From the cauldron of conflict: Endogenous gene regulation by piRNA and other modes of adaptation enabled by selfish transposable elements.

Transposable elements (TEs) provide a prime example of genetic conflict because they can proliferate in genomes and populations even if they harm the host. However, numerous studies have shown that TEs, though typically harmful, can also provide fuel for adaptation. This is because they code functional sequences that can be useful for the host in which they reside. In this review, I summarize the "how" and "why" of adaptation enabled by the genetic conflict between TEs and hosts. In addition, focusing on mechanisms of TE control by small piwi-interacting RNAs (piRNAs), I highlight an indirect form of adaptation enabled by conflict. In this case, mechanisms of host defense that regulate TEs have been redeployed for endogenous gene regulation. I propose that the genetic conflict released by meiosis in early eukaryotes may have been important because, among other reasons, it spurred evolutionary innovation on multiple interwoven trajectories - on the part of hosts and also embedded genetic parasites. This form of evolution may function as a complexity generating engine that was a critical player in eukaryotic evolution.

Russia Weaponization of Canada's Far Right and Far Left to Undermine Support for Ukraine.

This article details the Russian government's efforts to influence Canadians' perceptions of the war in Ukraine. Specifically, we examined Russian information campaigns tailored to Canadian audiences on X (formerly known as Twitter) and the supportive ecosystems of accounts that amplify those campaigns. By 2023, this ecosystem included at least 200,000 X accounts that have shared content with millions of Canadians. We identified ninety accounts with an outsized influence. The vast majority of the influential Canadian accounts were far right or far left in orientation. These networks were among Canada's most prolific and influential political communities online. We determined this by comparing these networks' potential influence to the online community engaging with Canada's 338 members of Parliament on X and a sample of twenty influential X accounts in Canada. The sophistication and proliferation of Canada-tailored narratives suggest a highly organized and well-funded effort to target Canadian support for Ukraine.

Assessment of conflicts of interest in literature on monoclonal antibodies for chronic rhinosinusitis with nasal polyposis using the Open Payments Database.

BACKGROUND: Accurate conflict of interest (COI) information is essential for promoting transparency and trust in research. We aim to assess COI disclosure patterns in monoclonal antibodies (MABs) research for chronic rhinosinusitis with nasal polyposis (CRSwNP) using the Open Payments Database (OPD). METHODS: Studies on FDA-approved MABs for CRSwNP (dupilumab, omalizumab, mepolizumab) published between 2019 and 2021 with at least one US author were identified through PubMed. Industry-reported payments from the manufacturers (Sanofi, Regeneron, Genentech, Novartis, and GlaxoSmithKline) between 2018 and 2021 in OPD's General Payments category were collected. Authors were cross-checked against OPD metadata using a previously published ChatGPT-based algorithm. Additionally, this novel algorithm analyzed COI statements for relevant author‒company specific disclosures, identifying disclosed and undisclosed payments made 3‒15 months prior to publication. RESULTS: A total of 214 unique authors from 76 studies were included. Of 30 articles that received at least one relevant payment, 21 (70%) were found to have an undisclosed COI, with a mean total undisclosed payment of $4890 and a median of $10,331. Fifty-six authors had relevant OPD payments and 40 (71.4%) authors did not declare a potential COI. Interestingly, 158 authors had no relevant payments and 62 (39.2%) declared a potential COI. Author order was not significantly associated with potential under- or over-disclosure. CONCLUSION: This study characterizes COI disclosure patterns in rhinosinusitis-relevant MABs research using a novel automated approach. Given the discrepancy between disclosures and industry-reported payments, our findings suggest a need for improved disclosure education and practices.

Anthropogenic impacts at the interface of animal spatial and social behaviour.

Human disturbance is contributing to widespread, global changes in the distributions and densities of wild animals. These anthropogenic impacts on wildlife arise from multiple bottom-up and top-down pathways, including habitat loss, resource provisioning, climate change, pollution, infrastructure development, hunting and our direct presence. Animal behaviour is an important mechanism linking these disturbances to population outcomes, although these behavioural pathways are often complex and can remain obscured when different aspects of behaviour are studied in isolation from one another. The spatial-social interface provides a lens for understanding how an animal's spatial and social environments interact to determine its spatial and social phenotype (i.e. measurable characteristics of an individual), and how these phenotypes interact and feed back to reshape environments. Here, we review studies of animal behaviour at the spatial-social interface to understand and predict how human disturbance affects animal movement, distribution and intraspecific interactions, with consequences for the conservation of populations and ecosystems. By understanding the spatial-social mechanisms linking human disturbance to conservation outcomes, we can better design management interventions to mitigate undesired consequences of disturbance.This article is part of the theme issue 'The spatial-social interface: a theoretical and empirical integration'.

