Evidence-based Planning Research Articles

The association between high ambient temperature and risk of hospitalization: a time-series study in eight ecological regions in Vietnam

Viet Nam is among the countries most threatened by and vulnerable to climate change and extreme weather events. However, research on the temperature-morbidity relationship at the national scale has been scarce. This study aimed to assess the impact of high temperatures on the risk of hospital admissions for all causes and heat-sensitive diseases across eight ecological regions in Vietnam. The study utilized a longitudinal dataset that included hospitalization and meteorological data from eight provinces representing eight regions in Vietnam. A time series analysis was applied using the generalized linear and distributed lag models with a quasi-Poisson family to examine the temperature-hospitalization association in each province. A random-effects meta-analysis was used to calculate the pooled estimate of risk for the national scale. The country-level pooled effects (%, [95% CI]) indicated that a 1 °C increase above the threshold temperature (19 °C) increased the hospitalization risk for all causes and infectious diseases by 0.8% [0.4%–1.2%] and 2.4% [1.02%–1.03%], respectively at lag 0–3 d. The effects of heat on respiratory diseases and mental health disorders were not significant. At the regional level, the association varied across eight regions, of which the Northern parts tended to have a higher risk than the Southern. This is among very few national-scale studies assessing hospitalization risk associated with high temperatures across eight ecological regions of Vietnam. These findings would be useful for developing evidence-based heat-health action plans.

La spécialité de la psychiatrie de l’enfant et de l’adolescent en Espagne. La route longue et sinueuse

ObjectivesAugust 3, 2021 marks an important milestone in the history of psychiatry in Spain with the establishment of the title of specialist in child and adolescent psychiatry. Until then, Spain remained one of the few European countries where this measure had not been implemented. This article aims to examine the development of child and adolescent psychiatry, highlighting the various contributions that have made it possible. MethodA literature review was conducted to trace the historical evolution of child and adolescent psychiatry. ResultsThe advancements in child and adolescent psychiatry worldwide are first presented, followed by an examination of the specific case of Spain. It is evident that the development of child and adolescent psychiatry in Spain has been slower compared to neighboring countries. Additionally, there is concerning heterogeneity in its implementation within the Spanish state. DiscussionThe findings suggest the emergence of new challenges, including the need to develop training programs and clinical guidelines based on scientific evidence. Ensuring effective, quality, and equitable mental healthcare services for children within the national health system is essential, with particular attention to patients with severe mental disorders. ConclusionThe introduction of the specialist title in child and adolescent psychiatry in Spain represents a significant advancement. However, new challenges need to be addressed, such as the formulation of evidence-based training plans and clinical guidelines. It is crucial to establish measures that ensure appropriate and equitable care for children and adolescents with mental disorders.

Strategies for obstetricians and gynecologists to advance reproductive autonomy in a post-Roe landscape

The monumental reversal of Roe vs Wade dramatically impacted the landscape of reproductive healthcare access in the United States. The decision most significantly affects communities that historically have been and continue to be marginalized by systemic racism, classism, and ableism within the medical system. To minimize the harm of restrictive policies that have proliferated since the Supreme Court overturned Roe, it is incumbent on obstetrician-gynecologists to modify practice patterns to meet the pressing reproductive health needs of their patients and communities. Change will require cross-discipline advocacy focused on advancing equity and supporting the framework of reproductive justice. Now, more than ever, obstetrician-gynecologists have a critical responsibility to implement new approaches to service delivery and education that will expand access to evidence-based, respectful, and person-centered family planning and early pregnancy care regardless of their practice location or subspecialty.

