Context Of Emergence Research Articles

Bridging the gap: community health workers as a vital link in humanitarian medical responses

Community Health Workers (CHWs) have proven essential in improving health outcomes and building community trust and their role in humanitarian emergency medical responses warrants further study. We illustrate this point with two case studies, the integration of community health workers into Mobile Medical Teams [MMTs] in both The Bahamas and Sierra Leone. CHWs in these examples came to the forefront of addressing community mistrust for external medical teams, health communication efforts and patient follow-up care. In Sierra Leone, this program resulted in a 32% rise in referrals to established health services. By exploring these contexts, the paper provides a new framework for enhancing humanitarian responses through CHWs, outlining the strategic, logistical, and cultural benefits of such an approach. This research suggests that integrating CHWs with MMT's can bolster health outcomes, especially in communities affected by political instability, natural disasters, and resource limitations. The paper ends by providing policy implications and recommendations for further research on the use of CHWs during a range of emergency contexts.

A Multi-Layered Socio-Ecological Framework for Investigating Teacher Well-Being: Key Predictors and Protective Factors

Understanding the factors that influence teacher well-being is crucial as it significantly affects students, teachers, schools, and the sustainability of the education system, especially during prolonged emergencies. This study contributes to the field by empirically testing a conceptual model of teacher well-being in emergency contexts, specifically addressing the COVID-19 school closures with a sample of over 19,600 teachers from Kazakhstan through an online survey design. Utilising a multidimensional socio-ecological framework that considers individual, school and home, community, and national factors, this study identifies key predictors of teacher self-reported well-being. Individual-level predictors explained 9.3% of the variation in physical well-being (F = 118, p < 0.001, R2 = 0.093) and 4.5% in psychological well-being (F = 72.2, p < 0.001, R2 = 0.045). In contrast, school- and home-level predictors demonstrated significantly greater explanatory power, accounting for 21.9% (F = 128, p < 0.001, R2 = 0.219) and 15.5% (F = 89.5, p < 0.001, R2 = 0.155) of the variation in physical and psychological well-being, respectively. Community-level predictors explained 12.8% of the variation in physical well-being (F = 191, p < 0.001, R2 = 0.128) and 10.2% in psychological well-being (F = 324, p < 0.001, R2 = 0.102), while national-level predictors accounted for much smaller proportions: 0.67% for physical well-being (F = 21.8, p < 0.001, R2 = 0.0067) and 1.4% for psychological well-being (F = 83.589, p < 0.001, R2 = 0.014). These findings highlight the significant influence of home and school, as well as community-level predictors, on teacher well-being during emergency contexts, suggesting that interventions targeting these areas may be particularly effective in supporting teacher well-being. The findings reveal that while Kazakhstani teachers reported poor physical well-being, they generally had a more positive assessment of their psychological well-being. Vulnerable groups included women, older teachers, non-Kazakh teachers, and those with higher education levels, as well as teachers in Russian medium and mixed-medium schools, all of whom reported lower physical and psychological well-being. Additional risk factors identified were a lack of student engagement, difficult relationships with parents, a directive leadership style, family conflicts, and inadequate resources at home and school. Conversely, protective factors such as teacher autonomy, collegiality, networking opportunities, and self-efficacy emerged as significant contributors to well-being. These findings reveal a complex interplay between cultural factors and subjective perceptions of well-being. This study emphasises the critical role of these predictors in both emergency and non-emergency contexts, underscoring the urgent need for targeted policies and programmes that sustainably support and enhance teacher well-being holistically. This approach will promote Sustainable Development Goal (SDG) 3 (well-being) and ensure access to equitable quality education (SDG 4) for all learners, ultimately contributing to the overall resilience of educational systems.

Hematuria in the ER patient: optimizing detection of upper tract urothelial cancer - A pictorial essay.

