations. After screening, 15 reviews (comprising 406 individual studies, of which 303 were unique) met inclusion criteria. Among the 100 randomly selected individual studies, PPI was reported across all phases of the research process including priority setting (30/100), input on study materials (50/100), and dissemination of study findings (52/100). The method of PPI was most commonly focus groups (29/100) or advisory committees (27/100). Of the 100 studies selected, 67/100 reported impact on the research process, 69/100 reported impact on patients and families, and 32/100 studies reported impact on researchers. Regarding the data sources used to evaluate PPI impact, 69/100 studies reviewed primary study field notes along with researcher observations and reflections, while 31/100 studies conducted independent, specific, focus groups and/or interviews and/or surveys to gather data. Regarding the analytic approaches used to evaluate PPI impact, formal qualitative and/or quantitative analyses of the data occurred in only 25/100 studies. Only 2/100 studies used a formal PPI reporting guideline. Only 31/100 studies collected specific, independent data on the impact of PPI in child health research, and only 25/100 studies applied formal analyses. Robust evaluation of PPI impact in child health research is essential for a strong PPI evidence base. A patient partner (co-author, FB) was a member of the research team from study inception, and contributed to the development of the study protocol, including refining the research question, input on study design, selection of relevant outcomes, interpretation of findings, writing the manuscript, and developing dissemination plans.

Extreme heat / poor air quality events can adversely impact health, and low-income communities are especially vulnerable to these impacts. Evidence-based interventions that minimize these impacts are needed and ideally will be developed and led by front-line organizations such as primary care community health centers (CHCs). A community-driven and -prioritized research agenda is necessary to guide the generation of evidence that CHCs need to intervene effectively. We will generate this agenda via the following protocol. We will first describe patterns of heat- and air quality-induced health impacts in a national CHC network (>2,400 clinics), focusing on hypertension and asthma. Results will be shared with advisors including: CHC staff and patients; representatives of community organizations focused on heat / air quality and health; and scientists with expertise in relevant fields. Advisors will identify additional needed analyses and consider potential interventions for interrupting the health impacts reflected in analysis results. Realist-informed qualitative data will be collected to identify likely mechanisms of effects of possible interventions. Using these inputs, we will identify a set of potential CHC-led interventions which will be categorized using a structured framework and then prioritized in terms of needed evidence on effectiveness, acceptability, and other factors. Several conceptual models guide this protocol. This study began in Fall 2024, funded by the National Institutes of Health as a center planning grant. Quantitative analyses and qualitative data collection are underway, to be completed by Spring 2026; advisory committees will meet continuously through September 2027 to provide feedback, request additional analyses, generate potential interventions, and identify evidence needs and a related prioritized research agenda. CHCs need evidence on: heat and air quality-induced health impacts in the populations they serve; how to intervene to minimize these impacts; and how to implement and sustain such interventions. Little prior research has identified or tested the effectiveness of such interventions in these settings. The process described here will create a research agenda on intervention effectiveness that reflects CHCs' needs. It will be the first research agenda developed in partnership with CHC staff and patients, community organizations, and multidisciplinary scientists in the United States.

Stakeholder engagement improves the quality, clinical relevance, and contextual fit of healthcare interventions. However, there is limited work characterizing how researchers approach stakeholder engagement in practice, and which organizational supports they most value. The objective of this study is to describe how experienced researchers engaged multilevel stakeholders in implementation studies, and the benefits, challenges, and needs they encountered. We identified Veterans Affairs (VA) healthcare system researchers with histories of stakeholder-engaged implementation research through a combination of literature review and snowball sampling. We conducted semi-structured telephone interviews with 28 participants in 2016. Two research team members analyzed interview data using a hybrid inductive-deductive approach. Participants described how multilevel stakeholder input substantively improved their research. Common engagement approaches varied in intensity and included interviews and focus groups, advisory committees, and stakeholder membership on research teams. Although participants expressed a desire-even a moral imperative-to increase stakeholder engagement, their efforts were limited by organizational constraints. Participants suggested that VA can support stakeholder engagement in research by reconceptualizing funding mechanisms, providing resources, and fostering an organizational culture that aligns with engagement principles. Experienced researchers perceived multilevel stakeholder engagement as both critical for implementation research and difficult to achieve. Findings highlight that stakeholder engagement is shaped not only by researcher commitment and skill but also by organizational constraints, incentives, and power structures. Results offer actionable suggestions for improving alignment between engagement activities, professional incentives, and organizational infrastructure that may strengthen stakeholder-engaged implementation research in VA and other healthcare settings.