Clinical Practice Guidelines For the Management of Hepatocellular Carcinoma: A Systematic Review

BackgroundHepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths globally, including Australia. The absence of a consensus clinical practice guideline (CPG) specific to HCC management poses challenges in reducing morbidity, mortality, and improving patient recovery. This systematic review aims to evaluate the existing evidence and assess the potential of published guidelines, including those with an international scope, to provide guidance for healthcare professionals in Australia.MethodsElectronic search of MEDLINE, Embase, Cochrane Library, Google Scholar, and PubMed was conducted. Peer-reviewed English language articles from 2005 to June 2022 were included if they described management of HCC as part of an evidence-based overall management plan or CPG. The quality of the included CPGs was assessed by the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool.ResultsTwenty-one articles from 16 regions throughout the world were included in this review. All included guidelines (n = 21, 100%) recommended evaluating cirrhosis, hepatitis B, and hepatitis C as potential risk factors of HCC. Obesity and non-alcoholic fatty liver disease were recommended by 19 CPGs (91%) as risk factor for HCC. Fourteen guidelines (67%) endorsed using the BCLC staging system. Eighteen guidelines (86%) recommended a multidisciplinary approach for the management of HCC. Eighteen guidelines (86%) advised that surveillance using ultrasound should be implemented in all cirrhotic patients every 6 months regardless of the cause of cirrhosis. AGREE II mean overall assessment score was 90% indicating that all guidelines included were highly recommended in majority of domains.ConclusionsThe included CPGs provided a comprehensive approach, emphasizing the evaluation of risk factors, utilization of the BCLC staging system, and the importance of a multidisciplinary approach. Regular surveillance using ultrasound for cirrhotic patients was widely recommended. An understanding of contemporary international CPGs can prioritize aspects of the management of HCC to assist healthcare professionals to develop a national guideline to enable standardized, comprehensive, and evidence-based care for patients with HCC.

Lessons learned in implementing the Low Birthweight Infant Feeding Exploration study: A large, multi-site observational study.

Globally, early and optimal feeding practices and strategies for small and vulnerable infants are limited. We aim to share the challenges faced and implementation lessons learned from a complex, mixed methods research study on infant feeding. A formative, multi-site, observational cohort study using convergent parallel, mixed-methods design. Twelve tertiary/secondary, public/private hospitals in India, Malawi and Tanzania. Moderately low birthweight infants (MLBW; 1.50-2.49 kg). We assessed infant feeding and care practices through: (1) assessment of in-facility documentation of 603 MLBW patient charts; (2) intensive observation of 148 MLBW infants during facility admission; and (3) prospective 1-year follow-up of 1114 MLBW infants. Focus group discussions and in-depth interviews gathered perspectives on infant feeding among clinicians, families, and key stakeholders. The outcomes of the primary study were: (1) To understand the current practices and standard of care for feeding LBW infants; (2) To define and document the key outcomes (including growth, morbidity, and lack of success on mother's own milk) for LBW infants under current practices; (3) To assess the acceptability and feasibility of a system-level Infant and Young Child Feeding (IYCF) intervention and the proposed infant feeding options for LBW infants. Hospital-level guidelines and provision of care for MLBW infants varied across and within countries. In all, 89% of charts had missing data on time to first feed and 56% lacked discharge weights. Among 148 infants observed in-facility, 18.5% were discharged prior to meeting stated weight goals. Despite challenges during COVID, 90% of the prospective cohort was followed until 12 months of age. Enrolment and follow-up of this vulnerable population required additional effort from researchers and the community. Using a mixed-methods exploratory study allowed for a comprehensive understanding of MLBW health and evidence-based planning of targeted large-scale interventions. Multi-site partnerships in global health research, which require active and equal engagement, are instrumental in avoiding duplication and building a stronger, generalisable evidence base.

Using satellite imagery to investigate Blue-Green Infrastructure establishment time for urban cooling

The process of urbanization can alter the local climate to the point that it threatens citizens’ well-being by creating heat-related hazards. The construction of Blue-Green Infrastructure (BGI) can improve the regulation of surface energy exchange processes and address this problem. However, the time needed for a BGI to deliver a stable cooling performance, referred to here as the Cooling Establishment Time (CET), is poorly understood and quantified in the literature and dependent on environmental, design and maintenance factors. Here, we analyze the feasibility of using satellite data to derive the CET for different BGIs across the city of Zurich, Switzerland. Results showed that remote sensing can quantify the land surface temperature impact of BGIs and assist in estimating their CET. BGI with trees or climbing plants required a longer CET (seven to ten years) before any notable shift in surface temperatures were visible, while grasses or artificial irrigated systems led to shorter CETs (one to three years). These results allow us to better account for BGI cooling establishment when planning for areas that need urgent action under warming climates. This work supports evidence-based urban greenery planning and design towards cooling our increasingly warming cities in a timely manner.