Upper tract urothelial carcinoma (UTUC) is a rare and challenging subset of the more frequently encountered urothelial carcinomas (UCs), comprising roughly 5-7% of all UCs and less than 10% of all renal tumors. Hematuria is a common presenting symptom in the emergency setting, often prompting imaging to rule out serious etiologies, with UTUC especially posing as a diagnostic challenge. These UTUC lesions of the kidney and ureter are often small, mimicking other pathologies, and are more aggressive than typical UC of the bladder, emphasizing the importance of timely and accurate diagnosis. Multidetector computed tomography urography (CTU) is the standard imaging modality for diagnosis, tumor staging, and surgical planning. Various postprocessing techniques like multiplanar reconstructions, maximal intensity projection (MIP) images, and 3D volumetric rendering technique (VRT) are crucial for accurate detection. In addition, 3D cinematic rendering (CR) is a novel technique that employs advanced illumination models, producing images with realistic shadows and increased surface detail, outperforming traditional VRT. We willreview the distinctive imaging features between UTUC and infiltrating mimicking lesions on CTU in patients who presented with hematuria, in conjunction with advanced postprocessing techniques,ultimately improving diagnostic confidence and preoperative planning in the emergency context.

The architecture design of emergency logistics management system based on the Internet of Things

The Internet of Things (IoT) aims to connect intelligent products with network functions through both wireless and wired technologies, enabling the safe and efficient distribution of services across global networks, including computers, mobile phones, and other electronic devices. The emergence of network devices with communication, sensing, and actuation capabilities since 2005 has led to a wide range of applications, such as inventory management, environmental monitoring, and tracking moving objects. However, the progress of IoT technology is hindered by the lack of adequate infrastructure capable of supporting trillions of devices. This paper explores the role of radio frequency identification (RFID) sensor networks within the IoT architecture for logistics management, positioning these networks as key “network-enabled” devices. The study investigates the components of the system, which include the domain sensor name server (DSNS), sensor service publisher (SSP), historical database, and RFID sensors. The strategic and operational implications of IoT architecture in logistics management are analyzed, with a particular focus on emergency response scenarios. The findings highlight the potential of IoT to improve resource allocation, enhance situational awareness, and support real-time decision-making during critical operations. This research offers valuable insights into the scalability challenges and the strategic benefits of IoT in logistics management, particularly in emergency contexts where timely data can significantly influence outcomes.

Spatial-temporal distribution and evolution of medical and health talents in China

BackgroundIn the context of public health emergencies, the presence of medical and health talents (MHT) is critically important for support in any country or region. This study aims to analyze the spatial and temporal distributions and evolution of MHT in China and propose strategies and recommendations for promoting a balanced distribution.MethodsThis research used data from 31 provinces in China to construct a multidimensional index system for measuring the agglomeration level of MHT. The indices include talent agglomeration density (TAD), talent agglomeration scale (TAS), talent agglomeration intensity (TAI), and talent agglomeration equilibrium (TAE). Using provincial data from the years 1982, 1990, 2000, 2010, and 2020, a spatiotemporal analysis of the MHT agglomeration levels was conducted. Furthermore, the regional dynamic distribution of MHT was analyzed using kernel density estimation diagrams. The spatial autocorrelation of MHT was assessed through global and local Moran’s I, and the spatial gap and decomposition of MHT were analyzed using the Dagum Gini coefficient.ResultsFrom the temporal level, the TAD and TAI of MHT showed an increasing trend over the studied period, whereas TAS decreased and TAE first increased and then decreased from 1982 to 2020. At the spatial level, the TAD, TAS, TAI, and TAE of MHT exhibited varied patterns among the eastern, central, and western regions of China, showing significant geographical disparities, generally demarcated by the Hu Huanyong Line. The regional dynamic distribution level of MHT in the country and the three regions were expanding. Spatial autocorrelation analysis using global and local Moran’s I for TAD, TAS, TAI, and TAE demonstrated significant regional differences. The Dagum Gini coefficient of TAD, TAS, TAI, and TAE revealed divergent trends in regional disparities, with overall declines in disparities for TAD and TAI, a slight increase for TAS, and fluctuating patterns for TAE.ConclusionsFrom a temporal perspective, the overall number of MHT in China has been increasing annually at the national and provincial levels. From the spatial perspective, TAD, TAS, TAI, and TAE exhibit significant differences among the three regions. Kernel analysis reveals that the distribution differences are gradually expanding in national level and varying in regional level. Moreover, the global and local Moran’s I indices reveal varying spatial autocorrelation for TAD, TAS, TAI, and TAE. The Dagum Gini coefficients of TAD, TAS, TAI, and TAE show different patterns of decomposition.