During the COVID-19 pandemic, both academic advisors and bureaucrats were involved in Scientific Advisory Committees (SACs) or Policy Advisory Systems (PASs) in Kenya and South Africa. Despite the involvement of stakeholders, including community members, interest groups, think tanks, donors, and development partners, the academic advisors and bureaucrats were central – to varying degrees – to the policy design in each country. This study analyzed the nature and scope of the interaction between academic advisors and bureaucrats in the management of the COVID-19 pandemic in the two countries. The comparative case analysis of Kenya and South Africa revealed significant bureaucratic control over the roles of SACs/PASs’, demonstrating that the extent of government control can greatly influence the nature and scope of engagement between academic advisors and bureaucrats in research, policy analysis, consultancy, and as seconded experts in emergency situations like the COVID-19 pandemic. Generally, being internal to the government, bureaucrats dominated the policy processes and invited academic advisors as needed, largely based on an authoritative form of PAS management. There is still much ground to cover regarding the role of academic advisors in the transitional democracies policy process.

Climate advisory committees in European climate governance: Expertise, representation and co-production

Background: Regulatory agencies operate their own advisory committee with external experts to address complex scientific issues in the approval of pharmaceutical products.However, each advisory committee operates very differently.Hence, the authors performed a comprehensive gap analysis among the committees operated by Food and Drug Administration (FDA), European Medicines Agency (EMA) and Ministry of Food and Drug Safety (MFDS).Methods: The regulations, guidelines, minutes and reports on advisory committees were retrieved from the websites of FDA, EMA and MFDS.A gap analysis comparing the advisory committees of each regulatory authority was performed, including the disclosure of information and meeting procedures, and conflict-of-interest policies.Results: Substantial differences were found among the advisory committees in the strictness of conflict-of-interests and the transparency of meeting details.Whereas FDA and EMA disclose the detailed curriculum vitae of each committee member, MFDS does only names and majors.Whereas FDA live-streams each meeting and publishes the transcript of all dialogues by each member, EMA and MFDS release only anonymized summary minutes without live broadcasts.Whereas FDA and EMA require members to disclose their financial interests, MFDS merely requires signing a statement that confirms no conflict-of-interest.Conclusions: Compared with Advisory Committee of FDA and Scientific Committee of EMA, the Central Pharmaceutical Affairs Advisory Committee (CPAAC) of MFDS appears to require substantial improvements in the disclosure of conflict-of-interests and the transparency of meeting details.This gap analysis will likely serve as a basis for policy discussions to improve the credibility of CPAAC.

This paper investigates the composition of REIT board committees in terms of the real estate expertise of the directors, type of director, gender, and tenure and the impact of these characteristics on REIT performance. The sample comprises data at the director level for 65 U.S. equity REITs during the period of 2010-2019. Using chi-square tests and logistic panel regressions, I provide evidence that the profile of REIT board members varies depending on their assignment to different committees and that, overall, the average REIT director does not match the expected director profile of having significant real estate expertise or long board tenure. I also find that finance and investment committee members are directors with very different characteristics despite tat these committees are function-related advisory committees and real estate expertise is associated with investment committee membership only. Furthermore, using panel fixed effects regressions, I find that the composition of REIT committees matters for REIT performance, especially in the case of investment committees for which the presence of outside and inside directors with real estate expertise and long tenure is associated with higher REIT performance. To the best of my knowledge, this is the first study that investigates the composition of REIT board committees and its impact on REIT performance. The findings are of interest to researchers and practitioners as they show the key characteristics of directors for REIT monitoring and advisory committees and their effect on REIT performance, and this information can assist in the understanding of REIT board functioning and the designing of the optimal REIT board.