Evidence-Based Teaching Plan, Test, and Evaluation on Caring for Healthcare Provider Second Victims

Background Healthcare providers as second victims witness significant patient or employee crises. Their intense emotional responses have been recognized by healthcare institutions. Purpose The study developed a literature- and expert-validated, evidence-based teaching plan and matching multiple-choice test for nursing staff and professional development educators. The teaching plan can structure educational sessions that disseminate content on second victim experiences. Methods The study used a mixed-method design to build an evidence-based teaching plan and multiple-choice test, and qualitative analysis of second victim literature to generate teaching plan components. Quantitative analysis was used to evaluate experts’ ranks on the teaching plan and pretest drafts. Results The mean pretest score was low, possibly showing that doctoral students may lack knowledge of the second victim phenomenon. Test statistics indicate the need for item revision. Conclusions Teaching sessions based on the revised teaching plan and test might raise awareness of aspects of the second victim experience and program among nursing staff and multidisciplinary team members.

June 2023-Printed Issue

The summer 2023 issue of Patient Safety is available to read online and download at no charge. This issue features two in-depth data analyses from the largest event reporting database of its kind in the United States, which reveal patient safety trends in serious events and incidents (https://patientsafetyj.com/article/74752-patient-safety-trends-in-2022-an-analysis-of-256-679-serious-events-and-incidents-from-the-nation-s-largest-event-reporting-database) and offer insights on healthcare-associated infections (https://patientsafetyj.com/article/74494-long-term-care-healthcare-associated-infections-in-2022-an-analysis-of-20-216-reports) in Pennsylvania last year. We also share some recent healthcare success stories in recognition of the winners of the 2023 I AM Patient Safety awards. Additional highlights include • A safety alert about methylprednisolone (https://patientsafetyj.com/article/77633-patient-safety-alert-methylprednisolone-and-patients-with-hypersensitivity-to-cow-s-milk-components), a medication that sometimes contains lactose monohydrate, and its risk of anaphylaxis, a life-threating allergic reaction, to patients with a cow’s milk allergy. • An expert on artificial intelligence discusses what AI can and can’t do in healthcare (https://patientsafetyj.com/article/77632-artificially-intelligent-machine-learning-in-healthcare-and-why-it-may-not-be-as-advanced-as-you-think), now and in the future. • Human factors researchers review best practices from high-risk industries (https://patientsafetyj.com/article/77769-informing-visual-display-design-of-electronic-health-records-a-human-factors-cross-industry-perspective) that may inform visual display design of electronic health records. • How an evidence-based teaching plan (https://patientsafetyj.com/article/77630-evidence-based-teaching-plan-test-and-evaluation-on-caring-for-healthcare-provider-second-victims) might raise awareness of the effect that significant patient and employee crises have on the staff who witness such events. • A study explores the feasibility of monitoring patients’ vital signs (https://patientsafetyj.com/article/77776-continuous-monitoring-of-vital-signs-after-hospital-discharge-a-feasibility-study) at home. Patient Safety is fully open access (no fees for authors or readers). We welcome manuscripts from all over the world. If your work can help advance patient safety, please submit it to us for consideration (https://patientsafetyj.com/for-authors), and kindly share our journal with friends, family, colleagues, and caregivers.

Improving healthcare value: integrating medical practitioners into hospital design in developing countries

The cost of healthcare is a burden in most developing countries, and this is exponentially increasing in the context of population growth, pandemics, and rapidly evolving medical necessities. A customized healthcare typology should rely on data collection and architectural requirements, before moving to aesthetically compelling designs, so hospitals in low-resource or developing countries will not mimic their Western counterparts. The greatest bearing that improves the patient’s outcome and well-being would engage a productive interaction between the hospital designers and the medical practitioners, this will also allow for evidence-based hospital planning. As the author of this short report, I use the best of my experience as a physician and healthcare planner to translate a successful interaction with multinational designers building hospitals in Rivers State, Nigeria.