Evaluation of the applicability of urine lateral flow immunochromatography tests for the detection of cocaine in plasma samples

IntroductionQualitative analysis of cocaine in urine is a common practice in emergency settings. However, positive results from urine screening tests do not necessarily indicate recent exposure. In this context, plasma is considered a more appropriate option due to its shorter detection window and better correlation with symptomatology. Therefore, the availability of rapid tests for this biological matrix is extremely relevant in the clinical and emergency context. MethodsA lateral flow immunochromatography test designed for analyzing cocaine in urine was evaluated for use with plasma samples. A total of 412 samples from suspected cases of intoxication were processed and tested. Concurrently, the samples were analyzed for cocaine and its metabolites, benzoylecgonine and ecgonine methyl ester, using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Reliability parameters, including sensitivity, specificity, positive predictive value, negative predictive value, and efficiency, were calculated considering different cutoff values. ResultsApproximately 8.3 % of the samples tested positive in the immunoassay, while 10.2 % had a concentration greater than 5 ng/mL for at least one analyte in the LC-MS/MS analysis. Using benzoylecgonine as the target analyte with a cutoff of 40 ng/mL yielded the best reliability results, with 96.3 % sensitivity and 97.9 % specificity. Cocaine did not show satisfactory results, whereas ecgonine methyl ester, despite having 92.9 % sensitivity and 94.7 % specificity at its best cutoff (20 ng/mL), had a positive predictive value of only 38.2 %. ConclusionsThe study evaluated the suitability of using rapid urine tests for cocaine detection in plasma, offering a simple and quick drug screening method that is particularly useful in toxicological emergencies.

Changes in the epidemiology of Crimean-Congo Hemorrhagic Fever: impact of travel and a OneHealth approach in the European region.

The World Health Organization has identified Crimean-Congo hemorrhagic fever (CCHF) as a priority disease for research and development in emergency contexts. The epidemiology of CCHF is evolving and this review highlights travel-associated cases and focuses on the need for a One Health approach in Europe. For this narrative review, two searches were performed in PubMed and Google Scholar for the period 1980-October 2024. The first search identified travel-associated CCHF cases globally, additional cases were identified in the ProMED mail database and through healthmap.org. The second search, with a focus on the European region, aimed to analyse reports of CCHF virus (CCHFV) detected in ticks, CCHF seroprevalence studies in animals and/or humans, and autochthonous CCHF cases. Seventeen cases of imported CCHF, the majority acquired in Africa, were identified. Importation to European countries accounted for eight of the cases. Most patients presented with fever and hemorrhagic manifestations and the estimated case fatality rate was 35%. In the WHO European region, 13 countries have reported ticks infected with different genotypes of CCHFV; 17 countries were found to have animals/humans with positive CCHF serology. Finally, 16 countries in the WHO European region have notified human cases of CCHF. The Russian Federation, Turkey, and several former USSR countries are considered highly endemic, followed by the Balkanic region, with sporadic cases emerging in Bulgaria, Greece, Spain, and recently Portugal. Travel-associated CCHF is infrequent. However, given the recently reported increased geographical distribution in ticks and animals in the European region, additional human cases may be anticipated in the near future. Europe receives over half of all international tourist arrivals annually, so healthcare professionals should be aware of risk factors and current protocols for the management of suspected and confirmed cases.

Consent for interventions during childbirth: A national population-based study.