This study conducts a comprehensive comparative analysis of multicultural education promotion ordinances enacted by the 17 metropolitan and provincial offices of education in Korea, focusing on both their normative and effectiveness frameworks. Drawing on a full census of current ordinances, the research systematically distinguishes between the declarative–normative dimension and the implementation–instrumental dimension and classifies key provisions accordingly. In terms of methodology, qualitative content analysis and categorization are employed to analyze normative elements such as policy objectives, definitions of target groups, responsibilities of superintendents of education, and obligations to establish basic plans, together with effectiveness elements such as fact‑finding surveys, advisory and deliberative committees, budgetary provisions, multicultural education support centers, and specific support programs for both students and schools. The analysis reveals that all offices of education explicitly stipulate the promotion of multicultural education and the provision of educational support for students from multicultural and migration backgrounds, thereby sharing a common overarching policy direction. However, there are notable regional differences in the legal clarity and inclusiveness of target group definitions, the specificity and continuity of basic planning duties, the binding force of fiscal clauses, and the robustness of inter‑agency cooperation mechanisms. In some regions, the normative system is relatively well elaborated, but overall effectiveness of said system remains weak, which lowers the actual enforceability and sustainability of the ordinances. In other regions, multi‑layered institutional tools such as standing committees, designated support centers, and regular surveys provide a comparatively solid basis for policy implementation. These findings highlight the need to balance normative clarity with administrative effectiveness within the context of local educational autonomy and national responsibility for multicultural education. Accordingly, the study proposes policy directions that include developing a model ordinance with minimum legal and fiscal guarantees, strengthening explicit budgetary and organizational bases, and institutionalizing regular surveys, monitoring, and evaluation systems. By mapping the nationwide landscape of multicultural education ordinances and diagnosing their structural strengths and limitations, this study contributes to the advancement of the legal framework for multicultural education and to the promotion of more inclusive and equitable regional educational governance in Korea.

The study assessed the impact of cooperative database building in Nigerian libraries. The study adopts a descriptive research design, which is most suitable for providing a detailed examination of cooperative data building practices within library and information science. The population of this study comprises of 500 respondents, made up of librarians, information professionals, data managers, and IT personnel across various libraries in Nigeria, particularly academic, public, and special libraries. The study employs purposive sampling to select 150 (30%) of the participants who are directly involved in cooperative data initiatives. Data was collected using a structured questionnaire. Reliability was tested through a pilot study, conducted in a small sample of libraries not included in the main study to help assess the consistency and clarity of the instrument. Cronbach's alpha was used to determine the internal consistency of the Likert scale items, with a score of 0.7 or above considered acceptable for reliability. To achieve the purpose of the study, three (3) research questions were formulated to guide the study. Simple percentage was used to answer these research questions. The result of the analyses revealed in general, most participants support cooperation in these areas as a way to cut expenses and redundant work. Again, the results revealed that a significant majority of participants see value in sharing resources and expertise across institutions to reduce duplication of efforts and enhance access to information, though a notable minority remains skeptical. The findings also reflect broad support for collaborative strategies that integrate knowledge-sharing and technology to enhance library services, especially in areas like automation and ILMS. Nonetheless, opinions differ somewhat on the effectiveness of specific initiatives. Based on the findings, it was recommended among others that Develop Comprehensive Governance Frameworks: Establish clear governance structures for collaborative efforts to address concerns related to centralized decision-making and resource distribution. This includes forming advisory committees with representatives from all participating libraries to ensure equitable input and decision-making. Clear policies and procedures should be created to manage shared resources, resolve conflicts, and delineate roles and responsibilities.