Iatrogenic perforation management using calcium silicate cement: a case report

The world today is literate enough about the basics of oral health conditions and available treatment options. Due to the availability of many resources on different platforms the urge to retain natural teeth rather than have extractions has increased. Dental catastrophes are sometimes unavoidable in everyday dental practice. The prime motive should be patient benefit while the general dental practitioner (GDP) identifies the risks associated with the case, availability of equipment and enhanced operator skill when deciding to the referral of the patient to a specialist. Most failed root canal treatment cases have one or more associated endodontic errors. This case report presents stepwise management of such a case of iatrogenic perforation that occurred during the initial endodontic management. It emphasizes the significance of evidence-based treatment planning, role of magnification, selection of the appropriate armamentarium for performing root canal treatment, use of bioactive materials that collectively demonstrate peri-apical healing following the repair of endodontic mishaps. It also emphasizes on the importance of recall in such cases where adequate healing can be tracked over a period. CPD/Clinical Relevance: Knowledge of management of iatrogenic perforations is useful information for clinicians.

Green Is Not the Same as Green: Differentiating Between the Association of Trees and Open Green Spaces With Children’s Brain Structure in the Netherlands

There is accumulating evidence for positive effects of green spaces on mental and brain health. Here we investigated whether differentiating the types of green spaces may be relevant. On longitudinal data of children ( N = 95) from the Netherlands, we quantified the link between green space exposure at home from birth onwards and MRI brain structure at 12.5 years. We differentiated between green space resulting from trees versus open green spaces and also associated visibility of sky (sky view factor) with brain structure (200 m buffer around home address). We observed a positive association between grey matter volume in different prefrontal clusters and green open space coverage as well as sky view, but a negative association within prefrontal clusters for tree cover density. Most importantly, in the medial prefrontal cortex, the only region in which all three analyses overlapped, the visibility of sky was the most important predictor. Our findings advance knowledge on health-promoting, evidence-based urban planning.

Hipertensión arterial en la enfermedad renal crónica

Chronic kidney disease (CKD) is increasingly prevalent worldwide, and it is associated with cardiovascular disease (CVD). Hypertension (HT) is therefore a cause as well as a consequence of CKD, and it affects the great majority of patients with CKD. It is highly important to control HT in individuals with CKD, as this slows down the progression of the disease and also reduces the risk of CVD. Existing treatment guidelines do not agree on the optimum target figures for blood pressure (BP) in this population. It is therefore crucially important to understand the mechanisms which contribute to the appearance of this pathology, to indicate the most suitable treatment to control it appropriately. Although non-pharmaceutical interventions are useful for reducing BP in CKD, they are rarely enough to achieve sufficient control of BP. Patients with CKD and HT often require a combination of antihypertensive drugs to achieve their target BP. Some pharmacological therapies have an action which protects the kidneys and/or the heart independently of their effect on BP, and this should be taken into account when prescribing a therapy. It is important to underline that a personalized and evidence-based management plan is still the key to achieve BP targets, reducing the risk of CVD and slowing down the progress of CKD.

Multidomain and multilevel strategies to improve equity in maternal and newborn health services in Nepal: perspectives of health managers and policymakers