To assess the frequency and determinants of medical interventions during childbirth without women's consent at the population level. The nationwide cross-sectional Enquête Nationale Périnatale 2021 provided a representative sample of women who delivered in metropolitan France with a 2-month postpartum follow-up (n = 7394). Rates and 95% confidence intervals (CI) of interventions during childbirth (oxytocin administration, episiotomy or emergency cesarean section) without consent were calculated. Associations with maternal, obstetric, and organizational characteristics were assessed using robust variance Poisson regressions, after multiple imputation for missing covariates, and weighted to account for 2-month attrition. Women reporting failure to seek consent were 44.7% (CI: 42.6-47.0) for oxytocin administration, 60.2% (CI: 55.4-65.0) for episiotomy, and 36.6% (CI: 33.3-40.0) for emergency cesarean birth. Lack of consent for oxytocin was associated with maternal birth abroad (adjusted prevalence ratio [aPR] 1.20; 95% CI: 1.06-1.36), low education level, and increased cervical dilation at oxytocin initiation, whereas women with a birth plan reported less frequently lack of consent (aPR 0.79; 95% CI: 0.68-0.92). Delivery assisted by an obstetrician was more often associated with lack of consent for episiotomy (aPR 1.46; 95% CI: 1.11-1.94 for spontaneous delivery and aPR 1.39; 95% CI: 1.13-1.72 for instrumental delivery, reference: spontaneous delivery with a midwife). Cesarean for fetal distress was associated with failure to ask for consent for emergency cesarean delivery (aPR 1.58; 95% CI: 1.28-1.96). Women frequently reported that perinatal professionals failed to seek consent for interventions during childbirth. Reorganization of care, particularly in emergency contexts, training focusing on adequate communication and promotion of birth plans are necessary to improve women's involvement in decision making during childbirth.

Establishment of a Low-Cost Reinforced Concrete Prefabricated Family Housing Construction System

Objective: The objective of this study is to investigate the feasibility of an affordable and rapidly deployable prefabricated housing system adapted to urban contexts and emergency scenarios. The aim is to design an integrated system for the production, construction, and assembly of prefabricated reinforced concrete housing, offering accessible, efficient, and flexible housing solutions. Theoretical Framework: The research is grounded in key concepts and theories such as prefabrication in construction, modularity, environmental sustainability, housing resilience, advanced concrete technology, and project management on-site, providing a solid basis for understanding its context. Methodology: The study employs a comparative method, analyzing six representative housing units with built areas of 25.83 m², 33.39 m², 39.06 m², 42.21 m², 52.29 m², and 59.85 m². Data collection occurred in three stages: (1) search and review of experiences, (2) design and development of basic housing models, production, and assembly, (3) results analysis to evaluate technical and economic feasibility. Results and Discussion: The results confirm the feasibility of designing six models of basic family housing that comply with Peruvian standards and are accessible to low-income families. A production process for prefabricated elements is proposed, adaptable to any location and operable with minimal equipment. Among the evaluated models, VUF 04 stands out for its lowest cost, estimated at $311.43 USD per square meter of built area. Research Implications: The implications of this research are broad and significant, highlighting its potential to transform the design, production, and assembly of housing in urban and emergency contexts. By addressing multiple aspects, this study establishes a solid foundation for the implementation of sustainable, accessible, and efficient housing solutions. Originality/Value: The originality of this study lies in its decentralized and simplified production approach, carried out on-site with minimal equipment. Its value resides in democratizing access to affordable, efficient, and sustainable housing, providing an alternative model to centralized systems and laying the groundwork for future research on accessible and resilient construction.

Learning through a separation process

In this article, I present an embodied a/r/tographical inquiry of my bodily and emotional responses experienced while going through a separation process, and a description of what I learned as part of this process that has implications for how I intend to teach and develop student teachers’ relational competence. By invoking the context of emergence, currere, the in-between and living inquiry, and in dialogue with the concepts of embodied affectivity and embodied interaffectivity, I observe the unfolding of themes such as activation of bodily resonance, the sharing of embodied experiences and embodied meaning-making, coming together to reveal an insight into relational competence as an embodied phenomenon. I have also revealed an awareness of my bodily inquiry and the merging of moving and writing. The implications of this study for teacher education may well include encouraging student teachers to consider their own relational competence by nurturing and enriching their own bodily awareness of a capacity to engage in meaningful and compassionate ways both with themselves and their pupils, not least when faced with unexpected and provocative situations in their practicum. Applying embodied a/r/tography as a method for developing student teachers’ relational competence may offer opportunities for including student teachers’ wonderings, feelings, reflections and meta-reflections as a means of knowing on their path to becoming teachers. Drawing: Linda Oloey (with permission)

Gramsci y la Hegemonía como proceso discursivo material.