Abstract Within the federal government, scientific advisory committees play a critical role in shaping evidence-based research priorities, clinical practice guidelines, and healthcare delivery for older people. There are over 1,000 advisory committees currently advising the federal government, 268 within the Department of Health and Human Services. Committee members are subject-matter experts who participate in committee work on a voluntary basis. As of July 2025, 79 committees have been terminated, and 23 are administratively inactive, representing a significant shift in governance and domain expertise across the Department.1 There have also been significant changes in the membership of several committees.2 This session will use the Advisory Committee on Immunization Practices (ACIP) as a paradigmatic case to describe the direct and indirect roles of scientific committees in guiding healthcare delivery and clinical practice.3, 4 We will also examine recent threats to the ACIP’s autonomy and outline potential consequences for clinicians, professional societies, and older patients. Data sources will include administrative notices of meeting postponements, CMS quality measures which incorporate ACIP recommendations, and legislation introduced by current members of Congress.5 We identify other committees related to aging which have faced interruptions, including the National Advisory Committee on Aging and identify the GSA’s role in restoring committee meetings. We advocate for HHS leadership and policy makers to preserve the ability of committees to function independently, promote certainty in guideline development, and improve stakeholder confidence. Finally, we address how organizations can advocate for these critical independent scientific committees and describe other routes to communicate science to policymakers.

ObjectivesThe use of economic evidence to prioritise vaccines and delivery strategies to optimally use in immunisation systems is becoming a global priority, especially in low- and middle-income countries (LMICs), in view of challenges in funding and the need to make more efficient use of available resources. We undertook a scoping review to identify and synthesise available evidence on strategies that have been used to enhance the use of economic evidence in policy and decision-making in the immunisation ecosystem in LMICs. The review was also used to identify the facilitators and constraints to the use of economic evidence for vaccination policy and decision making in LMICs and the sustainability of the identified strategies.DesignA scoping literature review was undertaken to generate the evidence. The review adhered to the first five steps of Arksey and O’Malley’s methodological framework (identifying and refining the research questions, identifying relevant articles, selection of studies, data extraction and charting and data synthesis) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews.Data sourcesFull-text articles were searched on PUBMED, HINARI and DOAJ using different combinations of search words as of 16 December 2024Eligibility criteria for selecting studiesWe included articles from LMICs, including Africa, and global experiences, including those from LMICs. Papers must be written in English or have an English language translation available and published between 1 January 2004 and 16 December 2024.Data extraction and synthesisTwo independent reviewers used standardised methods to search, extract, and screen included studies. The findings from the review were summarized in themes that were synthesized qualitatively.Results18 eligible articles met the inclusion criteria and were included in the synthesis. It was found that economic evidence was systematically requested and demonstrably influencing vaccine introduction or prioritisation decisions in only eight out of 32 LMIC settings with functional National Immunization Technical Advisory Groups (NITAGs) and in fewer than 20% of documented new vaccine introduction processes since 2015. In the majority of cases, decisions were reported as being driven primarily by disease burden, political priority, donor recommendations or historical precedent, with economic analyses either absent, produced post hoc or acknowledged but not used as a decisive factor.ConclusionsThere is minimal use of evidence from economics in decision-making within the immunisation ecosystem. Expert advisory committees in LMICS can, however, enhance the use of economic evidence in vaccination policy and decision-making. Hence, in order to use economic evidence for decision making, national advisory committees such as NITAGs need enhanced capacity, independence and close collaboration with researchers. LMIC NITAGs could also benefit from tailored adaptations, such as simplified cost-effectiveness tools and regional economic data hubs, to bridge this gap in decision-making and bring economic evidence to the fore of their decisions.

Social scientists not only conduct impact evaluations but also participate in the design and implementation of the programs being evaluated. While Institutional Review Boards (IRBs) oversee research activities, they do not assess risks posed by the interventions themselves. We propose establishing External Advisory Committees (EACs) to provide independent, expert oversight of programming risks. EACs complement IRBs by focusing on potential harms to participants and communities, offering dynamic risk assessments, and advising on program adaptations or termination. By providing impartial expertise, EACs help address potential conflicts of interest that may arise when researchers and implementers are invested in a program’s continuation. We illustrate the value of EACs through our experience implementing a cross-border labor migration program in Niger. Our EAC provided crucial guidance on scaling up the intervention after a pilot study and adapting the program following an unexpected military coup. While EACs introduce additional costs and may limit researcher autonomy, they generate accountability and are particularly valuable for novel and politically sensitive interventions in fragile environments.