Adolescent Emotional Reactivity in Family and School Contexts: Prospective Links to Adolescent Psychopathology.

Emotional reactivity has been linked to adolescent psychopathology and mental health problems. However, limited research has investigated the distinct associations between emotional reactivity in multiple interpersonal contexts and the development of adolescent psychopathology. The current study examined emotional reactivity to interparental conflict, parent-adolescent conflict, and school problems as predictors of adolescent internalizing problems, depressive symptoms, and anxiety symptoms six months later. The sample included 139 adolescents (54% girls; Mage = 13.30, SDage = 0.73) and their parents who completed 10-day daily reports and 6-month follow-up assessments in Taiwan. Results showed that negative emotional reactivity to interparental conflict was associated with increased internalizing problems, depressive symptoms, and anxiety symptoms, after controlling for emotional reactivity to parent-adolescent conflict and school problems, outcomes at baseline, mean negative emotions, and sex. Furthermore, the associations between both positive and negative emotional reactivity to interparental conflict and adolescent anxiety symptoms was stronger for girls than boys. Findings suggested that heightened emotional reactivity to interparental conflict is a risk factor for predicting adolescent psychopathology, especially for girls' anxiety symptoms. Results highlight the importance of emotional reactivity across multiple interpersonal contexts in adolescence.

Evaluation of Conflicts of Financial Interest in Publications on the Consumption of High-Intensity Sweeteners and Body-Weight Changes: A Systematic Review.

CONTEXT: Diseases related to excessive sugar consumption have become a public health concern. However, there may be a direct association between the consumption of artificial sweeteners and changes in body weight. OBJECTIVE: The aim was to evaluate potential industry financial conflicts of interest in publications on the relationship between high-intensity sweetener consumption and changes in body weight in observational and intervention studies. DATA SOURCES: The systematic review used the Medline, Embase, Cochrane, Scopus, and the VHL (Virtual Health Library) Regional Portal, including the LILACS databases. The PICOS strategy were used in the search strategy for intervention studies and for observational studies used the exposure factor as the criterion. DATA EXTRACTION: Inclusion criteria were observational and intervention studies in adults, without population or health status restrictions, without restriction on the year of publication, but restricted to full articles in Portuguese, English, and Spanish. Exclusion criteria were humans younger than 18 years, cross-sectional studies, and animal and in vitro studies. DATA ANALYSIS: There were extracted effect estimates, odds ratios, and linear associations, quantifying the effects per unit of intake of high-intensity sweeteners. The risk of bias in the intervention studies was assessed using the Cochrane Collaboration Risk of Bias tool (RoB). The Newcastle Ottawa Scale was used for observational studies (case-control and cohort). CONCLUSION: Most clinical trials favor using artificial sweeteners and receive contributions from the food industry. Observational studies, for the most part, show that the use of artificial sweeteners is unfavorable. In these studies, there was no sponsorship from the food industry, only from regulatory bodies. This result suggests that studies that had the support of the food industry had their influence on their outcomes. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no: CRD42016036204.

The dual journey: The development of twins' relationships throughout childhood.

Twin bonds, likely the most enduring of human relationships, provide both solace and rivalry for twins. Using an evolutionary psychology perspective, this chapter scrutinizes twins' bonds from prenatal stages to childhood to better understand their unique relationships. Twins' interactions, which begin in the womb, establish patterns of cooperation and competition. The initial years pose parenting challenges that shape the twins' experiences of dependency and rivalry. As twins grow, five dimensions-closeness, dependence, conflict, rivalry, and dominance-emerge, evolving distinctly between monozygotic twins (MZ: sharing close to 100% of their genes) and dizygotic twins (DZ: sharing on average 50% of their genetic variance). The chapter notes the closer relationship MZ twins share compared to DZ twins. While the closeness and dependence among DZ twins decline throughout childhood, these elements remain stable in MZ twins. The effect of zygosity on conflict and rivalry is less clear. For both MZ and DZ twins, conflict stays steady, while rivalry intensifies with school entry, probably driven by external comparisons, but lessens as twins develop into late childhood. Unlike singletons, where birth order dictates dominance dynamics, in twins, this dynamic is more variable and becomes more defined by around 6.5 years of age. Several factors are presented as impacting the nature of the twins' relationships: the evolvement of 'twin language', the parenting style and the differential parenting they receive. This exploration into the development of twins' relationships underlines the importance of tailored caregiving and invites further research into the genetic and environmental factors that shape close bonds.