The objective of this article is an assessment of the role of the notion of Hegemony developed by Antonio Gramsci to respond to the limits of Ernesto Laclau's communicative-discursive analysis. At the same time, its framework is an analysis of the effectiveness of the formalist and constructivist model in which Habermas analyzes the impact of digital networks on public opinion. From a Political Economy of Communication approach, the relevance of the category and approach to hegemony in Gramsci's own conceptualization is assessed. Its validity derives from the complexity that communicative processes and discursive production currently manifest. Just as the unusual role of discourses and communicative practices play in the production of political subjectivity that regulates the relationship between state and civil society. The assessment of Gramsci's conceptualization of hegemony also serves as the basis for an analysis of the context of emergence of far-right discourses in Latin America, as well as their ability to dominate the public and political sphere.

Migration policies versus public health – the ethics of Covid-19 related movement restrictions for asylum seekers in reception centers in Greece in 2020

Background The emergency context of the Covid-19 pandemic necessitated the use of national and international public health measures of unprecedented scale to minimize mortality and morbidity, often in conflict with other principles and rights, such as the autonomy of individuals. Concerns have been voiced that for populations facing precarity, such as migrants, a disproportionate and unfair application of restrictive measures, deficient application of protective measures, and even enforcement of restrictive migration policies under the pretext of the pandemic has occurred. Methods Experts have proposed various principles as possible moral foundations of public health interventions. The author used two public health ethics frameworks to examine the ethical acceptability of movement restrictions on asylum seekers residing in refugee camps in Greece from March 2020 to October 2020. Results Most of the principles described in the frameworks for the ethical application of movement restrictions were not adhered to. Main concerns include that, measures were prolonged despite lack of evidence about their effectiveness to reduce morbidity and mortality, while posing severe and disproportionate burdens for this population. Conclusions An ethically acceptable public health response to Covid-19 is incompatible with certain living conditions of refugees, asylum seekers, and migrants. Moral and political determinants of health, such as social inequalities and criteria for health resources allocation, can shape the form and effectiveness of public health interventions during emergencies. The role of the discipline of public health to address these underlying determinants, that influence health-related outcomes, is an important moral question in itself. It is essential for public health professionals to be aware of the moral theorizations that underpin their work, so as to ensure that their policies align with them and to contribute to the debate that shapes these determinants.

The Use of Artificial Intelligence in Patient Triage in Emergency Departments: an Integrative Review

Objective: This study aims to explore how AI has been applied in patient triage in emergency services, investigating its contributions to the efficiency of care, the challenges faced in implementation, and the opportunities for response time optimization and resource allocation. Method: An integrative literature review was carried out with studies published between 2020 and 2024. The research was guided by the PICo (Population, Interest and Context) model, focusing on patients treated in emergency services (P), the application of AI for triage (I) and the hospital and emergency context (Co). The search was carried out in databases such as PubMed, LILACS, SciELO and Scopus, applying the Boolean code "Artificial Intelligence" AND "Triage" AND "Emergency Services". After screening 214 initial articles, 12 studies were selected for final analysis, based on the PRISMA guidelines. Results and Discussion: The review pointed out that AI significantly improves response time and reduces the margin of error in patient classification, especially in high-demand situations. The use of AI stood out in identifying critical outcomes, such as the need for immediate care. During the COVID-19 pandemic, AI has proven to be essential in the remote triage of high-risk patients, ensuring efficient use of resources in overcrowded settings. However, implementation faces challenges, such as resistance from health professionals and the need for integration with existing health systems. Conclusion: In summary, the use of AI in emergency services has brought significant benefits, such as increased triage efficiency, improved diagnostic accuracy, and improved resource management. However, overcoming cultural and operational barriers and setting clear ethical guidelines are essential. The careful integration of AI, with continuous training and periodic assessments, is critical to transforming care and ensuring more effective and safer patient care.

Time is brain: detection of nonconvulsive seizures and status epilepticus during acute stroke evaluation using point-of-care electroencephalography