BackgroundNepal has committed to achieving universal coverage of quality maternal and newborn health (MNH) services by 2030. Achieving this, however, requires urgently addressing the widening inequity gradient in MNH care utilisation. This qualitative study examined the multidomain systemic and organisational challenges, operating in multi-level health systems, that influence equitable access to MNH services in Nepal.MethodsTwenty-eight in-depth interviews were conducted with health policymakers and program managers to understand supply-side perspectives of drivers of inequity in MNH services. Braun and Clarke’s thematic approach was employed in analysing the data. Themes were generated and explained using a multidomain (structural, intermediary, and health system) and multi-level (micro, meso and macro) analytical framework.ResultsParticipants identified underlying factors that intersect at the micro, meso and macro levels of the health system to create inequity in MNH services. Key challenges identified at the macro (federal) level included corruption and poor accountability, weak digital governance and institutionalisation of policies, politicisation of the health workforce, poor regulation of private MNH services, weak health management, and lack of integration of health in all policies. At the meso (provincial) level, identified factors included weak decentralisation, inadequate evidence-based planning, lack of contextualizing health services for the population, and non-health sector policies. Challenges at the micro (local) level were poor quality health care, inadequate empowerment in household decision making and lack of community participation. Structural drivers operated mostly at macro-level political factors; intermediary challenges were within the non-health sector but influenced supply and demand sides of health systems.ConclusionsMultidomain systemic and organisational challenges, operating in multi-level health systems, influence the provision of equitable health services in Nepal. Policy reforms and institutional arrangements that align with the country’s federalised health system are needed to narrow the gap. Such reform efforts should include policy and strategic reforms at the federal level, contextualisation of macro-policies at the provincial level, and context-specific health service delivery at the local level. Macro-level policies should be guided by political commitment and strong accountability, including a policy framework for regulating private health services. The decentralisation of power, resources, and institutions at the provincial level is essential for technical support to the local health systems. Integrating health in all policies and implementation is critical in addressing contextual social determinants of health.

Global Trends in Social Prescribing: Web-Based Crawling Approach.

Social loneliness is a prevalent issue in industrialized countries that can lead to adverse health outcomes, including a 26% increased risk of premature mortality, coronary heart disease, stroke, depression, cognitive impairment, and Alzheimer disease. The United Kingdom has implemented a strategy to address loneliness, including social prescribing-a health care model where physicians prescribe nonpharmacological interventions to tackle social loneliness. However, there is a need for evidence-based plans for global social prescribing dissemination. This study aims to identify global trends in social prescribing from 2018. To this end, we intend to collect and analyze words related to social prescribing worldwide and evaluate various trends of related words by classifying the core areas of social prescribing. Google's searchable data were collected to analyze web-based data related to social prescribing. With the help of web crawling, 3796 news items were collected for the 5-year period from 2018 to 2022. Key topics were selected to identify keywords for each major topic related to social prescribing. The topics were grouped into 4 categories, namely Healthy, Program, Governance, and Target, and keywords for each topic were selected thereafter. Text mining was used to determine the importance of words collected from new data. Word clouds were generated for words related to social prescribing, which collected 3796 words from Google News databases, including 128 in 2018, 432 in 2019, 566 in 2020, 748 in 2021, and 1922 in 2022, increasing nearly 15-fold between 2018 and 2022 (5 years). Words such as health, prescribing, and GPs (general practitioners) were the highest in terms of frequency in the list for all the years. Between 2020 and 2021, COVID, gardening, and UK were found to be highly related words. In 2022, NHS (National Health Service) and UK ranked high. This dissertation examines social prescribing-related term frequency and classification (2018-2022) in Healthy, Program, Governance, and Target categories. Key findings include increased "Healthy" terms from 2020, "gardening" prominence in "Program," "community" growth across categories, and "Target" term spikes in 2021. This study's discussion highlights four key aspects: (1) the "Healthy" category trends emphasize mental health, cancer, and sleep; (2) the "Program" category prioritizes gardening, community, home-schooling, and digital initiatives; (3) "Governance" underscores the significance of community resources in social prescribing implementation; and (4) "Target" focuses on 4 main groups: individuals with long-term conditions, low-level mental health issues, social isolation, or complex social needs impacting well-being. Social prescribing is gaining global acceptance and is becoming a global national policy, as the world is witnessing a sharp rise in the aging population, noncontagious diseases, and mental health problems. A successful and sustainable model of social prescribing can be achieved by introducing social prescribing schemes based on the understanding of roles and the impact of multisectoral partnerships.