Associations of work-family conflict with changes in metabolic risk factors: a four-year longitudinal study.

Cardiovascular disease (CVD) is becoming prevalent among younger people who have dual roles at both work and home. A possible contributor to CVD is conflict between work and home life. Thus, this study investigated the impact of work-to-family conflict (WFC) and family-to-work conflict (FWC) on metabolic risk factors. We used longitudinal data with a 4-yr interval from the Midlife in Japan study. 152 participants who were employed at baseline without missing variables of interest were included. We assessed the associations of baseline WFC and FWC with changes in metabolic risk factors between baseline and follow-up using Generalized Estimating Equations. After adjusting for baseline sociodemographic, work and family-related, and lifestyle factors, the fully adjusted model showed WFC was significantly associated with changes in low-density lipoprotein cholesterol (LDL-C) and Total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-C) ratio. However, FWC was not significantly associated with changes in any metabolic risk factors. Our findings indicated a significant impact of WFC on LDL-C and TC/HDL-C ratio but no significant impact of FWC on metabolic health. Since these metabolic risk factors cause CVD, understanding the physiological responses to occupational psychosocial stress could help create primary prevention interventions and assess their effects on workers' metabolic health.

Academy of Breastfeeding Medicine Position Statement: Breastfeeding in Emergencies.

Background: During emergencies, including natural disasters and armed conflict, breastfeeding is critically important. Breastfeeding provides reliable nutrition and protection against infectious diseases, without the need for clean water, feeding implements, electricity, or external supplies. Key Information: Protection, promotion, and support of breastfeeding should be an integral part of all emergency preparedness plans. Breastfeeding specialists should be part of plan development. Emergency protocols should include breastfeeding specialists among emergency relief personnel, provide culturally sensitive environments for breastfeeding, and prioritize caregivers of infants in food/water distribution. Emergency relief personnel should be aware that dehydration and missed feedings can impact milk production, but stress alone does not. Emergency support should focus on keeping mothers and infants together and providing private and/or protected spaces for mothers to breastfeed or express milk. Emergency support should also focus on rapidly identifying mothers with breastfeeding difficulties and breastfeeding mothers and infants who are separated, so their needs can be prioritized. Breastfeeding support should be available to all women experiencing difficulties, including those needing reassurance. Nonbreastfed infants should be identified as a priority group requiring support. Relactation, wet-nursing, and donor milk should be considered for nonbreastfed infants. No donations of commercial milk formula (CMF), feeding bottles or teats, or breast pumps should be accepted in emergencies. The distribution of CMF must be highly controlled, provided only when infants cannot be breastfed and accompanied by a comprehensive package of support. Recommendations: Protecting, promoting, and supporting breastfeeding should be included in all emergency preparedness planning and in training of personnel.

Tracking tantalum stocks and flows in China from 2000 to 2021: A material flow analysis.

Tantalum is not only one of the critical metals applied in various advanced industries such as electronics, aerospace, military, and medical applications, but also is considered a conflict mineral, posing a threat to its global supply security. China plays a significant role in the tantalum industrial chain; however, the complete picture of its anthropogenic tantalum cycle remains unknown. This study investigates the tantalum cycles in China from 2000 to 2021 by conducting a dynamic material flow analysis. The results reveal that China's domestic tantalum consumption surged from 91 tons in 2000 to 580 tons in 2021. China heavily relied on importing tantalum minerals to support its domestic production, with a trade dependence rate of 90 %. Moreover, the trade volume of tantalum-related commodities experienced substantial growth from 2000 to 2014 and then fluctuated, with tantalum concentrates as the primary imported goods and electronic products as the primary exported goods. Approximately 24.9 % of the overall tantalum demand was met with secondary tantalum, in which 80 % of such secondary material being recovered during the refining and production stages. Policy recommendations are proposed accordingly, including diversifying tantalum mineral resources and increasing the recovery rates from end-of-life products. These policies can significantly contribute to achieving sufficient tantalum supply and maintaining sustainable tantalum supply chain in China.

A Scoping Review of the Intimate Partner Violence Literature Among Afghans Across Contexts.