ObjectivesSeizures are both a common mimic and a potential complication of acute stroke. Although EEG can be helpful to evaluate this differential diagnosis, conventional EEG infrastructure is resource-intensive and unable to provide timely monitoring to match the emergent context of a stroke code. We aimed to evaluate the real-world use and utility of a point-of-care EEG device as an adjunct to acute stroke evaluation. Materials and MethodsWe performed a retrospective observational cohort study at a tertiary care community teaching hospital by identifying patients who underwent point-of-care EEG monitoring using Rapid Response EEG system (Ceribell Inc., Sunnyvale, CA) during stroke code evaluation of acute neurological deficits during the study period from January 1, 2020 to December 31, 2020. We assessed the frequency of seizures and highly epileptiform patterns among patients with either confirmed strokes or stroke mimics. ResultsPoint-of-care EEG monitoring was used in the wake of a stroke code in 70 patients. Of these, neuroimaging and clinical information resulted in a diagnosis of stroke in 38 patients (28 ischemic, 6 hemorrhagic, 4 transient ischemic attack; median NIHSS score of 6.5 [IQR 2.0-12.0]) and absence of any stroke in 32 patients. Point-of-care EEG detected seizures and highly epileptiform patterns in 6 (15.8 %) stroke patients and 11 (34.4 %) stroke-mimic patients, including 2 patients with persistent expressive aphasia due to repeated focal seizures. ConclusionsPoint-of-care EEG has utility for detecting nonconvulsive seizures in patients undergoing acute stroke evaluations.

Exploring Informal Work: Gaining Legitimation through Nudging

This article develops a micro-level understanding of informal work (IW) by exploring the legitimising factors which business owners exercise to provide the rationale for engaging in IW. Using the lens of nudge theory, originating from behavioural economics, we show how IW becomes legitimised through nudging. Empirically, we explore the lived experience of service sector business owners who engage in IW practices in the East Midlands, UK. The findings uncover how the business owners’ context is shaped through exposure to various IW arrangements early in their working life; we also reveal a range of actors who actively shape these arrangements for embracing IW while delegitimising formal work. We present the factors that condition the beliefs and embed the understanding that IW is legitimate for the individual business owners, thus highlighting an important and emergent context for future studies in the realm of IW.

Narrative review of chest wall ultrasound: a practical approach.

Traditionally, literature on thoracic ultrasound has focused on the study of pleural and pulmonary pathology. However, given the superficial location of thoracic wall structures, ultrasound proves to be an excellent technique for their examination. This study aims to evaluate the clinical utility of thoracic ultrasound in diagnosing various thoracic wall pathologies and to illustrate the primary diagnoses that can be achieved. We performed a literature search in January 2024 in PubMed and Google Scholar for articles on thoracic ultrasound. Relevant articles were selected and synthesized in a narrative form. Thoracic ultrasound has emerged as a powerful diagnostic tool, especially when combined with a thorough clinical history. It allows for rapid, inexpensive, and safe resolution of a wide range of common clinical uncertainties across all levels of healthcare. In emergency contexts, it excels in the detection of rib fractures, demonstrating superior capability compared to traditional chest X-rays and similar efficacy to computed tomography (CT) scans. Additionally, thoracic ultrasound is highly effective in evaluating tumors, often providing accurate diagnoses without the need for further studies. It also aids in differentiating pathologies that may require more advanced imaging such as CT or magnetic resonance imaging (MRI). Moreover, thoracic ultrasound plays a valuable role in the initial assessment of infectious and degenerative conditions. Thoracic ultrasound is a versatile and efficient diagnostic tool for examining thoracic wall structures. Its applications are particularly valuable in trauma assessment, tumor evaluation, and the differentiation of various pathologies. The rapid, cost-effective, and safe nature of this technique highlights its potential as a primary diagnostic tool in a wide variety of clinical settings.

The Ethical Case for Decentralized Clinical Trials.

The recent pandemic spurred interest in innovative design for clinical trials. In particular, constraints on the public's ability to gather led to an increase in remote or decentralized clinical trials (DCTs). DCTs present an opportunity to extend the benefits of research to underserved populations, decrease burdens, increase access to trials, and fill knowledge gaps surrounding rare conditions, though they are not without their own unique challenges and risks. These risks are far from irremediable, and the advantages are significant enough to merit attention. There is a scientific and moral case to increase the use of DCTs beyond the context of public health emergencies.

Chief medical officers in the United Kingdom: maintaining 'independence' inside government.