293 Risk of Clostridium Difficile Enterocolitis in SJS/TENS Patients Treated with Antibiotics

Abstract Introduction Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis Syndrome (TENS) are both rare conditions derived from adverse drug reactions. SJS/TENS patients are often treated with antibiotics, both prophylactically and therapeutically, for secondary infections. However, the subsequent development of Clostridium Difficile (C. Difficile) enterocolitis is unknown. Due to the rarity of SJS/TENS, institution trials are limited in their data quantify the additional risk of sequelae such as enterocolitis development after antibiotic administration. Therefore, we used a large commercially available database derived from inpatient hospital coding data to assess the incidence of C. Difficile enterocolitis within 2 weeks of antibiotic administration after development of SJS/TENS. Methods : Our study utilized a large commercially available database. Inclusion criteria identified adult patients ( >18 years old) diagnosed with SJS/TENS between 2002 and 2022, who were treated with antibiotics within 2 weeks of diagnosis, and who subsequently went on to develop Clostridium Difficile enterocolitis within 6 months. We compared our cohort to a control group which did not receive antibiotics and propensity score matched them for age, sex, race, HIV status, cancer, transplant status, and severe sepsis and SIRS and analyzed the risk of developing C. Difficile enterocolitis. Results There were 4,792 SJS/TENS patients who did not receive antibiotics and 5,652 who did. Our matched cohorts contained 4,595 patients. The relative risk of mortality between our cohorts was 4.962 (RR: 2.562, CI 95% 2.125-3.088; p< 0.0001). SJS/TENS who received antibiotics developed C. Difficile 68/4595 vs 30/495 and had a relative risk of 0.827% (RR: 2.267, 1.478-3.476, CI 95%; p< 0.0001). Therefore, an SJS/TENS patient incurred a 2.267 times higher risk of developing C. difficile enterocolitis after receiving antibiotics. Conclusions While causality cannot be affirmed with retrospective data, our findings do suggest that patients with SJS/TENS due to the statistically significant risk of C. Difficile enterocolitis development. However, the overall absolute risk of C. difficile enterocolitis remains disproportionately low in this population that warrants further exploration. Applicability of Research to Practice SJS/TENS patients are difficult to develop evidence-based treatment plans for because of their rarity and the multitude of conflicting small cohort studies available in the literature. Our study utilizes a large database to more robustly suggest that clinicians should be cautious about administering antibiotics to patients diagnosed with SJS/TENS.

Geospatial techniques for comparative case study of spatiotemporal changes in New Karachi and North Karachi parks

The well-known fact is that parks play a significant role in sustaining the urban environment. Megacities like Karachi are developing rapidly with a simultaneous increase in the city area, putting immense pressure on open green spaces. The widespread built-up development is replacing the previously existing vegetative cover. The lack of green spaces is the main concern, and this problem will only worsen due to overpopulation associated with the rapid growth of cities. The lack of evidence-based planning contributes to the unbalanced spatial distribution of parks in quantity and quality. The present research aimed to compare and find out the quality and status of parks such as park areas under encroachment and temporal changes in the vegetative cover of parks in the predominantly low to middle-income residential areas of New Karachi and North Karachi Towns of Karachi metropolitan. Geospatial techniques have been used for mapping, assessments, and analyses. Results indicate that boundary walls are a good solution to stop or reduce park encroachments as correlation indicates the parks with boundary walls have a significantly lower percentage of encroachment in 2022. The existing work indicated that the number of trees has increased in most parks in both towns in 2022. The overall correlation results indicate that factors affecting park quality positively have a positive association with other positively affecting factors and a negative association with factors that affect park quality negatively. There is a dire need to implement better planning strategies to enhance the quality of existing parks and construct new parks in the study area.

