RESUMO
Introduction: In mid-2020, the Emergency Medicine Education and Research by Global Experts (EMERGE) network surveyed the emergency response to the COVID-19 pandemic. We demonstrated that innovative measures were being generated at unprecedented rates. Our aim was to build on these findings to develop the first theoretical model with utility in assessing and developing emergency innovations. Methods: Phase 1 of a two-phase, explanatory sequential mixed methods study was a secondary analysis of the original EMERGE survey. Phase 2 involved follow-up interviews of a purposeful sample of 15 of the original survey respondents, representing 12 countries and all 6 World Health Organization regions. Thematic analysis was performed by three members of the research team. Results: Innovation is a nonlinear process in which ideas are developed, implemented, refined, and spread. Ideas grew from departmental needs or the spread of successful innovations from other sites. Development was highly localized, influenced by institutional and regional factors. Obtaining buy-in from relevant stakeholders and addressing various barriers were essential to implementation. The majority of innovations then underwent a process of evolution before some were spread to other institutions through a largely unidirectional flow of information. Conclusions: This study proposes the first model for emergency innovation processes and highlights multiple areas for improvement. Understanding how to prioritize departmental needs and the barriers may streamline development and implementation. Furthermore, the apparent unidirectional flow of information demonstrated by our participants suggests both an opportunity and a need for improved information systems. We present a framework for further research and an outline for innovation management.
RESUMO
Bovine respiratory disease (BRD) is an important health and economic burden to the cattle industry worldwide. Three bacterial pathogens frequently associated with BRD (Mannheimia haemolytica, Pasteurella multocida, and Histophilus somni) can possess integrative and conjugative elements (ICEs), a diverse group of mobile genetic elements that acquire antimicrobial resistance (AMR) genes (ARGs) and decrease the therapeutic efficacy of antimicrobial drugs. We developed a duplex recombinase polymerase amplification (RPA) assay to detect up to two variants of ICEs in these Pasteurellaceae. Whole genome sequence analysis of M. haemolytica, P. multocida, and H. somni isolates harbouring ICEs revealed the presence of tnpA or ebrB next to tet(H), a conserved ARG that is frequently detected in ICEs within BRD-associated bacteria. This real-time multiplex RPA assay targeted both ICE variants simultaneously, denoted as tetH_tnpA and tetH_ebrB, with a limit of detection (LOD) of 29 (95% CI [23, 46]) and 38 genome copies (95% CI [30, 59]), respectively. DNA was extracted from 100 deep nasopharyngeal swabs collected from feedlot cattle on arrival. Samples were tested for ICEs using a real-time multiplex RPA assay, and for M. haemolytica, P. multocida, H. somni, and Mycoplasma bovis using both culture methods and RPA. The assay provided sensitive and accurate identification of ICEs in extracted DNA, providing a useful molecular tool for timely detection of potential risk factors associated with the development of antimicrobial-resistant BRD in feedlot cattle.