The purpose of this scoping review was to ascertain the scope and nature of the literature focused on intimate partner violence (IPV) among Afghans across contexts, including Afghanistan. The scoping review adopted a systematic approach to search for, identify, and include peer-reviewed articles published in English. Fifty-two articles were retained in the final analysis, which generated results on IPV prevalence; multi-level risk and protective factors; qualitatively derived contextual factors; associations of IPV with adverse physical and psychological outcomes; IPV-related help-seeking behaviors; programs and interventions; the role of religion; IPV-related policies; and the role of fiction. Findings indicate that past-year physical IPV prevalence ranged from 52% to 56% in Afghanistan and 79.8% among Afghan refugees displaced in Iran. Studies conducted in Afghanistan identified a range of IPV risk factors occurring at the individual (e.g., age and employment), interpersonal/household (e.g., acceptance of IPV and violence perpetrated by in-laws), and societal levels (e.g., conflict/displacement). The findings highlight a rich literature on IPV in Afghanistan and significant gaps in IPV research across the Afghan diaspora and in contexts of displacement and resettlement. The results advance understanding of the drivers of IPV in the diverse Afghan population and highlight context-specific gaps, and needs for intervention and future research. These gaps indicate the importance of conducting research elucidating how risk and protective factors associated with IPV shift in forced migration and resettlement, and an urgent need for the development and testing of services and programs that respond to the specific needs of Afghan women experiencing IPV across contexts.

COVID-19 and coworker conflict among emergency medical service clinicians.

Objectives: Safety policies enacted in response to the emergence of coronavirus disease 2019 (COVID-19) have greatly affected the working environments of emergency medical service (EMS) clinicians. Our objective was to evaluate whether changes in the EMS environment during the COVID-19 pandemic were associated with increased workplace conflict. Methods: This evaluation was a cross-sectional analysis of a random sample of 19,497 national certified EMS clinicians who were selected to receive an electronic survey in April 2022. The survey included an assessment of their level of stress using the Perceived Stress Scale instrument and examined changes in their working environment they perceived had occurred due to the emergence of COVID-19. Logistic regression modeling was used to evaluate the associations between workforce demographics, infrastructure, scheduling, and policies to and COVID-19-induced coworker conflict. Results: A total of 1686 responses were evaluated (response rate 10%). We found that COVID-19 was reported to have exacerbated conflict between coworkers in 51% of responses. Respondents who perceived an increase in coworker conflict due to COVID-19 self-reported higher levels of stress than the rest of the respondents. Perceptions of the impact of COVID-19 on conflict had also an association with the level of certification, indicating that national registered paramedics were more likely than emergency medical technicians to report coworker conflict due to COVID-19 (adjusted odds ratio [AOR] 1.30, 95% confidence interval [CI] 1.05-1.61). Multivariable analysis highlighted the impact of mandatory overtime policies, reported by 27% of the respondents and associated with higher odds of exacerbated coworker conflict in our model (AOR 2.05, 95% CI 1.62-2.60). Conclusions: These findings indicate that conflict can be considered a potential indicator of high levels of stress in the EMS workforce and may be a reliable signal to monitor when implementing mandates that affect EMS clinicians and their workloads.

Examining the Role of Stress and Team Support in Decision Making under Uncertainty and Time Pressure.

Background. Previous research has examined the individual effects of uncertainty, time pressure, perceived stress, and team support on decision making. However, scant research has investigated how team support and perceived stress collectively influence providers' perception of decision conflict and satisfaction with decision. Objectives. The present study aims to fill this void by examining the potential mediating role of perceived stress and team support in the relationship between time pressure, uncertainty, decision satisfaction, and decision conflict. Methods. Obstetrics and gynecology (Obs and Gynae) physicians (N = 347) working in tertiary care hospitals were approached through snowball and purposive convenient sampling. Self-reported data were collected in the form of questionnaires. Results. Structural equation modeling was used to uncover the complex linkages. Perceived stress was found to be a significant mediator between uncertainty and decision conflict (b = -0.033, P < 0.05). In addition, team support was also found to be a significant mediator between uncertainty and decision satisfaction (b = 0.082, P < 0.05) as well as between time pressure and decision satisfaction (b = 0.086, P < 0.05). Conclusion. Team support acts as a bridge between uncertainty and decision satisfaction and also between time pressure and decision satisfaction, underscoring its critical role in provider perceptions of decision making in the Obs and Gynae context. Implications. This study highlights the significance of managing stress, enhancing team support, and giving priority to patient-centered care. These findings provide insights into risk and uncertainty management in medical decision making, advancing patient-centered care, and optimizing health care outcomes. Highlights: Stressors in hospital settings such as the complexity and uncertainty of tasks create stress among physicians, potentially leading to decision conflicts.Team support plays a fundamental role in mitigating the negative effects of stressors such as time pressure and uncertainty.Implementing stress management and team support interventions such as cognitive-behavioral therapy and mindfulness may enhance decision making among Obs and Gynae physicians.