The Chief Medical Officer (CMO), one of the UK's most senior public health leadership roles, was crucial in supporting policymakers in responding to COVID-19. Yet, there exist only a handful of (largely historical) accounts of the role in England. This article is the first to empirically examine how the scope, focus and boundaries of the CMO role vary over time across the four UK nations, including during public health emergencies. We undertook semi-structured interviews with 10 current and former CMOs/Deputy CMOs in the four UK nations and analysed relevant documents. The CMO role is not clearly defined in contemporary UK legislation and is instead shaped by iterative policies, incumbent preferences, and organizational needs, leading to variation over time and between nations. Nonetheless, most participants framed the role as primarily providing 'independent' advice to government despite being senior civil servants who, in communicating with the public, sometimes speak 'on behalf' of government. The flexibility of UK CMO roles allows for responsive adaption but poses risks for how well these roles are understood. A potential tension between providing 'independent' policy advice and a need to publicly communicate government policies and guidelines may be exacerbated in emergency contexts.

Developing an mpox risk assessment matrix for social listening and infodemic insights generation

Abstract Issue Any effective response to an infodemic, requires prioritizing public health response on identified narrative themes that pose highest risk to health and well-being of populations. High-risk narratives often require more swift and far-reaching action and low-risk narratives require little or no response. Description of the problem Different countries are assigned different levels of risk to specific narratives or concerns, recognizing that for some issues there may be a large gap between the true public health threat and what is generating lots of conversations, concerns and press coverage that indicate a high degree of risk perception that may be unwarranted. WHO developed a risk matrix to apply to global analysis of questions, concerns and narratives about mpox, which resulted in biweekly infodemic intelligence reports that risk-assessed identified infodemic themes and corresponding recommendations for action. Results Risk assessment criteria were defined in the context of WHO’s global infodemic insights analysis for low, medium and high risk and positive sentiment in mpox global outbreak context before conducting the integrated analysis so that insights were reproducible and infodemic response actions were prioritized. This implemented the WHO/UNICEF training manual on 6 steps to produce an infodemic insights report, which includes tools on how to develop and apply a risk matrix for a specific public health question of concern and apply it in analysis. Lessons The approach resulted in rapid, systematic, reproducible and evidence-driven decision-making to respond to the infodemic accompanying the mpox global outbreak. Risk matrices must be adapted to the context of the public health event and the mandate of the health authority taking action. An mpox risk matrix for narratives included adaptation to reflect high-risk from stigmatizing narratives, as well as narratives circulating around or within LGBTQI+ communities. Key messages • A risk matrix must be developed and adapted to the context of each health emergency and level of health authority action. • Prioritization for rapid infodemic response based on a risk assessment is that it facilitates more effective response in a health emergency.

Research ethics implications in the development of personalised therapy for pediatric SIRS patients

Abstract Background Pediatric Systemic Inflammatory Response Syndrome (SIRS) presents diagnostic and therapeutic challenge that can be addressed through personalised therapy. Related ethical challenges are understudied. Our report aims at identification and analysis of research ethics implications within the bigger ERA PerMed funded project of development of tailored immunotherapy for paediatric SIRS patients (TIPS) coordinated by Prof. Catharina Schütz from Technic University Dresden. Methods A sample of 10 experts with different backgrounds was studied through semi-structured interviews. Systematic literature review grounded the interview questionnaire. The transcripts were subjected to thematic analysis by two independent researchers. Results Five classical research ethics issues were identified: respect for autonomy; informed consent; risk-benefits ratio; data protection; social justice. All experts favoured the empowerment of children (N = 10) and obtainment of informed consent rather than assent was seen as a common goal (N = 5). The emergency context of SIRS research impeded the informed consent. Despite favourable risk-benefits ratio, no direct benefits resulted to study participants. Data anonymisation though necessary (N = 10), hinders proper dealing with incidental findings. Social justice issues apparently accompanied research design in personalised medicine (N = 2) but should not extend to access to personalised therapy. Conclusions The classical framework of research ethics is challenged by the new fields of medical research. Traditional concepts, such as informed consent in minors, are subject to rethinking. Current ethical and legal guidelines fall short of proper practical instructions in the specific case of SIRS pediatric patients. Thus, ethical aspects of new technology development should always be studied in parallel to the biometrics within personalised medicine projects so as to the development of guidelines is more evidence-based than precautionary driven. Key messages • Current ethical and legal guidelines fall short of proper practical instructions in the specific case of SIRS pediatric patients. • Ethical aspects of new technology development should always be studied within personalised medicine projects so as to the development of guidelines is more evidence-based than precautionary driven.