Closing Data Gaps and Paving the Way for Pan-European Fire Safety Efforts: Part I—Overview of Current Practices for Fire Statistics

The analysis of the current state of fire statistics and data collection in Europe and other countries is needed to increase awareness of how fire incidents affect buildings and to support pan-European fire prevention and fire mitigation measures. The terminology and data collected regarding fire incidents in buildings in the EU Member States were mapped to obtain meaningful datasets to determine common terminology, collection methodology, and data interpretation system. An extensive literature review showed that fire data collection systems have been instrumental in informing firefighting strategies, evidence-based planning, prevention, and educational programmes. Differences and similarities between fire data collection systems were also investigated. The amount and quality of the information in fire statistical recording systems appear to be influenced by the complexity and structure with which the data are collected. The analysis also examined the existing fire statistics in the EU Member States and a few other countries. Finally, a detailed investigation of the number of fires, fire deaths, and injuries from 2009 to 2018 in several countries was examined based on data from a report by CTIF. The trends showed differences attributable to the existing fire statistical practices in terms of terminology and data collection, and interpretation. Part II proposes a common terminology for selected fire statistical variables. The results provide relevant information regarding fire safety at the European level and should be used to guide the development of more uniform fire statistics across Europe.

Population-level health and economic impacts of introducing Vaccae vaccination in China: a modelling study

IntroductionGiven the ageing epidemic of tuberculosis (TB), China is facing an unprecedented opportunity provided by the first clinically approved next-generation TB vaccine Vaccae, which demonstrated 54.7% efficacy for preventing reactivation...

Pediatric Disaster Science: Pediatric Specific Considerations, A Global Imperative, A WADEM Opportunity

Introduction:Pediatric disaster science is critical to provide data and discovery to guide evidence-based preparedness, response, mitigation and recovery to best serve children, families and society. With the increasing frequency, severity and global scope of disasters, there is now an unprecedented imperative and opportunity to build a sustained pediatric disaster science workforce and infrastructure. The expertise, perspective and collaboration of the international, multidisciplinary community, including WADEM members, is integral to supporting effective, efficient, ethical, high quality pediatric disaster science and its implementation.Method:A landmark Pediatric Disaster Science Symposium was convened in-person/virtually by the US National Academies of Science Engineering and Medicine in August 2022. Forty-eight pediatric disaster focused invited speakers, collectively representing government, non-governmental organizations, academia and community attended, and online. Attendees were polled during the two-day meeting to assign priority ratings to the topics discussed.Results:Symposium topics included the importance, history and scope of pediatric disaster science, and research across the disaster management cycle. Research considerations specific to children included medical and psychosocial vulnerabilities and manifestations; ethics and protections; protocol development and deployment; research tools; and data collection/integration. Scientific methodology topics addressed pediatric considerations for basic science, surveillance, clinical trials, applied sciences, community-engaged research, dissemination and implementation. Infrastructure needs described leveraging disaster centers, research networks, disaster response teams, government agencies and professional societies integratively across disciplines. Building a sustainable workforce, including training and engaging pediatric scientists with disaster-focused/disaster-relevant research, funding streams, regulation and advocacy were also discussed. Research priority ratings yielded preliminary data to inform pediatric disaster science priorities.Conclusion:The meeting provided insights that can further guide discussions among global disaster experts and scientists, including WADEM members, to prioritize, build and scale sustainable pediatric disaster science that yields evidence-based strategies, plans, resources, and actions that improve disaster preparedness, response, mitigation, and recovery for children, families and societies worldwide.

Shortfalls in our understanding of the causes and consequences of functional and phylogenetic variation of freshwater communities across continents

Freshwater ecosystems harbour a disproportionately high biodiversity relative to their area, being also one of the most threatened ecosystem types worldwide. However, our capacity to design evidence-based conservation plans for this realm is restricted by all biodiversity shortfalls that have been recognized so far. In this context, the paucity of comparable field data and information on traits and phylogenies of freshwater organisms should be emphasized. Here, we highlight how increased knowledge could be gained and where we should aim at in research on the functional and phylogenetic features of freshwater communities. First, attempts to combine datasets from different sources should pay careful attention to data harmonization. Second, more effort should be focused on natural history observations on species habitats and life histories, providing the backbone of information for multi-trait databases. Third, fully resolved phylogenies would be required for deciphering the evolutionary relationships of freshwater organisms. Provided that these three hurdles can be overcome, conducting studies of local freshwater communities across continental spatial extents would pave the way for mapping functionally important ecosystems and evolutionarily valuable areas for the conservation of freshwater organisms and their habitats.