Human-wildlife conflict at high altitude: A case from Gaurishankar conservation area, Nepal.

Human-wildlife conflict studies of high-altitude areas are rare due to budget constraints and the challenging nature of research in these remote environments. This study investigates the prevalence and increasing trend of human-wildlife conflict (HWC) in the mountainous Gaurishankar Conservation Area (GCA) of Nepal, with a specific focus on leopard (Panthera pardus) and Himalayan black bear (Ursus thibetanus laniger). The study analyzes a decade of HWC reports and identifies goats as the livestock most targeted by leopards. The Dolakha district of GCA received the highest number of reports, highlighting the need for mitigation measures in the area. In GCA, livestock attacks accounted for 85% of compensation, with the remaining 15% for human injuries. We estimate that the number of reported wildlife attacks grew on average by 33% per year, with an additional increase of 57 reports per year following the implementation of a new compensation policy during BS 2076 (2019 AD). While bear attacks showed no significant change post-rule alteration, leopard attack reports surged from 1 to 60 annually, indicating improved compensation may have resulted in increased leopard-attack reporting rates. The findings emphasize the economic impact of HWC on local communities and suggest strategies such as increasing prey populations, promoting community education and awareness, enhancing alternative livelihood options, developing community-based insurance programs, and implementing secure enclosures (corrals) to minimize conflicts and foster harmonious coexistence. This research addresses a knowledge gap in HWC in high-altitude conservation areas like the GCA, providing valuable insights for conservation stakeholders and contributing to biodiversity conservation and the well-being of humans and wildlife.

Evaluation of the integration of palliative care in a fragile setting amongst host and refugee communities: Using consecutive rapid participatory appraisals.

BACKGROUND: Palliative care is seldom integrated in healthcare in fragile, conflict affected and vulnerable settings with significant refugee populations. AIM: This study aimed to evaluate the integration of palliative care into a fragile, conflict affected and vulnerable community in Northern Uganda. DESIGN: Consecutive Rapid Participatory Appraisals were conducted to evaluate the integration of palliative care in Adjumani District. The first established a baseline and the second, 4 years later, evaluated progress. Data collection included documentary review, key informant interviews and direct observation. SETTING/PARTICIPANTS: A rural district in Uganda with equal numbers of refugees and host populations living side-by-side. 104 key informants were interviewed, and practice observed in 11 health facilities. RESULTS: At baseline, palliative care was not routinely integrated in the health system. Barriers included health system challenges, cultural beliefs, understanding and trust, mental health issues, gaps in palliative care provision, the role of the community and beliefs about illness impacted care with the village health teams being a trusted part of the health system. Following integration activities including training, mentorship and community sensitisation, the repeat rapid appraisal after 4 years showed a significant increase in palliative care delivery. New themes identified included increased provision of palliative care, the impact of training and community engagement and ownership of palliative care. CONCLUSION: Community engagement and participation, training interventions and referral pathways enabled the integration of palliative care. Rapid Participatory Appraisal provides a useful framework to evaluate activities aimed at integration of palliative care in a community.

The geometry of the vergence-accommodation conflict in mixed reality systems.

Mixed reality technologies, such as virtual (VR) and augmented (AR) reality, present promising opportunities to advance education and professional training due to their adaptability to diverse contexts. Distortions in the perceived distance in such mediated conditions, however, are well documented and have imposed nontrivial challenges that complicate and limit transferring task performance in a virtual setting to the unmediated reality (UR). One potential source of the distance distortion is the vergence-accommodation conflict-the discrepancy between the depth specified by the eyes' accommodative state and the angle at which the eyes converge to fixate on a target. The present study involved the use of a manual pointing task in UR, VR, and AR to quantify the magnitude of the potential depth distortion in each modality. Conceptualizing the effect of vergence-accommodation offset as a constant offset to the vergence angle, a model was developed based on the stereoscopic viewing geometry. Different versions of the model were used to fit and predict the behavioral data for all modalities. Results confirmed the validity of the conceptualization of vergence-accommodation as a device-specific vergence offset, which predicted up to 66% of the variance in the data. The fitted parameters indicate that, due to the vergence-accommodation conflict, participants' vergence angle was driven outwards by approximately 0.2°, which disrupted the stereoscopic viewing geometry and produced distance distortion in VR and AR. The implications of this finding are discussed in the context of developing virtual environments that minimize the effect of depth distortion.

Optimization path of primary public health service talent team construction: a largescale survey in Huaihai Economic Zone, China.

Background: The primary public health service system is indispensable for the implementation of the "Healthy China 2030" strategy, and primary healthcare workers, as the key drivers of this system, play a pivotal role in its development and establishment to ensure population well-being. In developing countries, such as China, primary public health systems are still weak, and in order to address this phenomenon, health system reform is needed, and primary public health personnel are crucial to health system reform. The current situation of primary public health workers in low-income and developing countries is characterized by varying degrees of problems that need improvement. Objectives: The purpose of this study is to understand the current situation of primary public health service workforce building, analyze the existing problems of the workforce, put forward suggestions for improvement and explore countermeasures, and provide Chinese wisdom and a reference basis for primary public health workforce building in the world, especially in developing countries. Methods: Combining the Work-Family Conflict Scale, Copenhagen Burnout Inventory, Minnesota Satisfaction Questionnaire, and Turnover Intention Scale, a relevant survey questionnaire was designed to quantitatively investigate the baseline characteristics of primary public health service institutions and their staff in four representative cities in the Huaihai Economic Zone: Xuzhou in Jiangsu Province, Linyi in Shandong Province, Shangqiu in Henan Province, and Huaibei in Anhui Province. The collected data were analyzed and processed using SPSS 25.0 statistical analysis software through univariate analysis and logistic regression analyses. Methods such as one-way ANOVA, Logistic regression analysis, and independent samples t-test were used to analyze the influencing factors of primary public health workforce development. Results: The current work intensity at the primary public health level is currently high, the salary and benefits cannot meet the needs of most primary public health personnel, and the competition between work and family in terms of time and resources is pronounced, and the majority of primary public health personnel are dissatisfied with the status quo of "doing more work for less reward" and the poor social security. Emotional exhaustion, depersonalization, and a sense of personal accomplishment were positively correlated with the tendency to leave (all p < 0.01), and the burnout and emotional exhaustion of primary public health workers were intense. Conclusion: Primary public health personnel play an important role in providing primary public health services. However, the current working conditions of junior public health personnel in the Huaihai Economic Zone are influenced by factors such as workload, income level, and employment situation improvement, leading to low job satisfaction, significant work-family conflicts, and high turnover intention. In this context, based on the opinions of grassroots administrative departments and internationally relevant experiences, a series of suggestions have been proposed to improve the professional service level, job satisfaction, and occupational identity of staff members. These suggestions make valuable contributions to both the Huaihai Economic Zone and countries worldwide in safeguarding individual health and promoting national primary healthcare reform.

Conflict and fragmented public health emergency management system in Tigray region of Northern Ethiopia: A double burden to accommodate resilient and advanced public health emergency management. A commentary review for policy-makers and a call to action.

An estimated 2.5 million people have been internally and externally displaced in the Tigray region of northern Ethiopia in conflict and post-conflict settings. This induced a loss of access to basic and essential healthcare services. The situation was overwhelming, causing service inaccessibility, inadequate health facilities, unstable security to access the services, shortage of supplies and drugs, and medical equipment's in the region. The regional public health emergency management is one service delivery set up for the critically ill. It is characterized by weak emergency management capacities, poor coordination and integration. In addition, the system falls in to two independent sectors in the Tigray Health Bureau (THB), Tigray Health Research Institute (THRI). This leads to a fragmented system, an unclear leadership and governance role and a poor service delivery setup and tracking mechanism. The situation leads to resource duplication and poor business practice. Indeed, this type of service delivery setup secures personal and professional interest more than community interest. The situation exacerbated the occurrence of recurrent outbreaks in the region, with, for instance, zoonotic diseases (anthrax and rabies), acute watery diarrhoea, measles, malaria, yellow fever, and coronavirus disease 2019 (COVID-19) approaching to their level of epidemic. Moreover, they will spike as an epidemic in the future. All these circumstances made it evident that the system need reform to adhere with legal global, national, and regional frameworks, guidelines and proclamations. The system should have one service delivery set up at regional level. It must fall into regional public health institutes (PHIs) to adhere its service packages to the current advancements. Furthermore, integrated effort need from program implementers, relevant stakeholders and policy-makers should be committed and work together in the review and reform process.